Intoxication syndrome

Intoxication syndrome is a severe general condition of the body caused by infectious toxicosis, with a decrease in the body's resistance. As can be seen from the definition of the concept, two conditions are necessary for the development of intoxication syndrome: severe purulent infection and a decrease in the body's resistance.

What causes intoxication syndrome?

Intoxication syndrome develops mainly with extensive (although it can also be with small ones with high microflora tension) purulent processes of any localization (purulent pleurisy, pleural empyema, peritonitis, osteomyelitis, sepsis, phlegmon, etc.) against the background of reduced reparative processes and immunodeficiency states caused by many reasons. At these stages, with a severe local purulent-inflammatory process, general alteration also develops in all organs and tissues. In the first two weeks, it is reversible and occurs in the form of edema and swelling of tissues, with minor functional changes in organs and tissues. In cases where the local process and general alteration are not stopped during this time, irreversible alteration develops in the form of dystrophies: granular, fatty, amyloidosis, etc.

How does intoxication syndrome manifest itself?

During the course of intoxication syndrome, 3 stages are distinguished, which also determine the severity of its manifestations.

The first degree of severity and stage of development of the intoxication syndrome are caused by the formation of reversible alteration in all organs and tissues in the form of edema and swelling with functional disorders of their activity. The following signs are clinically revealed as manifestations of the intoxication syndrome. From the side of the brain, due to edema and swelling and, naturally, metabolic disorders, euphoria or a feeling of depression is noted. In the lungs, alterative pneumonitis develops, which is accompanied by an increase in respiratory rate to 24 per minute, but there is no shortness of breath; weakening or, conversely, harsh breathing; various wheezing, up to crepitating. The heart muscle is more resistant to the action of toxins; mainly swelling of cardiocytes with thickening of the myocardium and metabolic disorders in it occurs. Heart function is preserved; peripheral hemodynamics, as a rule, are not impaired. Toxic carditis is manifested by: tachycardia; systolic murmur at the apex of the heart; accentuation of the second tone on the pulmonary artery; decrease in central hemodynamic parameters.

The liver and kidneys are affected to a greater extent, since they bear the maximum load of detoxification of the body. Morphologically, the same edema and swelling develop in them, with functional disorders of activity. Clinical manifestations are weakly expressed: slight enlargement of the liver, compaction and pain on palpation. The kidneys are not palpated, with rare exceptions; Pasternatsky's symptom is negative. But laboratory tests reveal signs of damage to the liver parenchyma, primarily aminotransferases (transaminases) - ALAT and ASAT, determining the state of its enzymatic function, at the level of the hepatocyte membrane. Biochemical functional tests of the liver increase slightly, which indicates the absence of damage to the hepatocytes themselves. Renal syndrome is determined by the severity of intoxication and the infusion therapy. It is expressed in a change in the specific gravity of urine of the hyposmolar or hyperosmolar type, the presence of protein, spirals.

In clinical blood tests, an increase in leukocytes with neutrophilia and an increase in ESR are initially noted. But due to the depletion of primary immunity and hematopoiesis, leukopenia begins to form. This indicator is very important for determining the transition of purulent-resorptive fever to intoxication syndrome. Leukocytosis indicators, as they are interpreted in non-toxic diseases, lose their prognostic value. Intoxication indices come to the fore. An important role is also played by fractions of medium molecules (FSM), determining the severity of intoxication - the norm is 0.23. An increase in LII and FSM, especially in dynamics, indicates a worsening of intoxication, and a decrease - its reduction, which allows, to some extent, to predict the course of the disease and determine the effectiveness of the treatment. The criteria for the first degree of intoxication syndrome are: the growth of LII to 3.0, and FSM to 1.0, which, of course, is very conditional without a full clinical assessment of the process. To stop the intoxication already at this stage, a complete and perfect complex of local treatment of the purulent-inflammatory process and general intensive therapy aimed at stopping multi-organ alterations is necessary:

The II degree of severity and stage of development of the intoxication syndrome is morphologically determined by the development of irreversible alteration in the form of: dystrophies and gross, progressive proliferative reaction in the form of sclerosis, fibrosis and cirrhosis of parenchymatous organs, with a violation of their activity of a functional-morphological nature. The process is irreversible, but with the correct and complete treatment tactics it can at least be stopped or suspended at the level of subcompensation.

Clinically, this is manifested by: from the side of the brain by a disturbance of consciousness in the form of sopor or stupor, up to coma. The function of the lungs is severely impaired, with the development of respiratory failure (its genesis is different, determined by both morphological changes in the lungs and blood flow disorders), which sometimes requires oxygen therapy or artificial ventilation. The formation of granular myocardial dystrophy determines the development of heart failure; mixed type, with a violation of both central and peripheral hemodynamics. In the absence of the possibility of instrumental determination of the parameters of changes in cardiohemodynamics, the severity is subjectively assessed by general changes and progression of cardiovascular failure (BP, CVP, pulse).

Again, the most severe disorders develop in the liver and kidneys in the form of their joint functional insufficiency. Damage to hepatocytes is determined by a decrease in blood protein dysproteinemia, prothrombin index; changes in functional liver tests indicating damage to the hepatocytes themselves. A characteristic feature is the transition of oxygen metabolism in hepatocytes to peroxide amination, as a result of which the patient's skin color changes, acquiring the appearance of a "dirty tan". Renal amyloidosis is accompanied by a decrease in diuresis, an increase in the specific gravity of urine, and an increase in blood slags.

Immunity in all patients is sharply reduced. Hematopoiesis disorders are manifested by: leukopenia, anisocytosis and poikilocytosis. LII increases to 3-8. FSM increases to 2.0.

The third degree of severity and the stage of development of the intoxication syndrome is determined by gross degenerative changes in all organs and tissues with the development of multiple organ failure, which determines the fatal outcome in these patients.