Syndrome of intoxication

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

What causes intoxication syndrome?

The intoxication syndrome develops in the main with purulent processes of any localization (purulent pleurisies, empyema of the pleura, peritonitis, osteomyelitis, sepsis, phlegmon, etc.) at a background of reduced reparative processes and immunodeficient conditions, caused by a variety of reasons. In these stages, with a severe local pyoinflammatory process, general alteration also develops in all organs and tissues. In the first two weeks it is reversible and proceeds in the form of swelling and swelling of tissues, with small functional changes in organs and tissues. In cases where the local process and general alteration do not stop during this time, an irreversible alteration develops in the form of dystrophies: granular, fatty, amyloidosis, etc.

How does the intoxication syndrome manifest?

During the syndrome of intoxication, there are 3 stages, they also determine the severity of its manifestations.

I severity and stage of development of intoxication syndrome is 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. As manifestations of the syndrome of intoxication, the following signs are clinically revealed. Euphoria or feelings of depression are observed from the side of the brain, due to edema and swelling and, naturally, metabolic disorders. In the lungs, there is an alterative pneumonitis, which is accompanied by increased respiratory rate to 24 per minute, but there is no shortness of breath; weakness or, conversely, hard breathing; various rales, up to crepitating. Cardiac muscle is more resistant to toxins, mainly swelling of cardiocytes with thickening of the myocardium and metabolic disorders in it. The work of the heart is preserved; peripheral hemodynamics, as a rule, is not broken. Toxic carditis is manifested; tachycardia; systolic murmur at the apex of the heart; an accent of the second tone on the pulmonary artery; a decrease in the central hemodynamics.

The liver and kidneys are affected to a greater extent, since they are under the maximum load to detoxify the body. Morphologically they develop the same swelling and swelling, with functional impairment of activity. Clinical manifestations are poorly expressed: insignificant enlargement of the liver, denseness and painfulness upon palpation. The kidneys are not palpable, with rare exceptions; Pasternatsky's symptom is negative. But laboratory signs of liver parenchyma damage, especially aminotransferases (transaminases) - ALAT and ACAT, determining the state of its enzymatic function, at the level of the hepatocyte membrane, are determined laboratoryally. Biochemical functional tests of the liver increase insignificantly, which indicates the absence of damage to the hepatocytes themselves. Renal syndrome is determined by the severity of intoxication and conducted by infusion therapy. It is expressed in a change in the specific gravity of urine hyposmolar or hyperosmolar type, the presence of protein, spirals.

In clinical blood tests, the primary increase in leukocyte counts with neutrophilia is observed; an increase in ESR. But because of the depletion of primary immunity and hemopoiesis, leukopenia begins to form. This indicator is very important for determining the transition of purulent-resorptive fever into intoxication syndrome. The parameters of leukocytosis, as they are treated in non-toxic diseases, lose their prognostic significance. At the forefront indices of intoxication. An important role is played by the fractions of medium molecules (FSM), which determine the severity of intoxication - the norm is 0.23. The growth of LII and FSM, especially in the dynamics, indicates a heavier intoxication, and a decrease in its decrease, which allows, to some extent, to predict the course of the disease and determine the effectiveness of the treatment. Criteria for the 1st degree of intoxication syndrome are: LII growth up to 3.0, and FSM up to 1.0, which, of course, is very conditional without a complete clinical evaluation of the process. To stop intoxication already at this stage, a complete and perfect complex of local treatment for purulent-inflammatory process and general intensive therapy aimed at arresting multi-organ alterations is needed:

II degree of severity and stage of development of the intoxication syndrome are morphologically determined by the development of irreversible alteration in the form of: dystrophy and a coarse, progressive proliferative reaction in the form of sclerosis, fibrosis and cirrhosis of the parenchymal organs, with a violation of their already functional morphological character. The process is irreversible, but with the correct and complete therapeutic tactics, it can at least be stopped or suspended at the level of subcompensation.

Clinically, this manifests itself: from the side of the brain, a violation of consciousness in the form of a sopor or stupor, right up to the coma. The function of the lungs is grossly violated, with the development of respiratory failure (its genesis is different, defined as morphological changes in the lungs, and blood flow disorders), which sometimes requires oxygen therapy or mechanical 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, subjective severity is assessed by general changes and progression of cardiovascular insufficiency (BP, CVP, pulse).

Again, the most severe disorders develop in the liver and kidneys in the form of their joint functional insufficiency. The defeat of hepatocytes is determined by a decrease in the protein of the blood with dysproteinemia, a prothrombin index; a change in functional liver samples indicating a lesion of the hepatocytes themselves. A characteristic feature is the transition in hepatocytes of oxygen metabolism to peroxide amination, as a result of which the patient changes the color of the skin, acquiring the appearance of a "dirty sunburn". Amyloidosis of the kidneys is accompanied by a decrease in diuresis, an increase in the specific gravity of urine, and an increase in the slag of the blood.

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

III 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 multi-organ failure, which determines the lethal outcome in these patients.