Poisoning with medicines: signs, first aid, treatment

According to the doctors, most often they have to deal with drug intoxication - this is the so-called drug poisoning caused by improper intake of medications. Poisoning can be different - both in its manifestations and in its origin. The latter depends on which group of drugs led to intoxication.

To drug poisoning are able to lead a variety of situations: someone took the wrong dose of the drug, someone takes a lot of medication at the same time. The likelihood of a suicidal attempt, as well as the occasional administration of medication (most often this happens in childhood) is not ruled out. What if this happened, and how dangerous is it?

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

Epidemiology

The greatest amount of drug poisoning is usually associated with easy access to medications - either for self-treatment or for a suicide attempt. To date, drug poisoning accounts for 60% of all domestic intoxications. Consideration is not taken of drug intoxication in the form of side effects of medications.

Most often, poisoning is provoked by psychotropic drugs - hypnotics, benzodiazepines, phenothiazines, etc. Quite recently this list was replenished with tricyclic antidepressants, finlepsin, leponex.

[5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15],

Causes of the poisoning with medicines

There are many reasons for causing drug poisoning:

• Incorrect dose of the drug - for example, often the dose is calculated based on the weight and age of the person.
• Inappropriateness and misdirection of the drug - for example, it is possible to prescribe medication without taking into account other features of the patient's health. So, many drugs lead to intoxication of the body, if simultaneously with another disease there are serious problems with the kidney and / or liver.
• Improper combination of medicines: some medications are incompatible with each other, as well as with certain foods or alcohol.
• Accidental drug intake.

[16], [17], [18], [19], [20], [21], [22]

Risk factors

The greatest risk of drug poisoning is present in such situations:

• if the patient is engaged in self-medication, without consulting a doctor, or makes his own changes to the treatment plan proposed by the doctor;
• if the patient did not inform the patient that he is receiving parallel treatment with other medicines when prescribing treatment by the doctor;
• if in the house medicines do not have a specific place of storage, and are freely available, both for adult family members and for children;
• if the period of their validity and the tightness of the package are not checked before taking medication;
• if a person takes the medicine chaotically, not adhering to the necessary treatment schedule.

Separately, we should also highlight a risk factor, such as suicidal tendencies. Drug poisoning can sometimes be purposeful: a person takes a large dose of medication for the purpose of suicide.

[23], [24], [25], [26], [27], [28],

Pathogenesis

There are hundreds of medicines known to cause drug poisoning under certain circumstances. And almost all cases of poisoning are associated with the use of drugs inside.

The main reason is considered ignoring the rules of storage of medicines, as well as attempts to self-treatment, without first consulting a doctor.

Severe - in most cases, fatal - drug poisoning is more often intentional, with the aim of suicide.

To a lethal outcome lead mainly large doses of oral preparations and their combinations.

[29], [30], [31], [32], [33], [34], [35],

Symptoms of the poisoning with medicines

Clinical manifestations of drug poisoning may differ between each other, depending on which medication has caused intoxication. However, there is a definite symptom complex inherent in virtually any type of toxic drug poisoning.

The first signs are often the following:

• severe nausea, vomiting, digestive disorders;
• problems with sight and hearing, impaired motor coordination;
• change in the shade of skin;
• change in body temperature (in one direction or another);
• disorders of the respiratory, cardiac, CNS.

Acute drug poisoning manifests itself in different symptoms, depending on what medicine was taken the day before, and in what quantity.

When  poisoning with sleeping pills,  the work of the central nervous system, urinary system and respiratory centers is most often disrupted. Death usually comes on the background of acute circulatory failure due to paralysis of the respiratory system. Poisoning with hypnotics proceeds through the stages:

1. Drowsiness, apathy, contact with the victim is saved.
2. Loss of consciousness, tongue twisting, fever.
3. State of deep coma, respiratory center and central nervous system depression.
4. Lethal outcome, or exit from a coma with strong psychomotor agitation and instability of the nervous system.

When  poisoning with antidepressants  , the following symptoms are observed:

• hallucinatory vision;
• excited state;
• dilated pupils;
• thirst;
• Strong decrease in temperature indicators;
• oppression of the function of breathing and the activity of the heart (up to a stop).

When  poisoning with tranquilizers  are observed:

• thirst, dryness of mucous membranes;
• arrhythmia;
• hypotension;
• weakness of muscles, tremor.

In the absence of medical care, the activity of the nervous system, heart, vessels and respiratory organs is disrupted.

When  poisoning with drugs that stimulate the central nervous system, there are such symptoms:

• hyperexcitation;
• absence of sleep, hallucinations;
• disturbance of cardiac activity.

Morphine  poisoning  inhibits the work of the heart and respiratory organs, pupils narrow, blood pressure drops, and the state of superficial coma develops.

When  poisoning with drugs salicylic acid  , heartburn, burning in the stomach, frequent vomiting and bloody diarrhea. Victims complain of dizziness, a feeling of fatigue, impaired vision and hearing. Increased risk of internal and external bleeding.

When  poisoning with iodine preparations, there is a  noticeable discoloration of the mucous membranes of the oral cavity, which acquire a yellowish-brown hue. There is a urge to vomit, the stool becomes liquid with a feces of blue. There are mucous discharge from the nose, skin rashes, convulsions, coma.

Poisoning with medicinal plants

It is not uncommon to consider poisoning with plant raw materials, which happen:

• when using overestimated doses of herbal preparations;
• when used inside plants, which are classified as poisonous;
• when inhaled essential oil of some plants.

If signs of plant poisoning are detected, the patient is given a detoxification treatment.

You can not exclude the poisoning of relatively harmless medicinal plants that were collected incorrectly:

• near motorways and railways;
• near large enterprises;
• near dumps and sedimentation tanks.

There are cases of poisoning by berries, collected in places of mass growth of poisonous plants - for example, Ledum or rhododendron.

Poisoning children with medicines

A child can be poisoned by a medicine in such situations:

• if the parents leave unattended any (even harmless, in their opinion) medications, including vitamins;
• if the parents give the baby the wrong dose of the medicine;
• if a child (more often adolescence) is making a suicidal attempt.

Often, drug poisoning manifests symptoms not immediately, but only a few hours after the use of prohibited medicines. Therefore, if parents suspect a child's use of any medication, do not expect the first signs - you need to see a doctor as soon as possible.

Complications and consequences

Drug poisoning is a very common phenomenon. To develop intoxication, it is enough to take an excessive amount of drugs, or combine them incorrectly. And young children and old people can get poisoned, and, it would seem, the usual dose of a medicine.

Some medicines can strengthen the symptoms of other diseases that people suffer. True, I call this state not a poisoning, but a "medical disease". This happens if the patient does not warn the doctor that he has other serious illnesses, or by mistake of the doctor himself.

Drug poisoning is accompanied by the accumulation of toxic components, which are not always easy to remove from the body. It is also possible to exclude the increased likelihood of development of side effects, which significantly worsen the already unsatisfactory state of health of the patient.

The most severe consequence of drug poisoning is a lethal outcome. It is known that many cases of poisoning are deliberate and are done intentionally with a suicidal goal. Unfortunately, often attempts at suicide do lead to the death of the patient.

[36], [37], [38], [39], [40],

Diagnostics of the poisoning with medicines

To correctly orient in the situation of drug poisoning, the doctor needs to determine exactly which group of medicines the drug that caused intoxication belongs to, and also how much it was taken. Therefore, if the patient is conscious, a detailed survey is conducted, with further examination and clinical examination. Later, they also include information on laboratory analyzes.

Upon examination, the doctor should evaluate such points:

• whether there are disturbances of consciousness;
• how the patient is moving, whether the coordination is not broken, whether there is a forced position of the trunk;
• in what state are the organs of vision, are there asymmetry of the pupils, their constriction or expansion, icteric sclera;
• in which state the respiratory organs are, whether there is coughing, wheezing, or dyspnea;
• whether heart activity is not broken;
• whether there is a swelling or soreness of the abdomen;
• Whether the body temperature is not increased.

Already on the basis of the above diagnosis, the doctor can make a preliminary diagnosis. In order to confirm it, it may be necessary to conduct additional laboratory studies.

Analyzes are carried out only after emergency medical care, as laboratory studies take time, which in acute poisoning can cost lives.

So, traces of medicines can be found both in the blood of the victim and in his urine even several weeks after taking the medications.

Instrumental diagnostics at the first stage is rare, and can include the conduct of spectrophotometry, spinal puncture, ECG, fibrogastroscopy.

[41], [42], [43], [44],

Differential diagnosis

Differential diagnosis is performed with other types of poisoning. For example, it is important to distinguish between drug poisoning from food intoxication, from poisoning with chemicals, drugs, alcohol, heavy metal salts.

[45], [46], [47], [48], [49],

Treatment of the poisoning with medicines

The tactics of treatment of drug poisoning should be determined, taking into account the main necessary steps:

• Urgent delivery of the victim to a medical institution.
• Urgent early detoxification, removal of toxic components from the bloodstream and tissues.
• If possible, a specific treatment with the administration of antidotes.
• Use of symptomatic drugs.

What can people around or the victim do with the drug poisoning?

1. Call an ambulance brigade.
2. Provide pre-medical care: induce vomiting, give a sorbent and laxative in sufficient quantities.
3. Do not eat food or other medicines before the doctor comes.

The sooner the first aid is given, the better for the health and life of the victim.

Emergency aid for drug poisoning

• When drug poisoning with hypnotics, you need to do the following:
  • rinse affected stomach with plenty of water;
  • give the patient a sorbent (activated carbon, enterosgel, etc.);
  • give a salt laxative;
  • ensure sufficient introduction of fluid into the body with the simultaneous introduction of diuretics;
  • for problems with breathing and heart use analeptics, cardiac glycosides, if necessary - adrenaline.
• When medicinal poisoning with antidepressants or tranquilizers, the patient is washed with a weak solution of baking soda, given a salt laxative or an enema with a siphon type, and sorbents are given. Antidote when taking antidepressants is physostigmine - it is administered intravenously, which causes the stabilization of blood pressure and cardiac activity.
• In case of drug poisoning, stimulating CNS preparations should as soon as possible perform gastric lavage with a solution of baking soda, give the patient activated charcoal, make an enema of a siphon type. When the spasms are injected with aminazine, or dimedrol with novocaine. In severe cases, cardiovascular resuscitation may be necessary.
• In case of drug poisoning with morphine, the stomach is washed with a weak solution of potassium permanganate, the sorbent and the salt laxative preparation are given to the victim. Sometimes there may be a need for repeated washing of the stomach. Further, infusion therapy is performed with forced diuresis and intravenous infusion of 0.5% nalorphine.
• When medicinal poisoning with salicylic acid preparations, an alkaline gastric lavage is done, giving the victim plenty of alkaline drink. It is also possible to infuse the introduction of alkaline solutions. To neutralize salicylic acid 1 g of vitamin C per day, or injected ascorbic acid intravenously in combination with a glucose solution.
• When medicinal poisoning with iodine preparations, the victim is offered to take starch or flour paste, or another mucous drink, or fresh milk. In addition, you should take an antidote - up to 300 ml of sodium thiosulfate. Further, if there are indications, the treatment is symptomatic.

Medicines common to all types of medical poisoning:

Activated carbon	Take in the form of a suspension of 30 g per reception. Prolonged use can lead to constipation.
Enterosgel	Take one full art. L. On reception, washing down with water. With prolonged use, development of constipation is possible.
Sorbeks	Take 4-8 capsules at the reception. With prolonged use - more than 15 consecutive days, constipation may develop.
Karlovy Vary salt	Dissolve 1 tbsp. L. Salt in 100 ml of water, take if necessary 2-4 times a day. The drug is considered completely safe and does not cause side effects.
Rehydration	Brew a packet of the drug in 1 liter of clean warm water, take in the amount of 10 ml per kg of weight per hour, with dehydration. Side effects were not observed.

[50], [51]

Vitamins

With drug poisoning, in most cases, there is vomiting, diarrhea, general intoxication. In such conditions, many useful substances - vitamins, minerals - are rapidly excreted from the body. Their level needs to be restored - but only after the digestive tract is stabilized.

The first step is to provide the body with such vitamins:

• vitamin A - helps to restore the damaged tissues and functions of many organs (the vitamin is contained in bread, cereals, oils);
• B group vitamins - improve bowel function, stabilize digestion, strengthen the nervous system and immunity (such vitamins can be found in liver, milk, cabbage, sprouted wheat, carrots);
• ascorbic acid - strengthens blood vessels, supports immune defense (contained in berries, citrus, kiwi, bell pepper, tomatoes);
• Vitamin E - helps to quickly repair damaged tissues in the body (the vitamin can be obtained from vegetable oils, mountain ash, sea buckthorn, nuts).

At the restoration stage, you must include in the menu vegetable products with a high content of pectin - it can be apples, carrots, tomatoes. Pectin helps to clean the digestive system and protect mucous tissues from damage.

Physiotherapeutic treatment

Physiotherapy is not often connected with drug poisoning. Typically, this type of treatment is appropriate in the recovery phase after severe intoxication. Can be shown coniferous baths, electrophoresis of the neck area on the Scherbak, full quartz irradiation.

In addition, mud application, manual therapy, exercise therapy are sometimes used, and in the development of paresis, electrostimulation. In some cases, the doctor can recommend spa treatment.

Alternative treatment

To accelerate the removal of toxic substances and metabolic products from the body, dry laminaria is used: eat every 3 hours 3 grams of ground dry sea kale, with a glass of water.

With severe emetic attacks, you can use saline solution, which will provide detoxification and prevent the development of dehydration. The simplest recipe for a saline solution: dissolve in 1 liter of warm drinking water 1 tbsp. L. Sugar, 1 tsp. Salt and ½ tsp. Baking soda. Such a solution should be drunk in 0.5 liters every 30-40 minutes.

The tincture of Eleutherococcus helps to stabilize the function of vital organs during intoxication. Usually, with drug poisoning, take 10 drops of tincture in 50 ml of liquid. The medicine can be taken several times a day, but not more often than once per hour.

Dill has a good antitoxic effect: experts recommend preparing an infusion of 1 tbsp. L. Dried dill and 300 ml of boiling water. In a warm infusion, you can add 1 tsp. Honey.

With a low degree of drug poisoning, ginger tea will benefit. For cooking use 2 tsp. Grated root and 0.6 liters of boiling water, drink a little throughout the day.

[52], [53], [54], [55], [56]

Herbal Treatment

Herbs are usually used for light medicinal poisonings with minor intoxication symptoms, or at the stage of recovery after moderate or severe intoxication. Most experts advise using the following medicinal plants:

• Chamomile flowers that eliminate inflammation and have an antimicrobial effect.
• Mint leaves, stabilizing the digestive tract, soothing and eliminating nausea.
• Grass of St. John's wort having astringent and antimicrobial properties.
• Leaves of plantain, normalizing the composition of blood, improving the state of health in the disorder of intestinal function.
• Chicory, accelerating the excretion of toxins and improving kidney function.
• Herb yarrow, improving the work of the liver and restoring the function of the digestive system.
• Rhizome elecampane, which helps to remove toxic substances from the body and cleanses the blood.
• A mallow plant that eliminates the effects of inflammation.

It is allowed to use both individual plant species and their combinations. There is no need to prepare broths of herbs: they are poured with water, brought to a boil, and left for infusion for about half an hour. Average proportions for the preparation of infusion - 1 tbsp. L. Raw materials for 400 ml of water.

Homeopathy

A competent selection of classical homeopathic preparations will help in a short time to eliminate the signs of drug poisoning without any side effects. In addition, homeopathic remedies have a positive effect on immunity and stimulate regeneration processes.

The main drugs that are used for drug poisoning are:

• Hina - is prescribed for severe dehydration due to repeated vomiting and diarrhea.
• Carbo vegetalis - is used for poisoning, which is accompanied by severe flatulence, fever, and abdominal cramps.
• Nuks vomica - will help if signs of poisoning appeared on the second day. Symptoms can be muscle cramps, abdominal pain, nausea, vomiting, diarrhea, loss of strength, cold extremities.
• Arsenicum albumum - is prescribed for poisoning, which is accompanied by vomiting and diarrhea: the patient can not drink water because of the increased emetic reflex and gastric spasms.

The abovementioned means of homeopathy can be used, including, when children are poisoned. They are given to children in a dilution of 30 ° C every hour.

Diet for drug poisoning

The following rules should become the main principles of therapeutic nutrition after drug poisoning:

• The first day after the drug poisoning - the most severe for the body. Therefore it is desirable to give up food altogether.
• When drug poisoning should drink liquid, often, but little by little (so as not to provoke a vomitive reflex). The most optimal drink is non-carbonated mineral table water, rehydron.
• When there is an intolerable desire to eat, you can eat a small piece of dried bread, or cracker.
• If possible, it's better to spend the second day without food. The use of clean water is welcome.

Starting from the third day, it is allowed to drink a decoction of rice cereals, eat rice porridge-mash, dried bread. Little by little, dairy products are introduced into the diet, but they do it cautiously: if there is a loose stool or nausea, then with the introduction of such products do not rush.

Starting from the fourth day, they start to gradually expand the diet, adhering to such principles:

• Eat often, about every 2.5 hours, but portions should not exceed 100 g;
• preferring to choose food should be given to light, liquid or semi-liquid dishes;
• You can not "attack" food sharply: the return to the old food should be gradual;
• use sufficient fluid should be continued as long as possible;
• at first and until the patient's condition is completely normal, it is necessary to exclude from the menu foods that impede the digestive tract (cabbage, beans, fat, fried and smoked foods).

[57], [58], [59]

Prevention

To prevent drug poisoning the main point is observance of the elementary rules of storage and reception of medicines:

• It is correct to keep medicines in a specially designated place, inaccessible to children and mentally unbalanced people. The home medicine chest needs to be periodically reviewed, removing expired and unused medicines, and adding fresh ones as needed. It is necessary to pay attention not only to the date of production of medicines, but also to the integrity of their packaging, as well as the presence on the package of a clear name of the drug.
• Drinking these or other medicines is allowed only when they are prescribed by a doctor, in a strictly recommended dosage.
• Before taking any drug, you need to read the instructions to it. Separate attention is directed to contraindications and side effects during medication treatment. Also important is the information on drug interactions.
• Do not combine any medicines with liquor.
• If adults decide to throw out any of the medicines, then it must be done so that the child does not find this drug in the garbage can.

Forecast

The effectiveness and duration of treatment, as well as the prognosis for drug poisoning, depends on the mass of the factors. First of all, it is important how timely the victim was provided with the first medical aid. Early clearance and removal of the toxic component from the body increases the chances of an early recovery.

Drug poisoning in most patients arises from their own fault. The lack of a correct and clear treatment regimen, self-administration of drugs, unauthorized dosage adjustment - such factors can lead to the most unfavorable consequences. If a person has suspicious symptoms of drug poisoning, then it is necessary to contact the doctor without delay - sometimes only timely treatment allows saving the life of the patient.

[60], [61], [62], [63], [64], [65]