Treatment of foodborne diseases

Patients with a severe and moderate course, socially uncomfortable persons during the course of food poisoning of any degree of severity, are shown hospitalization in an infectious hospital.

Pathogenetic treatment of food toxic infections depends on the degree of dehydration and body weight of the patient, is carried out in two stages: I - elimination of dehydration. II - correction of continuing losses.

A sparing diet is recommended (table № 2, 4, 13) with the exception of milk ration, canned products, smoked products, spicy and spicy dishes, raw vegetables and fruits.

The standard of treatment of patients with food-borne disease

Clinical forms of the disease	Etiotropic treatment	Pathogenetic treatment
PTI of light current (intoxication is not expressed, dehydration of HI degree, diarrhea up to five times, 2-3-fold vomiting)	Not shown	Rinsing of the stomach with 0.5% solution of sodium bicarbonate or 0.1% solution of potassium permanganate, oral rehydration (volumetric rate of 1-1 5 l'h) 'sorbents (activated carbon): astringent and enveloping agents (vikalin, bismuth subgallate): intestinal antiseptics intetriks, enterol): spasmolytics (drotaverin, papaverine hydrochloride - to 0.04 g): enzymes (pancreatin, etc.); probiotics (sorbed bifid-containing, etc.)
RTIs of moderate severity (fever, dehydration of grade II, diarrhea up to 10 times, vomiting - 5 times or more)	Antibiotics are not indicated. They are prescribed for prolonged diarrhea and intoxication to elderly people, children	Rehydration by a combined method (intravenously with the transition to ingestion): a volume of 55-75 ml / kg of body weight, a volumetric rate of 60-80 ml, min. Sorbents (activated carbon): astringent and enveloping (vikalin, bismuth subgallate): intestinal antiseptics (intreatic C, enterol): antispasmodics (drotaverin, papaverine hydrochloride - 0,04 g each); enzymes (pancreatin, etc.): probiotics (sorbed bifid-containing, etc.)
PTI of severe course (fever, dehydration of III-IV degree, vomiting and diarrhea without an account)	Antibiotics are indicated with a duration of fever more than two days (when the dyspeptic phenomena subsided), as well as elderly patients and children. Persons suffering from immunodeficiency. Ampicillin - 1 g 4-6 times a day IM (7-10 days): chloramphenicol - 1 g three times a day in m (7-10 days), fluoroquinolones (norfloxacin, ofloxacin, pefloxacin - 0 4 g in в in 12 hours) Ceftriaxone 3 g IV in 24 hours for 3-4 days before the temperature normalization. With clostridiosis - metro-nidazole (by 0 5 g 3-4 times a day for 7 days)	Intravenous rehydration (volume of 60-120 ml, kg of body weight, volumetric rate of 70-90 ml / min). Detoxification - reopoliglyukin 400 ml IV after cessation of diarrhea and elimination of dehydration, Sorbents (activated carbon): astringent and enveloping (vikalin, bismuth subgallate) intestinal antiseptics (intetriks, enterol): spasmolytics (drotaverin, papaverine hydrochloride - 0.04 g) ; enzymes (pancreatin, etc.): probiotics (sorbed bifid-containing, etc.)

Treatment of food poisoning starts with a washing of the stomach with a warm 2% solution of sodium bicarbonate or water. The procedure is carried out prior to the departure of pure washings. Rinsing of the stomach is contraindicated with high blood pressure: people with IHD, peptic ulcer: in the presence of symptoms of shock, suspected myocardial infarction, poisoning with chemicals.

Treatment of food poisoning is based on the use of rehydration therapy, which contributes to detoxification, normalization of water-electrolyte metabolism and acid-base state, restoration of impaired microcirculation and hemodynamics. Elimination of hypoxia.

Rehydration therapy to eliminate existing and correct for continuing fluid loss is carried out in two stages.

For oral rehydration (with I-II degree of dehydration and absence of vomiting) apply:

• glucosolan (oralite);
• Citroglucosolane;
• rehydron and its analogues.

The presence of glucose in solutions is necessary to activate the absorption of electrolytes and water in the intestine.

Perspective use of solutions of the second generation, made with the addition of cereals, amino acids, dipeptides, maltodextran. Rice basis.

The amount of fluid injected into the body depends on the degree of dehydration and the patient's body weight. The volume rate of administration of oral rehydration solutions is 1-1.5 l / h; the temperature of the solutions is 37 ° С.

The first stage of oral rehydration therapy continues for 1.5-3 hours (enough to produce a clinical effect in 80% of patients). For example, a patient with foodborne toxicosis with dehydration of the second degree and a body weight of 70 kg should drink 3-5 liters of rehydration solution for 3 hours (the first stage of rehydration), because at the II degree of dehydration, the loss of fluid is 5% of the body weight of the patient.

In the second stage, the amount of liquid administered is determined by the amount of continuing losses.

With dehydration of III-IV degree and the presence of contraindications to oral rehydration, intravenous rehydration therapy is carried out with isotonic polyionic solutions: trisol, quartz, chlozole, acesol.

Not recommended for use in connection with the lack of potassium in the composition: Ringer's solution, 5% glucose solution, normasol solutions, mafusol.

Intravenous rehydration therapy is also carried out in two stages. The amount of fluid injected depends on the degree of dehydration and the patient's body weight.

The volumetric injection rate for severe food poisoning is 70-90 ml / min, with the moderate - 60-80 ml / min. The temperature of the injected solutions is 37 ° C.

When the injection rate is less than 50 ml / min and the volume of administration is less than 60 ml / kg, the symptoms of dehydration and intoxication persist for a long time, secondary complications develop (acute renal failure, disseminated intravascular coagulation, pneumonia).

Example calculation. The patient with foodborne toxicosis - III degree of dehydration, body weight - 80 kg. The percentage of losses is on average 8% of body weight. You should inject 6400 ml of solution intravenously. This volume of fluid is administered at the first stage of rehydration therapy.

To detoxify (only after the elimination of dehydration), you can use a colloidal solution - rheopolyglucin.

Drug treatment of food poisoning

• Cementing agents: Powder Kassirsky (Bismuti suhnitrici - 0.5 g, Dermatoli - 0.3 g, calcium carbonici - 1.0 g) one powder three times a day; bismuth subsalicynate - two tablets four times a day.
• Preparations that protect the intestinal mucosa: dioctahedral smectite - 9-12 g / day (dissolve in water).
• Sorbents: lignin hydrolyzed - 1 tbsp each. Three times a day; Activated 5 coal - 1.2-2 g (in water) 3-4 times a day; smect on 3 g in 100 ml of water three times a day, etc.
• Inhibitors of prostaglandin synthesis: indomethacin (secretory diarrhea) - 50 mg three times a day with an interval of 3 hours.
• Means that increase the rate of absorption of water and electrolytes in the small intestine: octreotide - at 0.05-0.1 mg subcutaneously 1-2 times a day.
• Calcium preparations (activate phosphodiesterase and inhibit the formation of cAMP): Calcium gluconate 5 grams orally twice a day after 12 hours.
• Probiotics: acipol, linex, acylact, bifidumbacterin-forte, florin forte, probiophore.
• Enzymes: Oraza, pancreatin, abomin.
• At the expressed diarrhea syndrome - intestinal antiseptics within 5-7 days: intestopan (1-2 tablets 4-6 times a day), intetriks (1-2 capsules three times a day).

Antibiotics for the treatment of patients with foodborne disease do not apply.

Etiotropic and symptomatic treatment of food toxic infections is prescribed taking into account the concomitant diseases of the digestive system. Treatment of patients with hypovolemic, ITH conducted in the ICU.

Complications of food poisoning

Mesenteric thrombosis, myocardial infarction, acute disturbance of cerebral circulation. The disease has a favorable prognosis, if the treatment of food poisoning is started in a timely manner.

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

Prognosis of food-borne diseases

The causes of rare deaths are shock and acute renal failure.

Approximate terms of incapacity for work

Stay in the hospital - 12-20 days. If it is necessary to extend the time, justification. In the absence of clinical manifestations and negative bacteriological analysis - an extract for work and study. In the presence of residual phenomena - observation of the polyclinic.

[4],

Clinical examination

Not provided.

[5], [6], [7],

Memo for the patient

Receiving eubiotics and dieting, with the exception of alcohol, spicy, fatty, fried, smoked food, raw vegetables and fruits (except bananas) for 2-5 weeks. Treatment of chronic diseases of the gastrointestinal tract is carried out in a polyclinic.