Antidote therapy - specific detoxification

A detailed study of the toxicokinetics of chemical substances in the body, the ways of their biochemical transformations and the realization of toxic effects, has now made it possible to more realistically assess the possibilities of antidote therapy and to determine its significance in various periods of acute diseases by chemical etiology.

Antidote therapy remains effective only in the early toxicogenic phase of acute poisoning, the duration of which is different and depends on the toxic-kinetic features of this toxic substance. The greatest duration of this phase and, therefore, the timing of antidote therapy is noted for poisoning with heavy metal compounds (8-12 days), the lowest - when exposed to the body highly toxic and rapidly metabolizable compounds, for example cyanides, chlorinated hydrocarbons, etc.

Antidote therapy is highly specific and can therefore be used only if there is a reliable clinical and laboratory diagnosis of this type of acute intoxication. Otherwise, if the antidote is mistakenly administered in a larger dose, its toxic effect on the body may be manifested.

The effectiveness of antidote therapy is significantly reduced in the terminal stage of acute poisoning in the development of severe disorders of the circulatory system and gas exchange, which requires simultaneous necessary intensive therapy.

Antidote therapy plays an important role in the prevention of states of irreversibility in acute poisoning, but does not have a therapeutic effect in their development, especially in the somatogenic phase of these diseases.

Among the numerous medicines proposed by different authors at different times as specific antidotes (antidotes) for acute poisoning by various toxic substances, we can distinguish four main groups of drugs that have not lost their significance to the present time.

[1], [2], [3], [4], [5]

Chemical (toxicotropic) antidotes 

Antidotes that affect the physico-chemical state of a toxic substance in the digestive tract (chemical antidotes for contact action). In general, this method of treating poisoning is currently attributed to the above-mentioned group of methods of artificial detoxification called enterosorption (gastrointestinal sorption). As sorbents use activated carbon (in a dose of 50-70 g) and various synthetic sorbents.

Antidotes that carry out a specific physicochemical interaction with a toxic substance in the humoral environment of the body (chemical antivenins of parenteral action). These drugs include thiol compounds (unitiol) used for the treatment of acute poisoning with heavy metal and arsenic compounds, and chelating agents (EDTA, sodium calcium edetate) to form non-toxic chelates with salts of some metals (lead, cobalt, cadmium and other).

Biochemical antidotes (toxic-kinetics), providing an advantageous change in the metabolism of toxic substances in the body or the direction of biochemical reactions in which they participate, without affecting the physicochemical state of the most toxic substance. Among these, cholinesterase reactors (oximes) are found to be of greatest clinical use at the time of poisoning with organophosphorous substances, methylene blue in meth- ogmoglobin-poisoning poisoning, ethanol in methanol and ethylene glycol poisoning, and antioxidants in poisoning with carbon tetrachloride.

Sodium hypochlorite (0.06% solution - 400 ml intravenously) has the most universal effect, since it promotes the oxidation of various toxicants (usually medicinal products), the natural detoxification of which in the body proceeds in the same way.

Pharmacological antidotes provide a curative effect due to pharmacological antagonism, acting on the same functional systems of the body as toxic substances. In clinical toxicology, the pharmacological antagonism between atropine and acetylcholine is most widely used for poisoning with organophosphorus compounds, naloxone for poisoning with opium preparations, between prozerin and pachycarpine hydroiodide, potassium chloride and cardiac glycosides. Their use makes it possible to stop many of the dangerous symptoms of poisoning with listed drugs, but rarely leads to the elimination of all symptoms of intoxication, since this antagonism usually turns out to be incomplete. In addition, drugs - pharmacological antagonists because of their specific action should be used in large enough doses, exceeding the concentration in the body of this toxic substance.

Biochemical and pharmacological antidotes do not change the physical and chemical state of the toxic substance and do not enter into any interaction with it. However, the specific nature of their pathogenetic therapeutic effect brings them closer to a group of chemical antivenoms, which allows them to be combined under one name - specific antidote therapy.

Essential medicines for specific (antidote) treatment of acute poisoning

Activated carbon, 50 grams inside	Nonspecific sorbent of medicines (alkaloids, hypnotics) and other toxic substances
Ethanol (30% solution inside, 5% intravenously 400 ml)	Methyl alcohol, ethylene glycol
Aminostigmine (2 mg intravenously)	Cholinolytics (atropine and others) hydrocyanic acid (cyanides)
Atropine (0.1% solution)	Amanita, pilocarpine, cardiac glycosides, FOB, clonidine
Acetylcysteine (10% solution - 140 mg / kg intravenously)	Paracetamol pallid grebe
Sodium bicarbonate (4% solution - 300 ml intravenously)	Acids
HBO (1-1.5 ati, 40 min)	Carbon monoxide, carbon disulfide, methemoglobin formation
Dysferal (5,0-10,0 g inside, 0 5 g 1 g / day intravenously)	Iron
Penicillamine (40 mg / kg per day orally)	Copper, lead, bismuth, arsenic
Ascorbic acid (5% solution, 10 ml intravenously)	Aniline, potassium permanganate
Vicasol (5% solution, 5 ml intravenously)	Anticoagulants of indirect action
Sodium hypochlorite (0.06% solution, 400 ml intravenously)	Medications
Sodium nitrite (1% solution, 10 ml intravenously)	Hydrocyanic acid
Prozerin (0.05% solution, 1 ml intravenously)	Pahikarpine hydroiodide, atropine
Protamine sulfate (1% solution)	Sodium Heparin
Anti-muscle serum (500-1000 units intramuscularly)	Snake bites
Reactivators of cholinesterase (dipiroksim 15% solution 1 ml, diethoxim 10% solution 5 ml intramuscularly)	FOB
Magnesium sulfate (25% solution of 10 ml intravenously)	Barium and its salts
Sodium thiosulfate (30% solution, 100 ml intravenously)	Aniline, benzene, iodine, copper, hydrocyanic acid, sulem, phenols, mercury
Unitiol (5% solution, 10 ml intravenously)	Copper and its salts, arsenic, thiols, phenols, chromium
Flumazenil (0.3 mg, 2 mg / day intravenously)	Benzodiazepines
Sodium chloride (2% solution, 10 ml intravenously)	Silver nitrate
Calcium chloride (10% solution, 10 ml intravenously)	Anticoagulants, ethylene glycol, oxalic acid
Potassium chloride (10% solution, 20 ml intravenously)	Cardiac glycosides, formalin (gastric lavage)
Edetic acid (10% solution, 10 ml intravenously)	Lead, copper, zinc
Methylene blue (1% solution, 100 ml intravenously)	Aniline, potassium permanganate, hydrocyanic acid

Antitoxic immunotherapy has been most widely used to treat poisoning with animal poisons when snake and insect bites are in the form of antitoxic serum (anti-muscle, anti-smoking, etc.)

[6], [7], [8],