Treatment of food toxic infections

Patients with severe and moderate cases, socially disadvantaged individuals with food poisoning of any severity are recommended to be hospitalized in an infectious diseases hospital.

Pathogenetic treatment of food toxicoinfections 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 ongoing losses.

A gentle diet is recommended (table No. 2, 4, 13) with the exclusion of milk, canned foods, smoked foods, spicy and hot dishes, raw vegetables and fruits from the diet.

Standard of treatment for patients with food poisoning

Clinical forms of the disease	Etiotropic treatment	Pathogenetic treatment
Mild PTI (intoxication is not pronounced, dehydration of HI degree, diarrhea up to five times, vomiting 2-3 times)	Not shown	Gastric lavage with 0.5% sodium bicarbonate solution or 0.1% potassium permanganate solution, oral rehydration (volume rate of 1-1.5 l/h) sorbents (activated carbon): astringents and enveloping agents (vicalin, bismuth subgallate): intestinal antiseptics (intetriks, enterol): antispasmodics (drotaverine, papaverine hydrochloride - 0.04 g each): enzymes (pancreatin, etc.); probiotics (sorbed bifidobacteria-containing, etc.)
Moderate PTI (fever, dehydration of the second degree, diarrhea up to 10 times, vomiting - 5 times or more)	Antibiotics are not indicated. They are prescribed for prolonged diarrhea and intoxication in elderly people and children.	Rehydration by a combined method (intravenously with transition to oral administration): volume 55-75 ml/kg of body weight, volumetric rate 60-80 ml, min. Sorbents (activated carbon): astringents and enveloping agents (vicalin, bismuth subgallate): intestinal antiseptics (intetrik S, enterol): antispasmodics (drotaverine, papaverine hydrochloride - 0.04 g each); enzymes (pancreatin, etc.): probiotics (sorbed bifid-containing, etc.]
Severe PTI (fever, dehydration grades III-IV, vomiting and diarrhea without count)	Antibiotics are indicated if the fever lasts more than two days /when dyspeptic symptoms subside), as well as in elderly patients, children, and people suffering from immunodeficiency. Ampicillin - 1 g 4-6 times a day intramuscularly (7-10 days): chloramphenicol - 1 g three times a day intramuscularly (7-10 days), Fluoroquinolones (norfloxacin, ofloxacin, pefloxacin - 0.4 g intravenously every 12 hours) Ceftriaxone 3 g intravenously every 24 hours for 3-4 days until the temperature returns to normal. For clostridiosis - metronidazole (0.5 g 3-4 times a day for 7 days)	Intravenous rehydration (volume 60-120 ml, kg of body weight, volumetric rate 70-90 ml/min). Detoxification - rheopolyglucin 400 ml intravenously after cessation of diarrhea and elimination of dehydration, Sorbents (activated carbon): astringents and enveloping (vicalin, bismuth subgallate) intestinal antiseptics (intetriks, enterol): antispasmodics (drotaverine, papaverine hydrochloride - 0.04 g); enzymes (pancreatin, etc.): probiotics (sorbed bifid-containing, etc.)

Treatment of food poisoning begins with gastric lavage with a warm 2% sodium bicarbonate solution or water. The procedure is carried out until the lavage water is clear. Gastric lavage is contraindicated in cases of high blood pressure: in people suffering from coronary heart disease, gastric ulcer: in the presence of shock symptoms, suspected myocardial infarction, poisoning with chemicals.

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

Rehydration therapy to eliminate existing and correct ongoing fluid losses is carried out in two stages.

For oral rehydration (for I-II degree dehydration and absence of vomiting) use:

• glucosolan (oralit);
• citroglucosolan;
• rehydron and its analogues.

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

The use of second-generation solutions made with the addition of cereals, amino acids, dipeptides, maltodextran and a rice base is promising.

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

The first stage of oral rehydration therapy lasts 1.5-3 hours (enough to achieve a clinical effect in 80% of patients). For example, a patient with food poisoning with stage II dehydration and a body weight of 70 kg should drink 3-5 liters of rehydration solution in 3 hours (the first stage of rehydration), since with stage II dehydration, fluid loss is 5% of the patient's body weight.

At the second stage, the amount of liquid introduced is determined by the amount of ongoing losses.

In case of dehydration of grades III-IV and the presence of contraindications to oral rehydration, intravenous rehydration therapy is performed with isotonic polyionic solutions: trisol, quartazole, chlosol, acesol.

Not recommended for use due to the lack of potassium in the composition: Ringer's solution, 5% glucose solution, Normasol and Mafusol solutions.

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

The volumetric rate of administration in severe cases of food poisoning is 70-90 ml/min, in moderate cases - 60-80 ml/min. The temperature of the administered solutions is 37 °C.

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

Calculation example. A patient with food poisoning has stage III dehydration, body weight is 80 kg. The percentage of losses is on average 8% of body weight. 6400 ml of solution should be administered intravenously. This volume of liquid is administered at the first stage of rehydration therapy.

For the purpose of detoxification (only after eliminating dehydration), a colloidal solution, rheopolyglucin, can be used.

Drug treatment of food poisoning

• Astringents: Kassirsky powder (Bismuti suhnitrici - 0.5 g, Dermatoli - 0.3 g, calcium carbonici - 1.0 g) one powder three times a day; bismuth subsalicylate - two tablets four times a day.
• Preparations that protect the intestinal mucosa: dioctahedral smectite - 9-12 g/day (dissolve in water).
• Sorbents: hydrolytic lignin - 1 tbsp. three times a day; activated carbon - 1.2-2 g (in water) 3-4 times a day; smecta 3 g in 100 ml of water three times a day, etc.
• Prostaglandin synthesis inhibitors: indomethacin (stops secretory diarrhea) - 50 mg three times a day at 3-hour intervals.
• Agents that promote an increase in the rate of absorption of water and electrolytes in the small intestine: octreotide - 0.05-0.1 mg subcutaneously 1-2 times a day.
• Calcium preparations (activate phosphodiesterase and inhibit the formation of cAMP): calcium gluconate 5 g orally twice a day every 12 hours.
• Probiotics: Acipol, Linex, Acylact, Bifidumbacterin-forte, Florin forte, Probifor.
• Enzymes: oraza, pancreatin, abomin.
• In case of severe diarrhea syndrome - intestinal antiseptics for 5-7 days: intestopan (1-2 tablets 4-6 times a day), intetrix (1-2 capsules three times a day).

Antibiotics are not used to treat patients with food poisoning.

Etiotropic and symptomatic treatment of food toxicoinfections is prescribed taking into account concomitant diseases of the digestive organs. Treatment of patients with hypovolemic, ITS is carried out in the intensive care unit.

Complications of food poisoning

Mesenteric thrombosis, myocardial infarction, acute cerebrovascular accident. The disease has a favorable prognosis if the treatment of food toxic infections is started in a timely manner.

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Prognosis of food poisoning

Rare fatalities include shock and acute renal failure.

Approximate periods of incapacity for work

Hospital stay - 12-20 days. If extension is necessary - justification. In the absence of clinical manifestations and a negative bacteriological analysis - discharge to work and study. In the presence of residual effects - observation at the outpatient clinic.

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Clinical examination

Not provided.

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Patient information sheet

Taking eubiotics and following a diet with the exclusion of alcohol, spicy, fatty, fried, smoked food, raw vegetables and fruits (except bananas) from the diet for 2-5 weeks. Treatment of chronic gastrointestinal diseases is carried out in a polyclinic.