Acute alcohol poisoning - description, causes, symptoms (signs), diagnosis, treatment. The toxic effect of alcohol on the human body Alcohol poisoning mkb 10

Alcohol intoxication is the poisoning of the body with the breakdown products of ethanol. First of all, the central nervous system suffers from this. The patient has mental disorders, slowing down of reflexes, deterioration of the functions of the musculoskeletal system.

The degree of damage to the body by alcohol depends on the individual physiological and psychological characteristics of a person, the dose of alcohol consumed and the metabolic rate. The diagnosis of alcohol intoxication according to the International Classification of Diseases (ICD-10) has its own internal coding, which displays the stage of poisoning and depends on the concentration of alcohol in the blood.

• Code Y91.0 - easy stage (0.5-1.5‰). Main symptoms: attention disorder, mild headache, nausea, increased heart rate, redness of the face, poor coordination and profuse salivation.
• Code Y91.1 - middle stage (1.5-2.5‰). Thinking slows down, it is difficult for the patient to move around and speak clearly, there is a tremor of the hands, vomiting, aggressiveness, anxiety and guilt increase.
• Code Y91.2 - severe stage (2.5-4‰). The central nervous system is almost completely affected, as a result, a person feels absolutely no pain, loses consciousness and may even die from hypoxia. If the patient has chronic alcohol intoxication, then at this stage he speaks quite coherently and can move around without assistance. In his blood, alcohol breaks down 2 times faster than in an ordinary person.

In the presence of disturbances in the work of the nervous system due to insomnia, overwork, psychogenia, pathological intoxication may suddenly occur, which quickly passes and ends in deep sleep. It is expressed in inadequate behavior with normal coordination of movements, and manifests itself in an epileptoid and paranoid form.

In the first case, the drinker is poorly oriented in time and space, lashes out at others, and after an attack of transistor psychosis, he absolutely does not remember what stupid things he did.

A paranoid seizure is characterized by frightening visual or auditory hallucinations, of which the most vivid fragments remain in the memory of the drinker.

First aid for alcohol poisoning

Loss of consciousness as a result of alcohol abuse is one of the main symptoms of severe alcohol intoxication. Ignoring a person who has not calculated his strength with the hope that he will sleep until the morning can have catastrophic consequences, even death. Therefore, you need to urgently call a doctor, and before his arrival, try to provide first aid aimed at removing alcohol intoxication:

1. Lay the patient on his side. The gag reflex is one of the body's natural ways of self-cleansing. If the patient sits or lies on his back, the liquid can enter the lungs and he will suffocate.
2. Induce vomiting. If a person is conscious, but there is no vomiting, then it is stimulated by pressing on the base of the tongue with a spoon or finger.
3. Ensure oxygen supply. With alcohol intoxication at home, after the urge to vomit has passed, the patient can be taken outside or open a window to improve access to fresh air.
4. Do not take medication. Before the doctors arrive, do not take pills for the treatment of food poisoning.
5. Plentiful drink. Poisoning dehydrates the body, so after alcohol you need to drink as much water or strong tea as possible.

After providing emergency care, the patient's condition may improve significantly, but qualified medical care is still necessary to completely remove alcohol from the body.

Benefits of infusion therapy

Chronic alcohol intoxication and toxic damage received by the patient at one time are very different. Therefore, medications used to eliminate alcohol intoxication are classified depending on the spectrum of action and method of application.

A dropper for alcohol intoxication (sometimes the medical term “infusion therapy” is used) is the most effective method of treatment. Its main advantages over tablets and powders:

• The medicine in a dropper is injected directly into the blood, and when taking pills, only a small part of the active ingredients enters the blood, the rest are deposited in the tissues.
• Being unconscious, a person, in principle, is not able to swallow a pill.
• Severe vomiting and nausea prevent the tablet from even reaching the gastrointestinal tract.
• The liquid structure allows you to combine various medications by adjusting their ratio and quantity.
• You can add medicines to the dropper that restore acid-base and salt balances, improve metabolism in the body, contain vitamins, hepatoprotectors.

Features of the action of medicines

Only a medical worker can competently choose the composition for a dropper for alcohol intoxication, so you should not mix the various ingredients on your own. Unqualified help can only worsen the patient's condition.

Preparations for the removal of alcohol intoxication are selected depending on the stage of intoxication, the physiological and psychological characteristics of the patient. They affect the body in different ways, therefore, depending on the spectrum of action, droppers are used for different purposes.

Blood thinning

As a result of alcohol poisoning, hypovolemia progresses in the body, in other words, the blood becomes dehydrated and thickens, and liquid is needed to break down alcohol. Therefore, the first and main composition for droppers is the alternation of saline (NaCl) and glucose solution (5-10%). They reduce the amount of alcohol in the blood and restore fluid levels in the circulatory system. Powder Regidron with alcohol intoxication is used to eliminate a hangover at a mild and moderate stage of poisoning. The sachet contains dextrose, sodium and potassium chloride, easily dissolves in water and quickly restores water balance.

Salt balance restoration

The lack of mineral salts, which occurs as a result of alcohol intoxication, negatively affects the work of the heart and circulatory system. To balance minerals, instillation with Disol and Acesol preparations with a polyionic solution of crystalloids is used. After that, you can drip the patient with a 10% glucose solution with magnesium chloride or Panagin.

Normalization of the acid-base level

Under the influence of alcohol, the work of enzymes slows down and occurs metabolic acidosis. It is characterized by muscle weakness, shortness of breath and loss of consciousness as a result of an excess of drunken glycerol, lactic and pyruvic acid in the body. Soda is dripped with alcohol intoxication to normalize the level of Ph.

Elimination of toxins

Popular detoxifying drugs Reamberin and Mafusol contain tricarboxylic acids. Furmaric and succinic acids improve the utilization of oxygen by the body and eliminate the symptoms of acidosis.

Reamberin spurs metabolic processes and promotes the breakdown of alcohol. The optimal infusion rate with Reamberin is 60-90 drops per minute, but not more than 800 ml per day. In the treatment of seriously ill patients, Reamberin is combined with blood substitutes. Unithiol and sodium thiosulfate can also be used as a solution. Drugs for removing toxins, such as Reamberin, are contraindicated in case of traumatic brain injuries and brain disorders.

Of the powder preparations, the most convenient intoxication sorbent is Polysorb. It dissolves quickly in water, has clear instructions indicating the amount of medication, which varies depending on the weight of the patient. Polysorb is also used before a feast for prevention alcohol poisoning.

Addition of vitamins

To stabilize the work of the body, the solutions are enriched with vitamins B1, B6, E and C. They contribute to the transformation of pyruvic acid into lactic acid, relieve hangover symptoms, and the treatment is much faster.

Liver protection

The main load in any poisoning falls on the liver. To prevent damage to enzymes in solutions, Essentiale is used. It contains phospholipids that neutralize toxic substances.

Resumption of breathing

Severe alcohol intoxication makes it difficult to breathe until it stops completely, due to a violation in the work of brain receptors. To prevent this situation, Verapamil, Corinfar and other calcium antagonists are administered.

Normalizing the amount of glucose

Hypoglycemia inhibits the work of brain cells. Therefore, treatment involves the presence of a small amount of insulin in the solution to utilize glucose.

Ancient folk recipes for a hangover

Alcohol poisoning is a fairly common and ancient disease. Therefore, there are many folk recipes, potions and even conspiracies that will help relieve alcohol intoxication. However, not all of them are effective enough, and sometimes even dangerous.

Consider some of the most popular recipes:

• Water with honey. A drink of 150 g of honey and an arbitrary amount of boiled water contains fructose, which reduces the symptoms of a hangover, poisoning during alcohol intoxication and helps to eliminate toxins.
• Herbal teas. Linden flowers, parsley root, mint leaves and thyme, saffron powder are suitable for brewing.
• Egg white. To relieve alcohol intoxication at home, 2 fresh proteins are whipped and drunk in one gulp.
• Ammonia. Dissolve 8-10 drops in half a glass of water and drink a sip every 15 minutes.
• Citrus. Fresh orange or lemon juice provides vitamin C to the body and stabilizes blood sugar levels.
• Brine. The old recipe has not lost its relevance. Brine, especially from sauerkraut, is rich in vitamins and salts, is easily absorbed into the blood and helps to cure a hangover.

Treatment

Therapy is prescribed by a narcologist after a complete examination. The main goal of taking medications is to detoxify the body, reduce clinical manifestations and reduce the risk of complications.

In most cases, the following groups of drugs are prescribed:

• saline solutions;
• diuretics;
• nootropics;
• neuroleptics;
• vitamins;
• sorbents;
• antacids;
• analgesics;
• antispasmodics.

Treatment is sometimes supplemented with glucocorticoids, beta-blockers, atropine. Mechanical purification of blood is possible with the help of hemodialysis, plasmapheresis. Rehabilitation of the patient takes place at home within one month.

The effectiveness of treatment and the overall prognosis for the victim will depend entirely on the accepted dose of the surrogate and on the timeliness of medical care. In addition, an important factor is the initial physical condition of the patient.

So, chronic alcoholics are more difficult to tolerate the toxic effects of surrogates. However, the consequences for both can be the same - from loss of vision and paralysis to death with kidney or liver failure.

In general, a number of specific measures are used in relation to the victim in the hospital. Emergency care for poisoning looks like this:

• Probe gastric lavage. Shown if the victim is conscious.
• Taking sorbents to bind and remove toxins.
• Administration of intravenous antidotes. In most cases, ethanol is used. In the case of ethylene glycol poisoning, calcium gluconate is used as an antidote.
• Increased diuresis for the rapid elimination of toxins through the kidneys (shown only with the normal functioning of the kidneys).
• The introduction of vitamins of group B, C into the body. Having poisoned, a person loses all electrolytes, minerals and vitamins, which requires restoring their balance.

At the stage of primary health care, it is recommended to normalize impaired breathing and restore or maintain adequate hemodynamics (see 3.1 "Treatment of hemodynamic disorders".

Level of persuasiveness - D (level of evidence - 4)

1. in cases of aspiration-obstructive respiratory disorders, it is recommended to perform an oral toilet; to reduce hypersalivation and bronchorrhea, atropine ** (1-2 ml of a 0.1% solution) is injected subcutaneously;
2. with a superficial coma - aspiration of the contents of the upper respiratory tract is carried out using an air duct;
3. with a deep coma - tracheal intubation is performed.
4. in case of respiratory failure of the central type, it is necessary to carry out artificial ventilation of the lungs after preliminary intubation of the trachea.
5. with a mixed form of disorders, aspiration-obstructive respiratory disorders are first eliminated, and then artificial lung ventilation is connected.
6. inhalation of oxygen is shown.
7. for the resolution of atelectasis - a sanitation FBS.

In severe hemodynamic disorders, anti-shock therapy is recommended: intravenous plasma-substituting solutions, saline solutions and glucose solutions.

After relief of respiratory failure and associated hypoxia, the use of succinic acid preparations (solution of meglumine sodium succinate ** - 1.5% - 400.0) and cardiovascular agents in therapeutic doses (cordiamin, caffeine) is recommended.

Correction of water and electrolyte balance is recommended to be carried out with crystalloid, colloidal solutions and glucose under the control of pulse, blood pressure (BP) and central venous pressure (CVP), cardiac index, total peripheral resistance, hematocrit, hemoglobin and electrolyte concentrations, as well as diuresis.

The general hypothermia of the body is below the critical level in persons with an alcoholic coma who were outside closed heated rooms during the cold season;

Chronic alcohol intoxication in the terminal stage with signs of multiple organ failure (hepatic, cardiovascular, metabolic disorders) alcoholic cardiomyopathy;

Acute alcoholic delirium on the background of chronic alcohol intoxication, which develops almost immediately after the patient exits from an alcoholic coma, is dangerous with complications (pneumonia, cerebral edema, acute cardiovascular insufficiency.

Order No. 520n of the Ministry of Health of the Russian Federation dated June 15, 2016 “On approval of the criteria for assessing the quality of medical care, clause 3.13.6;

Toxic effect of substances, predominantly non-medical (T51-T65) / World Health Organization // International Statistical Classification of Diseases and Related Health Problems. Tenth revision. Volume 1 (part 2) .- M .: Medicine, 1995 .- S. 337-344 .;

Order of the Ministry of Health of the Russian Federation No. 925n dated November 30, 2012 “On approval of the procedure for providing medical care in case of acute chemical poisoning”;

Order of the Ministry of Health of the Russian Federation dated October 05, 1998 No. 298 “On analytical diagnostics drugs, psychotropic and other toxic substances in the human body”;

Order of the Ministry of Health and Social Development of the Russian Federation dated January 27, 2006 No. 40 "On the organization of chemical and toxicological studies in the analytical diagnosis of the presence of alcohol, narcotic drugs, psychotropic and other toxic substances in the human body."

Chronic alcohol intoxication - poisoning of human organs by the decay products of alcohol when consumed in excessive doses. There may be no alcohol addiction. In contrast to the long-term negative effects of alcohol on the body in alcoholism, chronic intoxication is caused even by irregular drinking, if the doses of alcohol are large enough.

TREATMENT Tactics of management (see Non-specific drug therapy (see also Poisoning, general provisions) With acidosis - 4% r - r sodium bicarbonate IV up to 1,000-1,500 ml / day With agitation and convulsions - 10 ml 25% r - ra magnesium sulfate IM Prednisolone, thiamine, triphosadenine, ascorbic acid, glucose-procaine mixture (200 ml 40% r-ra glucose and 20 ml 2% r-ra procaine) intravenously.

A mild degree of intoxication does not require medical attention. The patient should be allowed to sleep, after which his condition is normalized.

In case of moderate and severe poisoning, assistance is provided according to the following algorithm:

• state stabilization;
• gastric lavage;
• body detoxification;
• management of complications and symptomatic treatment.

Treatment of alcohol intoxication at home is possible only if the victim is conscious, does not turn blue, breathes well and does not show signs of severe toxic effects of ethanol (shortness of breath, decreased blood pressure, severe abdominal pain, low temperature bodies, etc.).

State stabilization

Measures to stabilize the patient's condition are aimed primarily at restoring adequate spontaneous breathing. To do this, with the help of an electric suction, the remnants of vomit, saliva and sputum are removed from the upper respiratory tract.

With absence necessary equipment the procedure is carried out by wrapping a bandage or napkin on two fingers and thus cleaning the oral cavity. In case of severe respiratory disorders according to the central type, the patient is intubated and transferred to mechanical ventilation. As a rule, this happens only with a deep alcoholic coma.

The level of hypersalivation can be reduced by subcutaneous administration of atropine sulfate (0.5-1 ml). It should be remembered that the drug can significantly increase the heart rate and provoke mental arousal. The latter is stopped with the use of chlorpromazine, haloperidol, relanium.

Low blood pressure is corrected by prescribing vasopressors to the victim. With a slight decrease in blood pressure, caffeine is injected under the skin, mezaton at a dose of 0.5 ml. Coma combined with significant hypotension is an indication for drip intravenous administration dopamine, norepinephrine, mezaton.

Gastric lavage

Gastric lavage can be performed at home or in a hospital setting. At home, the victim is given to drink 0.5-1 liter of water, after which they induce vomiting. The procedure is repeated several times.

For washing, pure water, water with the addition of activated carbon powder or sodium bicarbonate ( baking soda). Gastric lavage in this way is possible only with the patient's consciousness and the ability to swallow.

In the hospital and at the SMP stage, lavage is carried out through a thick gastric tube. The latter is brought into the stomach through the mouth, and after the procedure is removed.

Alcohol surrogates are alcohol-based liquids that are not meant to be taken orally. When using alcohol surrogates, poisoning develops, which often leads to death.

Alcohol surrogates are liquids containing alcohol that are not drinks. Once in the human body, they cause intoxication with severe health consequences.

Ethyl alcohol in the composition of surrogates may or may not be present. The ethanol group includes:

• Butyl alcohol.
• wood spirits.
• Denatured alcohol.
• Colognes.
• Varnish.
• Stain.

Surrogates are much more toxic than alcohol. So, wood spirits contain methanol, denatured alcohol contains aldehyde, polish contains a whole combination of various toxic alcohols. The stain contains chemical dyes, which, when ingested, cause blue skin and mucous membranes.

The second group includes "false surrogates":

• methanol.
• Ethylene glycol.
• Isopropanol.
• Clay BF.
• Dichloroethane.

Toxic doses

Alcohol surrogates are dangerous because even a small amount of these liquids, when ingested, provokes a fatal outcome.

Their toxic doses for the development of acute poisoning differ depending on the composition:

• methanol - 7-8 ml;
• ethylene glycol - 50 ml;
• polish - 50 ml;
• acetone - 30 ml;
• isopropanol - 0.5 - 2 ml / kg;
• glue BF - 20-50 ml.;
• dichloroethane - 5 ml.

Methanol is broken down in the human body to formic acid and formaldehyde. These substances are highly toxic and cause severe CNS damage. 7 ml. enough for acute poisoning with fainting and loss of vision. 50 cause lightning death.

Poisoning by alcohol substitutes is very dangerous, as it is often accompanied by severe pathological lesions of the liver, kidneys, and central nervous system. Such lesions often end in the death of the poisoned.

Some poisonings are associated with the use of low-quality alcohol, but in most cases poisoning with alcohol substitutes occurs in chronic alcoholics who use household chemicals, medicinal liquids and industrial alcohols.

Classification of alcohol surrogates

What are alcohol substitutes? These are liquids containing alcohol, used in everyday life and for technical needs. They are used for the purpose of intoxication, when ordinary alcoholic beverages are not available. The group of alcohol surrogates can also include low-quality / counterfeit wine, cognac, vodka and other types of alcoholic beverages.

Treatment begins with urgent gastric lavage and the introduction of sodium sulfate through a tube. In case of methanol poisoning, the patient is given ethanol (antidote) orally or a 2-5% alcohol solution is injected intravenously.

In case of poisoning with substances containing ethylene glycol, sodium bicarbonate solution administered orally or intravenously is used to eliminate acidosis. Tactics further treatment in case of poisoning with true surrogates, it is determined by the identified violations on the part of various organs and systems.

All patients undergo detoxification therapy, prescribe vitamins, nootropics, etc.

In case of poisoning with alcohol surrogates containing methanol, prednisolone, atropine, ATP and lumbar punctures are used to correct visual impairment. With ethylene glycol poisoning, the first priority is to combat kidney damage.

Patients are prescribed diuretics, drinking plenty of fluids and magnesium sulfate. Carry out correction of water-salt balance.

In severe cases, hemodialysis or peritoneal dialysis is performed. The prognosis for poisoning with alcohol substitutes is determined by the type and amount of fluid taken.

After the use of true surrogates, death rarely occurs, and long-term consequences are possible as a result of damage to internal organs. As a result of taking substances containing methanol and ethylene glycol, a fatal outcome is often observed, many surviving patients become disabled.

Titles

Alcohol poisoning.

Titles

Russian name: Piracetam.
English name: Piracetam.

Latin name

Piracetamum (Piracetami).

chemical name

2-Oxo-1-pyrrolidineacetamide.

Pharm Group

Nootropics.

Nosology

A89 Viral infection of the central nervous system, unspecified.
D57 Sickle cell disorders.
F00 Dementia in Alzheimer's disease (G30).
F01 Vascular dementia.
F03 Dementia, unspecified.
F04 Organic amnestic syndrome not caused by alcohol or other psychoactive substances.
F05 Delirium not caused by alcohol or other psychoactive substances.
F06.7 Mild cognitive impairment.
F07.1 Postencephalitic syndrome.
F07.2 Post-concussion syndrome.
F07.9 organic disorder personality and behavior due to disease, damage or dysfunction of the brain, unspecified.
F09 Organic or symptomatic mental disorder, unspecified.
F10.2 Syndrome alcohol addiction.
F10.3 Withdrawal state.
F10.4 Withdrawal state with delirium.
F10.5 Alcoholic psychosis.
F11 Mental and behavioral disorders caused by the use of opioids.
F13 Mental and behavioral disorders due to the use of sedatives or sleeping pills.
F29 Nonorganic psychosis, unspecified
F32 Depressive episode.
F34.1 Dysthymia.
F41.2 Mixed anxiety and depressive disorder.
F48.0 Neurasthenia.
F60.3 Emotionally unstable personality disorder.
F63 Disorders of habits and drives.
F79 Mental retardation unspecified.
F80 Specific developmental disorders of speech and language.
F90.0 Violation of activity and attention.
F91 Conduct disorders.
G21.8 Other forms of secondary parkinsonism.
G25.3 Myoclonus.
G30 Alzheimer's disease.
G40.9 Epilepsy, unspecified.
G46 Vascular cerebral syndromes in cerebrovascular diseases.
G80 Infantile cerebral palsy.
G93.4 Encephalopathy, unspecified.
H55 Nystagmus and other involuntary eye movements.
I61 Intracerebral hemorrhage.
I63 Cerebral infarction.
I67.2 Cerebral atherosclerosis.
I69 Consequences of cerebrovascular diseases.
P15 Other birth injuries.
P91 Other disorders of cerebral status of the newborn.
R26.8 Other and unspecified disorders of gait and mobility
R40.2 Coma, unspecified.
R41.0 Disorientation, unspecified.
R41.3. 0* Reduced memory.
R41.8. 0* Intellectual-mnestic disorders.
R42 Dizziness and impaired stability.
R45.1 Restlessness and agitation.
R46.4 Lethargy and delayed reaction.
R47.0 Dysphasia and aphasia.
R51 Headache.
R53 Malaise and fatigue.
R54 Old age.
S06 Intracranial injury.
T40 Drug and psychodysleptic [hallucinogen] poisoning.
T42.3 Barbiturate poisoning.
T51 Toxic effect of alcohol.
Z55 Problems related to learning and literacy.

CAS code

Substance characteristic

Cyclic derivative of GABA.

Pharmacodynamics

Pharmacological action - nootropic.
Pharmacodynamics.

Improves connections between the hemispheres of the brain and synaptic conduction in neocortical structures, improves cerebral blood flow.
It has an effect on the central nervous system in various ways: it modifies neurotransmission in the brain, improves metabolic conditions that promote neuronal plasticity, improves microcirculation by affecting the rheological characteristics of the blood and does not cause vasodilation.
With cerebral dysfunction, it increases concentration and improves cognitive functions, including the ability to learn, memory, attention and consciousness, mental performance, without having a sedative or psychostimulating effect. The use of piracetam is accompanied by significant changes in the EEG (increase in α- and β-activity, decrease in δ-activity).
Promotes the restoration of cognitive abilities after various cerebral injuries due to hypoxia, intoxication or electroconvulsive therapy.
It is indicated for the treatment of cortical myoclonus both as monotherapy and as part of complex therapy.
Reduces the duration of vestibular neuronitis and nystagmus.
The hemorheological effects of piracetam are associated with its effect on erythrocytes, platelets and the vascular wall.
In patients with sickle cell anemia with pathological rigidity of erythrocytes, piracetam restores the elasticity of the erythrocyte membrane, increases their ability to deform and filter, reduces blood viscosity and prevents the formation of coin columns. In addition, it inhibits the increased aggregation of activated platelets without significantly affecting their number. At a dose of 9.6 g, it reduces the level of fibrinogen and von Willebrand factor by 30–40% and prolongs bleeding time.
Animal studies have shown that piracetam inhibits vasospasm and counteracts various vasospastic substances.
In studies on healthy volunteers, piracetam reduced the adhesion of erythrocytes to the vascular endothelium and stimulated the production of prostacyclins in the endothelium.

Definition and background[edit]

Acute intoxication with alcohol (without consequences and the formation of the disease).

Etiology and pathogenesis[edit]

Types of alcohol intoxication

1. Simple alcohol intoxication.

Alcohol intoxication with hebephrenic features;

Alcoholic intoxication with hysterical features.

2. Pathological intoxication.

Clinical manifestations[edit]

Acute alcohol intoxication: Diagnosis[edit]

- violation of concentration;

Narrowing of mental possibilities;

Decreased mental and industrial productivity.

Negative Romberg test;

A thorough somatoneurological examination of the patient is necessary, taking into account the possibility of injuries and infections. The patient should always be examined for possible multi-substance intoxication.

Differential diagnosis[edit]

Acute alcohol intoxication: Treatment[edit]

Indications for hospitalization

1. The presence of convulsive phenomena.

2. Concomitant acute consequences of TBI.

4. High temperature.

5. Physical exhaustion or dehydration.

7. Severe depression or obvious risk of suicidal behavior.

Therapeutic measures include monitoring the patient symptomatic therapy, if necessary - parenteral nutrition.

Bibliography

BP - blood pressure

ADH - alcohol dehydrogenase

ALAT - alanine transferase

ASAT - aspartate transferase

GGTP - gamma-glutamyl transpeptidase

GGTP - gamma-glutamyl transferase

HD - hemodialysis

HDF - hemodiafiltration

GLC - gas liquid chromatography

GIT - gastrointestinal tract

IVL - artificial lung ventilation

KOS - acid-base state

CT - computed tomography

CPK - creatine phosphokinase

LDH - lactate dehydrogenase

ICD10 - International Statistical Classification Classification of Diseases and Related Health Problems, Tenth Revision

MRI - magnetic resonance imaging

ARDS - acute respiratory distress syndrome

ICU - intensive care unit

PZh - gastric lavage

Ultrasound - ultrasound procedure

FBS - fibrobronchoscopy

FD - forced diuresis

CVP - central venous pressure

AP - alkaline phosphatase

EC - ethyl alcohol

EGDS - esophagogastroduodenoscopy

ECG - electrocardiography (cardiogram)

EEG - electroencephalography

EAPCCT – European Association of Poison Centers and Clinical Toxicologists

LD - lethal (lethal) dose

Rg - radiograph

Terms and Definitions

In response to the question “what is surrogate alcohol”, it is worth conveying to the reader the information that surrogate alcoholic beverages are considered to be those that were produced in an artisanal way in violation of the recipe or those that have expired.

Such alcohol is so toxic to the human body that in ICD 10 (International Classification of Diseases) such conditions have their own code. In particular, it is poisonings of this type that are indicated by coding in the T51 range.

Moreover, according to ICD-10, each component, which is the main active ingredient in a surrogate drink, is classified with certain codes.

All low-quality (surrogate) alcoholic beverages can be divided into two main groups:

• Alcohol containing ethyl alcohol and its derivatives. These include drinks based on butyl alcohol (lethality within an hour when taking 30 ml), sulfite and hydrolytic alcohol, industrial alcohol or denatured alcohol. Also included in this category are all lotions / colognes / polishes and stains. In the latter case (when using stain) skin and the patient's mucosa become blue.
• False surrogate. This is the most dangerous category of low-quality alcoholic beverages for human life. To reduce the cost of alcohol production, methyl alcohol or ethylene glycol is used here instead of ethanol. Both lead to paralysis or death of the person.

0 Thus, the term alcohol is essentially used as a synonym for alcoholic beverages.

Alcohol intoxication is a phrase that characterizes a health disorder caused by excessive consumption of alcoholic beverages. Historically, the term "alcohol intoxication" is used by medical specialists of various profiles, including toxicologists, psychiatrists-narcologists (mainly), forensic doctors.

Currently, the concept of "alcohol intoxication" is present in the ICD10 under the code F10 - Mental and behavioral disorders caused by alcohol, including: F.10. 0 "Acute intoxication" - as acute intoxication with alcoholism and alcohol intoxication.

At the same time, it is customary to distinguish the following clinical forms: acute alcohol intoxication: simple alcohol intoxication; altered forms of alcohol intoxication; pathological intoxication; chronic alcoholism 1, 2, 3 stages; alcoholic psychoses (alcoholic delirium, acute alcoholic hallucinosis, acute alcoholic paranoid, etc.).

"Chronic alcohol intoxication" characterizes a disease that has developed as a result of prolonged abuse of ES and is not accompanied by coma (with the exception of the terminal stage of multiple organ failure).

For this disease, various behavioral and mental disorders are more characteristic. The substitution of the concepts of "alcohol intoxication", "acute alcohol intoxication" and "alcohol poisoning" often leads to incorrect diagnosis, hospitalization and therapy of the victim.

Alcoholic coma is a coma that has developed as a result of the use of ES mainly in the form of alcoholic beverages in a toxic / lethal dose with the appearance of a toxic / lethal concentration of ethanol in the blood.

Alcohols are an extensive and very diverse class of organic compounds: they are widely distributed in nature, are of great industrial importance, and have exceptional properties. chemical properties.

Aliphatic saturated alcohols with a long chain of up to 5 carbon atoms (methyl, ethyl, propyl, butyl and amyl) have the greatest toxicological significance.

The toxic effect of alcohol (according to the ICD10 wording) implies a health disorder caused by the ingestion of one or more representatives of this group and is interpreted as acute poisoning.

At the same time, from the position clinical characteristics the predominant value, both in terms of the frequency of occurrence of this pathology, and in terms of medical consequences, the leading one is poisoning with ES (ethanol) or a commonly used concept - alcohol poisoning, which, from the point of view of toxicologists, is a disorder of consciousness (coma) caused by excessive simultaneous intake of ethanol.

Poisoning with other alcohols of this group may manifest itself various symptoms with preserved consciousness.

Given the higher toxicity and the specificity of clinical manifestations and complications, these recommendations do not consider the toxic effect (poisoning) of methanol (methyl alcohol), which is separated into separate clinical recommendations.

Surrogate alcoholic products are considered to be those drinks that were not originally intended for drinking. Conventionally, they can be divided into 2 groups.

First group

Short description

Acute alcohol poisoning (ethanol) is usually associated with the ingestion of ethyl alcohol or drinks containing more than 12% ethyl alcohol. The lethal concentration of ethanol in the blood is 5–8 g.l, the lethal single dose is 4–12 g.kg (300–500 ml of 96% ethanol); however, this rate varies from patient to patient and often depends on acquired tolerance to alcohol.

Acute alcohol poisoning is most widespread in countries of northern and middle latitudes.

Frequency. 25% of all acute poisonings. More than 60% of all fatal poisonings are due to alcohol. The predominant gender is male. Risk factors Alcoholism (about 90% of those hospitalized with acute alcohol poisoning are alcoholics) Drinking alcohol on an empty stomach (food masses in the stomach slow down the absorption of alcohol) Alcoholic beverages with a strength of up to 30% are absorbed faster.

Acute poisoning with alcohol surrogates is associated with the intake of ethyl alcohol containing impurities of various substances prepared on the basis of ethanol or other monohydric or polyhydric alcohols.

Alcohol surrogates prepared on the basis of ethyl alcohol containing various impurities. The clinical picture, course and treatment are similar to those for alcohol intoxication (see.

When ingested - alcohol intoxication; intense staining of the skin and mucous membranes in blue, which persists for 3-4 months. Differential diagnosis - methemoglobinemia.

Alcohol surrogates that do not contain ethyl alcohol and are other monohydric or polyhydric alcohols (false surrogates) Methyl alcohol (methanol, wood alcohol). The lethal dose when taken orally is about 100 ml (without prior intake of ethanol).

The toxic concentration in the blood is 300 mg/l, the lethal concentration is more than 800 mg/l. Ethylene glycol is classified as a dihydroxy higher alcohol; is part of antifreeze and brake fluid. The lethal dose when taken orally is 100 ml.

Symptoms

Poisoning by alcohol surrogates can manifest itself in different ways, it directly depends on what was drunk and in what quantity. If it was a substance from group I, then most likely the threat to life will not be very big and poisoned in 9 cases out of 10 it will be possible to “pump out” safely.

But if we are talking about the internal use of group II surrogates, then the poisoning will be extremely difficult, and the consequences can be the most unpredictable.

Intoxication with alcoholic surrogates includes such initial symptoms as:

• emotional arousal;
• increased physical activity;
• strong euphoria;
• dizziness, loss in space;
• redness of the skin of the face;
• profuse salivation;
• physical and emotional relaxation.

After some time, intoxication begins to manifest itself in the following symptoms:

• pale skin;
• severe dry mouth;
• frequent urination;
• dilated pupils that do not respond to light;
• impaired motor coordination;
• the affected nervous system;
• labored breathing;
• loss of the ability to speak and reason.

The first sign of alcohol poisoning is loss of consciousness, deep sleep, coma. There are three stages of coma in alcohol poisoning according to severity.

superficial coma. The pupils are constricted, but react to light.

From the mouth - a sharp smell of the alcoholic beverage that the patient had previously consumed. When trying to revive the vapors of ammonia, the patient reacts with an appropriate grimace and protective movements of the hands, but does not come to his senses.

The prognosis is usually favorable. If at this stage the patient is given a gastric lavage with the help of a gastric tube, then he quickly regains consciousness.

Coma of moderate severity. It differs from the previous one by a pronounced relaxation of muscle tone.

It reacts weakly to the inhalation of ammonia vapors. Gastric lavage does not bring recovery of consciousness.

Such patients require hospitalization in the toxicology department. deep coma.

Complete absence tendon reflexes. The pupils are constricted or (in violation of breathing) wide and do not react to light.

Pain sensitivity and reaction to ammonia is absent. Requires emergency hospitalization in the toxicology department.

You should know that all types of alcohol intoxication can be accompanied by a retraction of the tongue, which blocks the access of air to the larynx and lungs, the ingress of mucus and vomit into the respiratory tract.

Blood pressure in a state of mild coma is usually increased, but in a state of deep coma it drops to critical numbers. Characterized by increased heart rate.

Alcoholic coma should be distinguished from a traumatic brain injury (often drunk people have a combination of both), from a stroke, and also from drug poisoning.

If the poisoned person drank surrogates with ethanol in the composition, this is not so bad, although sometimes in these cases the poisoning is too difficult. Of particular danger are alcohols from the group that does not contain ethanol. When poisoned by them, a person first looks like with ordinary alcohol intoxication:

• the drinker's face turns red;
• the person becomes excited emotionally and physically;
• a state of euphoria appears;
• increased sweating;
• saliva is produced more abundantly;
• excitement is replaced by relaxation.

• the skin turns pale;
• pupils become wider;
• dry mouth;
• increased diuresis;
• movements become uncoordinated, their amplitude expands;
• physical and mental activity increases again;
• attention weakens;
• speech becomes slurred and unintelligible.

These symptoms of poisoning are still more like a high degree of intoxication. However, when using different surrogates, the signs will differ.

methanol

Quickly absorbed into the blood, methanol deals a crushing blow to the kidneys and nervous system. As a result of the poisoning effect, a number of characteristic symptoms will appear in a person:

• the optic nerve is affected;
• a person is sick and vomits;
• vision worsens (black dots appear, double vision, vision of objects becomes blurry, blindness may gradually develop);
• the pupils are dilated, the response to the light stimulus is insufficient.

After 1-2 days, other signs of poisoning with burned vodka or other counterfeit alcoholic beverages are added:

• the whole body hurts (aches in the muscles, lower back and joints, pains and pains in the abdomen are felt);
• the temperature rises to 38 ° C;
• pressure drops;
• drying of the mucous membranes and skin is observed;
• the heart works intermittently;
• consciousness becomes clouded;
• agitation and convulsions occur.

As symptoms increase without assistance, a coma occurs in a person, followed by paralysis and death.

ethylene glycol

This surrogate is also rapidly absorbed, and the liver and kidneys suffer from its toxic effects. In severe intoxication, damage to the nervous system is observed. Developing clinical picture on the rise, respectively, the three stages of poisoning:

1. Early. The first 12 hours after drinking surrogate alcohol, symptoms of intoxication do not appear. The man looks just drunk, but he still does not complain about his health.
2. Toxic damage to the nervous system. At this stage, a person vomits, there are complaints of headache, thirst. Diarrhea appears, the skin and mucous membranes become bluish, the temperature rises and the pupils dilate. It is difficult for the poisoned person to breathe, the heart beats rapidly, and the excitation phase begins. If you do not help, the victim will lose consciousness, and he will begin to have convulsions.
3. Hepato- and nephrotoxic stages. This stage begins on 2-3 days. A person's kidneys and liver fail. The skin turns yellow, itching begins. Urine darkens, its production decreases and disappears altogether. Liver and kidney failure develops, resulting in organ failure.

The symptoms of poisoning with alcoholic surrogates differ depending on which group they belong to. They will be more favorable if they are alcoholic surrogates of the first group containing ethyl alcohol, and more severe and dangerous in case of methanol or ethylene glycol poisoning, so they should be considered in more detail.

Symptoms of poisoning with surrogates containing ethyl alcohol

Clinically observed first signs of alcohol intoxication:

• emotional and motor excitement;
• redness of the face;
• state of euphoria;
• sweating;
• increased salivation;
• feeling of mental and physical relaxation.

Poisoning by alcohol surrogates microbial 10 (International Classification of Diseases) is represented by codes T51.1 - T52.9.

Symptoms will depend, first of all, on the type of surrogate accepted. So, in people poisoned by alcohol with ethanol, the symptoms are not so dangerous. Substitutes that do not contain ethyl alcohol are of great danger.

In both cases, common symptoms will be nausea, vomiting, abdominal pain, and dizziness. They are similar to those that occur with ordinary poisoning. It is possible to determine the type of accepted surrogate by the symptoms characteristic of each of them.

This poisoning is not so scary compared to the poisoning by surrogates of the second group, since ethanol is used to make alcoholic beverages. First, a person gets drunk, feels relaxed, peaceful, is in a euphoric state.

With further use of the surrogate, symptoms of ordinary poisoning appear, as well as:

• Pale face, skin;
• A person increasingly wants to go to the toilet;
• pupils dilate;
• Dryness appears in the mouth, a person is thirsty;
• The person cannot control his movements;
• It is difficult for a poisoned person to speak, speech is confused;
• There may be confusion or loss of consciousness.

Methanol or wood alcohol acts on the body as psychotropic drugs. You can die by taking only 50 milliliters of the substance. Symptoms of methanol poisoning include:

• Symptoms of ordinary poisoning: nausea, dizziness, etc.;
• Virtually no sense of intoxication;
• Dilated pupils that do not respond to light
• Vision problems: inability to focus, black dots before the eyes, etc.;
• A few days after the poisoning of the patient, pain in the joints and muscles begins to bother;
• The temperature rises;
• The skin becomes dry, as do the mucous membranes;
• The pressure drops;
• The patient is worried about the heartbeat;
• Consciousness is confused;
• The person becomes agitated, which may be accompanied by convulsions.

Ethylene glycol quickly spreads throughout the body, and the main blow is taken by the liver and kidneys, since it is through them that the substance is excreted. Symptoms of ethylene glycol poisoning include:

• Feeling of intoxication in the first 12 hours, no signs of poisoning;
• Then nausea, vomiting, diarrhea begin;
• There is a feeling of thirst;
• The skin acquires a blue tint, as do the mucous membranes;
• Pupils dilate;
• The temperature rises;
• It becomes difficult to breathe;
• The heartbeat quickens.

If the patient does not seek help or treatment does not help, his skin begins to turn yellow, the kidneys and liver fail, the skin itches and the urine darkens. In this case, death is possible.

Russia is among the top ten countries in the world in terms of the number of people who abuse alcohol.

A huge number of deaths occur from poisoning with alcohol substitutes, the use of which leads to serious intoxication of the body, in most cases ending in the death of a person.

It is rarely possible to save people, because not everyone pays attention to the terrible symptoms of poisoning with burned vodka, the development of which quickly leads to death. Knowing how to help the victim will save him from death.

What is surrogate alcohol

Alcohol is drunk to change emotional state to more comfortable. However, there are products approved by the state for ingestion that have been certified, and there are products that are not intended for drinking at all.

Why do we need surrogate vodka and analogues? Such a “singed” product is cheaper than a certified one, it is easier to get it, and the effect of intoxication is almost the same. Poisoning by surrogates, according to the classification codes according to ICD 10, belongs to the groups of diseases T5.1.1 - T5.2.

9. Surrogate alcohol includes:

• Chemical liquids containing ethyl alcohol as the main component - lotions, cosmetic and medicinal tinctures, methylated spirits, industrial alcohols, insect stains.
• Deceptive or false substitutes for alcohol-containing drinks, in which there is no ethanol, but there is methanol, dichloroethane, ethylene glycol.

Poisoning from surrogate alcohol containing ethyl alcohol is very common, as alcoholics consider such liquids to be the safest to drink.

However, all these substances are by no means intended for the human body, they contain a high concentration of potent chemicals, the impact of which destroys internal organs.

These include: BF-based glue, glass cleaners, colognes, deodorants, mouth fresheners, and other household chemicals that contain ethyl alcohol.

False surrogates

Poisoning by alcohol surrogates, which do not contain ethyl alcohol, is considered the most severe and leads to almost instant death, since methyl alcohol, ethylene glycol are quickly absorbed by the body and decompose into separate, extremely toxic substances.

AT best case, when using methyl alcohol, the alcoholic will get off with blindness. Ethylene glycol is part of the brake and defrosting fluid for cars, dichloroethane is a solvent for adhesive bases.

The WHO presents impressive and terrible figures - approximately 60% of men in Russia aged 15 to 60 die from intoxication with surrogates, which dramatically reduces the age of survival for men to retirement in the country to 59 years instead of 75, as, for example, in the UK.

Ethanol is a toxic substance, and poisoning with alcohol and its surrogates depends on the individual reaction of the body. A lethal dose for any person is considered to be three bottles of cognac, drunk with an interval of less than 5 hours.

At the same time, doctors stipulate that for fakes, the lethal dose may not exceed one sip, depending on the concentration of toxins in the substance that the person drinks.

Paradoxically, an immoderate snack can lead to death, because the body does not have time to cope with the incoming food that accumulates in the digestive tract, and alcohol is simply not absorbed at first, but then it enters the blood in huge quantities, which can lead to death.

The mechanism of action of poison on the body

Each toxic substance acts on the internal organs in its own way, however, since the poison passes through the digestive tract, all organs of the gastrointestinal tract are at risk, from the stomach to the kidneys.

Unable to cope with incoming poisons, the gastric mucosa reacts with ulcerative formations.

Approximately one third of methanol and ethylene glycol are excreted by the kidneys, which leads to acute organ failure, up to the absence of urination, the rest enters the bloodstream, causing a serious blow to the cells of the central nervous system, up to cardiac arrest.

Signs of alcohol poisoning

It is not uncommon for people to buy a bottle of alcohol in a store, labeled and certified, which turns out to be “burnt”.

It is difficult to notice poisoning by surrogates if alcohol is drunk in a cheerful company, especially when you consider that the first signs of the effect of alcohol are euphoria, emancipation, high spirits.

And only a few hours after drinking alcohol with toxic impurities, frightening symptoms of a hangover may appear, indicating that poisoning by alcohol surrogates has occurred.

ethyl alcohol

Poisoning by alcohol substitutes in most cases is fatal if the victim is not provided with emergency medical care in time. The poison quickly not only affects the organs of the gastrointestinal tract, but also spreads through the blood throughout the body. A person experiences severe intoxication, the symptoms of which can be very painful.

Alcohol surrogates are conditionally divided into several types. The first is those that contain ethyl alcohol. It can be cosmetics, liquids for cleaning household items, etc.

The second type is surrogates that do not contain ethyl alcohol. These include means for processing materials against the negative effects of insects, mold, as well as dyes, adhesives, etc. There is also a third type. It's called false surrogates.

Poisoning by alcohol surrogates occupies a leading position in the statistics of all intoxications. Moreover, 98% of patients die before hospitalization. To understand the reason for such a high mortality will help a brief description of alcohol substitute.

What are alcohol substitutes? What are the signs of poisoning with such an alcoholic fake? How to help the victim? What are the consequences of such intoxication? We will analyze the answers to these questions in this article.

Alcohol carries a considerable danger to the body. Using a poor quality product can not only poison you, but also die.

According to statistics, poisoning by alcohol substitutes occurs quite often and often leads to irreparable consequences. For example, in Russia in 2011, according to statistics, about 11,700 people died from poisoning, but the true result exceeds this figure.

And every year the number of victims of the surrogate is growing.

Symptoms of poisoning with surrogates are different, since everything depends on the type of substance and its amount. A more favorable prognosis with the use of low-dangerous surrogates. And in case of poisoning with methanol and ethylene glycol, the consequences are severe and most often fatal.

Since there are 2 groups of surrogates, it is important to understand that the symptoms will also differ greatly depending on the cause of the poisoning. Even if it is known which group the surrogate that provoked the poisoning belonged to (for example, it was a true surrogate), it is necessary to know what kind of impurity was contained in the drink in order to competently help the victim.

Symptoms of poisoning with true surrogates

Signs of poisoning with surrogates are similar to those that indicate that the patient has consumed ethyl alcohol, but in the first case, the malaise is more pronounced and is observed after a shorter period of time. The consequences of poisoning with a base alcoholic drink depend on the amount of alcohol ingested.

When poisoned by true surrogates, intoxication occurs due to toxic impurities. For example, after drinking hydrolytic alcohol, all the same symptoms appear as after drinking high-quality alcohol:

• nausea;
• vomit;
• weakness;
• drowsiness;
• sudden changes in blood pressure.

However, the speed of manifestation of the first signs is much higher. Intoxication is often recorded with the use of drugs for the heart on an alcohol basis. In this case, the symptoms of poisoning will be added:

• bradycardia;
• decompensated dysfunction of the myocardium.

Surrogate alcohol poisoning is often provoked by the use of alcohol-containing products for external use. In this case, the patient will experience a sharp blue of the lips and mucous membranes, and the blood will become more brown. This is due to the presence of anestezin in the composition, which tends to prevent oxygen from entering the tissues and internal organs.

The use of alcohol in the form of cosmetics leads to disruption of the functioning of the digestive tract along with signs of simple alcohol poisoning. This is due to the presence of butyl and methyl alcohols in most cosmetic products, which can lead to acute gastritis and even provoke the development of hepatitis.

When using the stain, a change in the color of the mucous membranes is observed, but this is due to the presence of dyes in the composition.

The main harm of moonshine lies in the danger of fusel oils, which have an extremely destructive effect on the liver and lead to acute liver failure, and in the most advanced cases, even to cirrhosis. To provoke severe poisoning by surrogates of this group, you need to drink a relatively small portion of an alcoholic liquid.

Symptoms of poisoning with false surrogates

The most common "substitute" for ethyl alcohol is methyl alcohol, which in itself does not cause much harm to the human body. The main danger is represented by its decomposition products - formic acid and formaldehyde.

It is possible to avoid acute poisoning with surrogate alcohol if ethyl alcohol is present along with methyl alcohol in the composition of the drink. The thing is that ethanol is an “antidote” that prevents the transformation of methanol into substances harmful to the body.

Therefore, people suffering from chronic alcoholism mix two types of alcohol, but such experiments are extremely dangerous to health.

A small dose of a surrogate causes a mild stage of intoxication, during which a person feels satisfactory, only the main signs of alcohol intoxication appear. Poisoning with low-quality alcohol occurs at the end of this "hidden" period.

If the amount of alcohol taken is a little more, signs of intoxication appear instantly: in just a few hours, a fatal outcome can occur if the person is not given proper assistance.

With a mild and moderate degree of poisoning, the following are observed:

• a sharp deterioration in vision with its subsequent restoration;
• dizziness;
• nausea.

In the severe stage, there are very pronounced symptoms of acute alcohol poisoning. A person can fall into an alcoholic coma within 2 hours after the onset of the first symptoms:

• drowsiness;
• violation of self-control;
• sudden changes in blood pressure;
• strong thirst;
• pain in the joints.

Another common substitute for ethyl alcohol is ethylene glycol, which is present in brake fluid. The danger is the decomposition products of this substance, the most toxic of which is oxalic acid, which causes kidney damage. Main symptoms:

• redness of the skin;
• change in the color of the mucous membranes;
• increase in heart rate;
• hyperthermia;
• violation of the perception of the surrounding world;
• psychomotor disorders;
• convulsions.

Oxalic acid leads to acute heart failure, disrupts the liver and provokes acute kidney failure, which is the most common cause of death in human poisoning with ethylene glycol.

At the first signs of poisoning by surrogates, it is necessary to seek qualified help, as the ailment progresses at a very high rate. The first aid should always be gastric lavage with warm water.

Further treatment measures directly depend on the cause of the poisoning:

1. methanol. For treatment, ethanol is used in small doses, which prevents the breakdown of methanol. Atropine and prednisolone are used to restore vision.
2. Ethylene glycol. Sodium bicarbonate solution is used. It is necessary to correct the water and electrolyte balance and drink diuretics to restore kidney function.
3. True surrogates. Here, treatment is prescribed depending on which organs and systems of the body are affected. It all depends on the amount of alcohol taken and its type.

Alcohol poisoning and any of its surrogates can be extremely dangerous. Surrogate alcohol very often leads to death, and many people who have been treated after poisoning by surrogates become disabled. It is important to protect a person from drinking such alcohol.

Surrogate alcohol has become a real national problem due to the increasing cases of poisoning with toxic compounds instead of alcoholic beverages.

The later stages of alcoholism are characterized by the degradation of personality and thinking, which leads to ill-considered actions, including drinking cheap products that are unsuitable for food consumption and life-threatening.

The impact of surrogate alcohol on mortality

Toxic doses

Surrogate alcohol has become a real national problem due to the increasing cases of poisoning with toxic compounds instead of alcoholic beverages. The later stages of alcoholism are characterized by the degradation of personality and thinking, which leads to ill-considered actions, including drinking cheap products that are unsuitable for food consumption and life-threatening.

However, not only chronic alcoholism can cause poisoning - illegally manufactured low-quality products can be found on store shelves under a harmless label.

Poisoning by alcohol and its surrogates is accompanied by a rapid loss of consciousness, the development of a soporous and coma. First of all, the brain and the circulatory system suffer from toxic drinks, therefore, in addition to impaired consciousness, the symptoms are accompanied by problems with breathing and blood vessels.

The clinical picture of poisoning may vary slightly - it all depends on the type of product that caused it. So, moonshine poisoning is accompanied by persistent irreversible changes, since this highly toxic alcoholic surrogate contains a number of heavy and dangerous compounds.

The main danger of low-quality alcohol is due to fusel oils, from which it is either not cleaned at all, as is the case with moonshine, or is partially cleaned. Moreover, it is very difficult to clean burnt vodka or moonshine at home from fusel oils.

The taste and smell of methyl alcohol are the same as those of ethyl alcohol. A lethal outcome can occur after consuming only 100 ml.

Individual sensitivity varies, so after consuming the same dose, one patient may experience more severe alcohol surrogate poisoning than another. The severity of poisoning also depends on whether the patient simultaneously took ethanol, which is an antidote to methanol - some alcoholics dilute methyl alcohol with ethyl alcohol to avoid poisoning.

However, such attempts to save are associated with an immediate risk to life. Methanol itself is not poisonous, but when it is broken down in the body, strong poisons formaldehyde and formic acid are formed.

When using a large dose, signs of poisoning by alcohol surrogates appear almost immediately, death occurs after a few hours. When taking a small dose, there is a latent period during which the patient feels satisfactory.

A mild form of poisoning with alcohol surrogates is manifested by nausea, repeated vomiting, headache, dizziness, epigastric pain, mild visual impairment - flickering flies, impaired clarity of perception (“it is visible as through a fog”).

Symptoms persist for several days and then gradually disappear. In case of poisoning with alcohol surrogates of moderate severity, the manifestations are similar, but all the symptoms are more pronounced.

After 1-2 days the patient loses sight. Subsequently, vision is partially restored, but then deteriorates again.

Such poisonings usually do not pose a threat to life, but can lead to visual impairment with access to disability.

Causes

The cause of severe poisoning and death of a person can be a single use of surrogates in a large dosage or their regular use over many years. Predisposing factors are:

• antisocial lifestyle;
• bad Company;
• alcohol addiction;
• burdened heredity;
• addiction;
• lack of permanent residence;
• severe family events.

Ethanol

1.2 Etiology and pathogenesis

Alcohols included in the T51 group are characterized by limited volatility and, with relatively low toxicity, acute inhalation alcohol poisoning in clinical practice practically does not occur, with the exception of cases of inhalation use of some alcohols (isopropyl) and some technical formulations containing alcohols for the purpose of drug intoxication.

The most common in clinical practice are acute oral poisoning with alcohols used for the purpose of intoxication.

Acute alcohol poisoning usually occurs when taking ethyl alcohol or various alcoholic beverages with an ethyl alcohol content of more than 12%. The lethal dose of 96% ethanol ranges from 4 to 12 g per 1 kg of body weight (approximately 700-1000 ml of vodka in the absence of tolerance).

Alcoholic coma occurs when the concentration of ethanol in the blood is 3 g.l and above, death occurs at a concentration of 5-6 g.l and above. Poisoning, as a rule, is of the nature of household - accidental, with the aim of intoxication.

Poisoning with pure higher alcohols - propyl, butyl, amyl alcohols are much less common in toxicological practice than with ethyl alcohol, poisoning with their mixture with ethyl alcohol is more common.

Lethal doses and concentrations: cases of fatal poisoning by ingestion are described - 0.1-0.4 liters of propyl alcohol or more. Death occurred in the period from 4-6 hours to 15 days, coma - when the content of propanol in the blood was about 150 mg%.

However, fatal poisoning is also described when 40 ml of alcohol is ingested. The lethal dose (LD100) of isopropyl alcohol by mouth for adults is considered to be 240 ml, lethal concentration levels vary from 0.04 mg/l in children and 4.4 mg/l in adults.

Routes of entry into the body are inhalation, oral, percutaneous, however, in clinical practice, poisoning as a result of oral intake of these alcohols predominates.

1.3 Epidemiology

Acute ES poisoning is one of the leading causes of emergency hospitalization for poisoning. According to the reports of the toxicological centers of Russia (Form No. 64), patients with this pathology amounted to 37.

9%, 30.7%. of all hospitalized in these units in 2008 - 2011, respectively.

In 2015, this figure averaged 32.7%. In federal districts, the proportion of patients hospitalized with ethanol poisoning in 2015 ranged from 7.1% in the Northwestern Federal District to 69% in the Urals and Siberian Federal Districts.

The average hospital mortality rate for ethanol poisoning was 3.0% in 2005-2012, and 4.7% in 2015. Mortality as a result of ethanol poisoning in relation to other causes of death from poisoning in the Russian Federation is the leading factor for the same period, ranging from 55.8% in 2005 to 42.1% in 2012, 2015 - 43, 7%, other alcohols - 3.3% - 4.0%.

Criteria for assessing the quality of medical care

Classification

Classification of coma due to the toxic effect (acute poisoning) of ethanol, which is subdivided by depth, respectively

coma superficial uncomplicated,

coma superficial complicated,

deep coma uncomplicated

coma deep complicated.

Toxic effect of alcohols:

2-propanol (propyl alcohol),

fusel oils (alcohol: amyl;

butyl; propyl

classified according to severity:

mild - not accompanied by loss of consciousness,

moderate severity - with a disorder of consciousness according to the type of stupor condition, toxic encephalopathy, but without complications,

severe - characterized by complete loss of consciousness (coma), which may be accompanied by various complications.

First group

Low-dangerous

Low-dangerous

The toxicology of poisoning with alcohol and its surrogates distinguishes two types of substances: those produced on the basis of ethanol and those made with the use of impurities. The first group includes the following:

1. ethanol made using hydrolysis from wood;
2. denatured alcohol;
3. cosmetic lotions, cologne;
4. glue BF - the composition includes polyvinyl acetal, phenol-formaldehyde resin, dissolved in acetone, alcohol;
5. varnish - a mixture of ethanol with butyl, amyl, acetone;
6. nigrosine - stain containing ethanol, dyes. It is used for processing wood, coloring leather products in blue.

The second variety includes chemicals that do not contain ethanol. They are made using ethylene glycol, methyl alcohol with the addition of various impurities.

Diagnostics

Should be organized immediately. The doctor initially collects an anamnesis of the disease, life, conducts a general examination, draws Special attention on the smell from the mouth, the consciousness of the victim, the skin. After that, laboratory and instrumental examination methods are prescribed. The most informative are:

• general urine analysis;
• general and biochemical blood test;
• electrocardiogram;
• Ultrasound of the abdominal cavity, heart;
• CT and MRI;
• electroencephalogram.

An ECG is usually performed by SMP doctors, which makes it possible to identify disorders that threaten the patient's life and stop them in time.

2.3.1 Chemical-toxicological laboratory diagnostics

The basis is chemical-toxicological laboratory diagnostics. It is not recommended to use for the purpose of diagnosis the determination of the presence and level of ES in the blood using the analysis of exhaled air (alcometer), since this method does not allow determining the presence of other alcohols, is inferior in accuracy to GLC, and also does not allow obtaining the required amount of exhaled air (maximum complete active expiration) in a patient in a coma).

The determination of ethyl alcohol in blood and urine is recommended to be carried out 2 times with an interval of 1 hour in order to confirm the result of the first study and determine the phase of poisoning by the ratio of ethanol concentration in these biological media (resorption or elimination).

Instrumental diagnostics has no specifics and is carried out for the purpose of differential diagnosis and monitoring of the patient's condition.

electrocardiography (ECG) - the probability of the presence of cardiomyopathy, chronic cardiac pathology (especially since the history of the life of such patients upon admission to the hospital is practically unknown),

chest radiography,

x-ray of the skull in two projections - for patients brought from the street, public places, with traces of injuries.

esophagogastroduodenoscopy (EGDS) - higher alcohols have a local irritating effect on the mucous membrane of the digestive tract (up to 2 times).

Additional instrumental diagnostic methods are recommended to be carried out once in order to identify trauma, concomitant pathology or possible complication(ultrasound examination (ultrasound) (ECHO-scopy) of the brain, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, ultrasound of the abdominal organs, kidneys, pancreas, fibrobronchoscopy FBS.

At the stage of primary health care, it is recommended to exclude the disease or condition that caused the coma on the background of alcohol intoxication, in particular:

traumatic brain injury, acute cerebrovascular accident;

hypoglycemic coma;

infectious disease (meningitis, encephalitis, etc.)

hepatic and uremic coma, coma with endocrinological diseases, severe encephalopathy with water-electrolyte and metabolic disorders.

In the hospital, upon admission of the patient, it is also recommended to exclude the diseases or conditions listed above, and in the absence of positive dynamics after 2.0-4.0 hours after the start of infusion therapy, a more in-depth study is recommended, including chemical-toxicological, in order to exclude the presence of a combined intake of any - or psychotropic drugs or other somatic or infectious disease.

Arriving doctors will first interview witnesses of the poisoning, examine the victim himself. If necessary, medical assistance will be provided on the spot, after which the patient will be transferred to a hospital for further examination:

• a blood test from a vein to detect alcohol, which contained drunk singed vodka;
• blood for the detection of methanol;
• ECG to study the activity of the heart (is the rhythm disturbed, is there any damage to the myocardium, etc.).

After the diagnosis, when a specific surrogate is known and the true picture of the patient's condition is revealed, doctors will prescribe targeted treatment.

Methods for studying the EEG ECG (decrease in the S-T segment, negative T wave, extrasystole; with alcoholic cardiomyopathy, persistent rhythm and conduction disturbances are possible) Microdiffusion test and gas-liquid chromatography - tests for the presence of ethanol in the blood.

Differential diagnosis of TBI Acute cerebrovascular accident Poisoning by false alcohol surrogates (chlorinated hydrocarbons, methanol, ethylene glycol) Poisoning sleeping pills, drugs and tranquilizers Hypoglycemic coma.

EEG research methods Gas-liquid chromatography. Differential diagnosis is carried out with acute alcohol poisoning.

TREATMENT Tactics of management (see Lack of positive dynamics of the patient's condition within 3 hours against the background of ongoing therapy indicates unrecognized complications (TBI, pulmonary atelectasis, etc.) or an erroneous diagnosis.

Toxic doses

2.1 Complaints and medical history

With ethanol poisoning, there are practically no complaints, since the patient is unconscious. In case of poisoning with higher alcohols with preserved consciousness, complaints are characteristic of exposure to narcotic and irritating substances: weakness, dizziness, headache, pain in the epigastric region, nausea, vomiting.

In case of poisoning with butanol, amyl alcohols, there may be complaints of diarrhea.

The anamnesis should be aimed at clarifying the following data: type of toxic substance (vodka, wine, beer, technical alcohol, solvent - its name, trade mark, etc.), dose, time of taking the toxicant.

In addition, it is advisable to find out some data from the anamnesis of life: previous diseases, injuries, bad habits.

2.2 Physical examination

In case of poisoning with ethanol, higher alcohols, it is recommended to evaluate the following:

The appearance of the skin - there is no specific color, in case of respiratory failure, shock, cyanosis of the lips, face, acrocyanosis, cold snap is noted, with a deep coma there may be moisture. It is necessary to identify the presence / absence of a rash, local changes, the so-called. “Decubitus ulcers” due to positional injury due to pressure from one’s own body weight, the so-called positional pressure on certain areas of soft tissues, leading to the appearance of areas of skin hyperemia, which are often regarded as bruises, hematomas, burns, phlebitis, allergic edema, etc. and are usually detected in the early stages (1-3 days).

Assess the psychoneurological status: state of consciousness (clear, lethargy, stupor, coma, psychomotor agitation, hallucinations). In the presence of coma - assess its depth, the presence or absence of reflexes, the width of the pupils, their reaction to light, the presence (absence) of anisocoria, the state of muscle tone. When anisocoria, pathological reflexes are detected, pay attention to their constancy (“pupil game”), since with a superficial alcoholic coma, anisocoria and pathological reflexes can appear and quickly disappear.

Assess the state of breathing: adequacy, frequency, depth, uniformity of participation in the act of breathing of all parts of the chest, auscultatory picture.

Examine visible mucous membranes - some higher alcohols are irritating and can cause a burning sensation, pain when swallowing.

Pay attention to the presence / absence of injuries, especially in the face, head, abdomen, lower back.

Pay attention to the presence / absence from the exhaled air of a smell characteristic of ES, higher alcohols, but it is not an absolute fact confirming ES poisoning, since the state of alcoholic intoxication can accompany various somatic, infectious diseases, injuries.

Pharmacodynamics

Nootropics.

Pharmacological action - nootropic. Pharmacodynamics.

Piracetam binds to the polar heads of phospholipids and forms mobile piracetam-phospholipid complexes. As a result, the two-layer structure of the cell membrane and its stability are restored, which in turn leads to the restoration of the three-dimensional structure of membrane and transmembrane proteins and the restoration of their function.

At the neuronal level, piracetam facilitates various types of synaptic transmission by predominantly influencing the density and activity of postsynaptic receptors (data from animal studies).

Improves connections between the hemispheres of the brain and synaptic conduction in neocortical structures, improves cerebral blood flow. It has an effect on the central nervous system in various ways: it modifies neurotransmission in the brain, improves metabolic conditions that promote neuronal plasticity, improves microcirculation by affecting the rheological characteristics of the blood and does not cause vasodilation.

With cerebral dysfunction, it increases concentration and improves cognitive functions, including the ability to learn, memory, attention and consciousness, mental performance, without having a sedative or psychostimulating effect.

The use of piracetam is accompanied by significant changes in the EEG (increase in α- and β-activity, decrease in δ-activity). Promotes the restoration of cognitive abilities after various cerebral injuries due to hypoxia, intoxication or electroconvulsive therapy.

It is indicated for the treatment of cortical myoclonus both as monotherapy and as part of complex therapy. Reduces the duration of vestibular neuronitis and nystagmus.

The hemorheological effects of piracetam are associated with its effect on erythrocytes, platelets and the vascular wall. In patients with sickle cell anemia with pathological rigidity of erythrocytes, piracetam restores the elasticity of the erythrocyte membrane, increases their ability to deform and filter, reduces blood viscosity and prevents the formation of coin columns.

In addition, it inhibits the increased aggregation of activated platelets without significantly affecting their number. At a dose of 9.6 g, it reduces the level of fibrinogen and von Willebrand factor by 30–40% and prolongs bleeding time.

Animal studies have shown that piracetam inhibits vasospasm and counteracts various vasospastic substances. In studies on healthy volunteers, piracetam reduced the adhesion of erythrocytes to the vascular endothelium and stimulated the production of prostacyclins in the endothelium.

Nosology

A89 Viral infection of the central nervous system, unspecified. D57 Sickle cell disorders.

F00 Dementia in Alzheimer's disease (G30). F01 Vascular dementia.

F03 Dementia, unspecified. F04 Organic amnestic syndrome not caused by alcohol or other psychoactive substances.

F05 Delirium not caused by alcohol or other psychoactive substances. F06.7 Mild cognitive impairment.

F07.1 Postencephalitic syndrome. F07.2 Post-concussion syndrome.

F07.9 Organic disorder of personality and behavior due to disease, damage or dysfunction of the brain, unspecified. F09 Organic or symptomatic mental disorder, unspecified.

F10.2 Alcohol dependence syndrome. F10.3 Withdrawal state.

F10.4 Withdrawal state with delirium. F10.5 Alcoholic psychosis.

F11 Mental and behavioral disorders caused by the use of opioids. F13 Mental and behavioral disorders due to the use of sedatives or hypnotics.

F29 Nonorganic psychosis, unspecified F32 Depressive episode.

F34.1 Dysthymia. F41.2 Mixed anxiety and depressive disorder.

F48.0 Neurasthenia. F60.3 Emotionally unstable personality disorder.

F63 Disorders of habits and drives. F79 Mental retardation, unspecified

F80 Specific developmental disorders of speech and language. F90.0 Violation of activity and attention.

F91 Conduct disorders. G21.8 Other forms of secondary parkinsonism.

G25.3 Myoclonus. G30 Alzheimer's disease.

G40.9 Epilepsy, unspecified. G46 Vascular cerebral syndromes in cerebrovascular diseases.

G80 Infantile cerebral palsy. G93.4 Encephalopathy, unspecified.

H55 Nystagmus and other involuntary eye movements. I61 Intracerebral hemorrhage.

I63 Cerebral infarction. I67.2 Cerebral atherosclerosis.

I69 Consequences of cerebrovascular diseases. P15 Other birth injuries.

P91 Other disorders of cerebral status of the newborn. R26.8 Other and unspecified disorders of gait and mobility

R40.2 Coma, unspecified. R41.0 Disorientation, unspecified.

R41.3. 0* Reduced memory.

R41.8. 0* Intellectual-mnestic disorders.

R42 Dizziness and impaired stability. R45.1 Restlessness and agitation.

R46.4 Lethargy and delayed reaction. R47.0 Dysphasia and aphasia.

R51 Headache. R53 Malaise and fatigue.

R54 Old age. S06 Intracranial injury.

T40 Drug and psychodysleptic [hallucinogen] poisoning. T42.3 Barbiturate poisoning.

T51 Toxic effect of alcohol. Z55 Problems related to learning and literacy.

The use of alcohol-containing liquids is a common cause of acute alcohol surrogate poisoning in adults. A similar problem is faced mainly by people suffering. By itself, it has a moderate, easily penetrates into tissues and, in a large dosage, leads to damage to many organs (liver, brain, stomach, heart, blood vessels). Poisoning with alcohol substitutes is more dangerous, as they contain various harmful impurities. Severe poisoning can cause death. ICD-10 code T51.

Drinking liquids containing alcohol is a common cause of acute poisoning in adults.

What about surrogates

Surrogates are liquids containing alcohol, but not intended for ingestion in order to obtain euphoria. They can be used in technical and medical purposes. Surrogates are true (contain ethanol) and false (contain other alcohols). These include:

• varnish;
• medicines used for heart disease (hawthorn tincture);
• technical alcohol;
• moonshine;
• antifreeze;
• brake fluid;
• glass cleaners;
• lotions and colognes;
• stain;
• "singed" vodka;
• White Spirit;
• methyl and butyl alcohols;
• ethylene glycol.

Homemade drinks

Many women and men use alcohol solutions home cooking. These include moonshine liquid. It is obtained using a special apparatus by distillation of mash. During this process, many volatile compounds are formed, including methyl alcohol. With improper distillation (cleaning the solution of impurities), toxic substances may be preserved. Home-made alcoholic drinks are in high demand in rural areas. Such people often experience poisoning by alcohol surrogates.

alcohol poisoning

alcohol poisoning

Medicines containing alcohol

In order to achieve a state of intoxication, alcoholics can use drugs based on alcohol. Most in demand:

• hawthorn tincture;
• tincture of valerian;
• motherwort tincture.

Hawthorn tincture can be purchased at any pharmacy for affordable price. This medicine contains alcohol and fruits, and is used in diseases of the heart and nervous system. Hawthorn improves blood flow and has a calming effect. When used in high doses ah, the work of the heart is disturbed and the pressure drops. People who use this medicine often develop heart failure.

How to determine

Surrogates can be distinguished from alcoholic products intended for mass consumption by smell, color and method of application. All household products (solvents, industrial alcohol) should not be taken orally.

Classification of alcoholism: ICD-10 codes

This page contains all the ICD-10 codes that affect alcohol and the consequences of its use. Alcoholism, intoxication, poisoning, delirium and other diseases and their codes in accordance with the International Classification of Diseases, 10th revision.

Alcohol-related diseases are classified under codes Z 71.4, Z 50.2, Z 72.1, Z 81.1, block F10.0-F11 (alcoholism and chronic alcoholism) and other codes classifying alcohol-related diseases.

Classification of alcoholism according to ICD-10:

Z71.4 - Alcoholism counseling and supervision

Women are 34% more likely to be diagnosed with Alcoholism Counseling and Supervision than men. Diagnosis code according to ICD-10 Z71.4.

At the moment, more than 14,000 people have been diagnosed, while 0% mortality of patients with this diagnosis has been recorded. This does not mean that alcoholism is not dangerous - most patients with this diagnosis systematically deal with the problem of alcohol dependence, which is the reason for the statistically zero risk of death. In the presence of more serious conditions, another diagnosis is made with the appropriate codes.

Z50.2 - Rehabilitation of persons suffering from alcoholism

During rehabilitation from alcohol dependence, the code Z50.2 is assigned. In ICD-10, section Z50 is described as "Assistance involving the use of rehabilitation procedures."

During the rehabilitation process, the patient may be prescribed various drugs to restore the state of the body (Anxiolytics, Fosenazide (Fosenazide) and others). The exact methods of treatment and the relevance of making this diagnosis depend on the patient's condition, the course of alcoholism, and anamnesis.

Q86.0 Fetal alcohol syndrome (dysmorphia)

Fetal dysmorphia is classified in the ICD-10 in the class "Q00-Q99 Congenital anomalies [malformations], deformities and chromosomal abnormalities."

Alcohol syndrome in the fetus (dysmorphia) occurs in the case of prolonged alcohol abuse by a woman during pregnancy and before it. malformations and congenital pathologies may look different, depending on many conditions, the main of which is the amount and regularity of alcohol consumed. The cause of the disease is the toxic effect of acetaldehyde and other alcohol breakdown products that enter the child's body through the mother.

Symptoms of fetal alcohol dysmorphia are represented by four main groups of abnormalities:

1. Craniofacial dysmorphia.
2. Prenatal and postnatal dysmorphia.
3. Brain damage.
4. Somatic deformities.

Unfortunately, almost all pathologies are manifested from birth and practically cannot be treated. Damage to the nervous system caused by the inability of the child's body to process alcohol manifests itself immediately (especially for tremors and other visible abnormalities). Treatment is symptomatic and aims to relieve pain as much as possible. Children with such a diagnosis require significant social and legal assistance and support.

G31.2 - Degeneration of the nervous system due to alcohol

Prolonged alcohol abuse causes irreversible degenerative damage to the nervous system. The disease is described in the ICD-10 in class G00-G99 "Diseases of the nervous system", block G30-G32 "Other degenerative diseases of the nervous system".

Read more about nerve damage, possible consequences and recovery of the nervous system after alcoholism in the article “The effect of alcohol on the nervous system: how to restore nerves?”

P04.3 Fetus and newborn affected by maternal alcohol consumption

Fetal dysmorphia is far from the only consequence of mother drinking during pregnancy. Code P04.3 is classified under P00-P96 "Special Conditions Occurring in the Perinatal Period".

Dysmorphia (fetal alcohol syndrome) was excluded from the rubric, since it received a separate code Q86.0 in the classification of diseases. As with the alcohol syndrome, all damage occurs for two reasons:

Y57.3 Special drugs for the treatment of alcoholism causing alcohol intolerance

Code Y57.3 refers to external causes of morbidity and mortality, in block Y40-Y59 "Drugs, medicaments and biological substances that cause adverse reactions in therapeutic use." In this case, drugs with a negative effect are special drugs for the treatment of alcoholism, causing alcohol intolerance.

Similar medicinal and folk methods encodings are highly effective, since the patient will not physically be able to drink alcohol due to an extremely negative and painful reaction of the body. Severe health consequences and the possibility of death usually occur when the patient tries to drink alcohol contrary to the prohibitions of doctors. Much less common are cases of accidental ingestion of alcohol into the blood along with drugs or products.

T51 - Toxic effect of alcohol

The toxic effect of alcohol and poisoning by alcohol surrogates in the ICD-10 is described under the code T51. The detailed content of section T51 is available in the article The toxic effect of alcohol, poisoning with surrogates.

ICD-10 codes for alcohol surrogates:

The following diseases have been excluded from T51 and moved to F10:

F10.2-F11 - Alcoholism and chronic alcoholism

According to the Order of the Ministry of Health of the Russian Federation No. 140 dated April 28, 1998, the classification of alcoholism should be carried out using the codes of the International Classification of Diseases of the 10th revision indicated below. The specific code is set depending on the history of the disease, the severity of the addiction, the degree of behavioral, physical and psychological damage in the body.

F10.0 - Acute intoxication
In the ICD-10, acute alcohol intoxication is classified under section F10 "Mental and behavioral disorders caused by alcohol use." The diagnosis is made because of the complex physical, psychological and behavioral changes and consequences resulting from overuse alcoholic drinks.

The diagnosis of acute intoxication can be made both to alcoholics and to people without dependence on alcohol at all. The severity of intoxication depends on the amount drunk and the individual reaction of the body. In most cases, intoxication requires only simple household measures and causes a hangover. In the acute form, medical attention, drips, body cleansing and other detoxification measures may be required.

The main symptoms of severe intoxication followed by acute intoxication:

F10.1 - Harmful use, alcohol abuse
Harmful use refers to the misuse of alcohol that causes severe adverse health effects.

Code F10.1 includes the systematic use of alcohol over the past year or more. When such abuse is not yet accompanied by the formation of alcohol dependence (aclogolism), but at the same time causes physical damage to health. The social side of the issue is not considered in this case.

F10.2.4.1 Chronic alcoholism (dependence on alcohol)
The initial stage of alcoholism in the phase of exacerbation is implied. At this stage of the development of the disease, all the symptoms of alcohol dependence are present. Usually, exacerbations occur when, for some reason, an already addicted person physically cannot get the desired alcohol for a long time.

The following manifestations are characteristic of the initial stage of addiction:

One of the characteristic differences of the first stage of alcohol addiction is that there is already an increased craving for alcohol, but there is still no withdrawal syndrome.

F10.2.2.1 - Initial stage of chronic alcoholism, maintenance phase
The following symptoms of alcohol dependence are characteristic of the current stage:

F10.3 - Medium stage of alcohol dependence (mild, moderate, severe)
Code F10.3 (F10.2.4.2) is assigned if the patient has an alcohol dependence (chronic alcoholism) of the middle stage - when the disease is in the exacerbation phase, there is an abstinence syndrome.

Symptoms of alcoholism of the middle stage, mild degree Gravity::

At this stage, it is extremely difficult for patients to give up alcohol on their own. Without proper treatment and behavioral modification, alcoholism will continue to progress.

Symptoms of the middle stage in exacerbation medium degree gravity:

The craving for alcohol becomes even stronger, the patient is practically unable to control it.

Symptoms of the middle stage of alcoholism in the phase severe exacerbations:

With a severe degree of withdrawal syndrome, an active craving for alcohol occurs. Independently, an alcoholic no longer refuses alcohol almost never, with the exception of critical situations and circumstances (and then, until the opportunity arises).

F10.2.2.2 Intermediate alcoholism, supportive care
Supportive treatment in the middle stage of alcohol dependence implies a stable satisfactory condition of the patient.

Classical clinical picture:

In such a state, the patient can feel quite well and lead adequately, but at the same time, attitudes towards a sober lifestyle are perceived passively.

F10.2.4.3 End-stage chronic alcoholism, exacerbation with severe withdrawal syndrome
The general disease code according to ICD-10 remains the same (F10.3). Clarifying code - F10.2.4.3, is assigned at the final stage of alcohol dependence, in the exacerbation phase with a severe withdrawal syndrome. Light and moderate severity of withdrawal symptoms are uncharacteristic for this stage of alcohol dependence.

This phase is characterized by the following symptoms:

• Strong feelings of guilt and anxiety, fears, insomnia.
• Dizziness, headaches, difficulty in contact with people.
• Chills, heavy sweating (especially at night), nausea and vomiting.
• Rapid heartbeat, tremor of the whole body.
• Episodic occurrence of hallucinations and illusions.
• Motor restlessness, flickering disorientation.

At the final stage of alcoholism, the patient has an active craving for alcohol. The patient is no longer able to independently control cravings for alcohol and refuse alcohol.

F10.2.3.3 - End-stage alcoholism, therapeutic remission on the background of taking aversive drugs
Treatment with aversive drugs can achieve therapeutic remission in end-stage alcoholics.

Against the backdrop of remission:

• There is a partial reduction of neurological and somatic symptoms.
• The patient remains persistent psychopathological disorders.
• Against the background of a general improvement in well-being, patients manage to instill formal attitudes towards sobriety and further treatment.

F10.4 - State of alcohol withdrawal with delirium (alcoholic delirium, delirium tremens)
According to the ICD-10, the withdrawal syndrome with delirium (delirious tremens) is assigned the code F10.4. An acute mental disorder that appears in the final stages of alcoholism against the background of alcohol withdrawal - stopping the use of alcoholic beverages.

Symptoms of alcohol withdrawal syndrome with delirium:

• Chills, fever.
• Rave; auditory, auditory and tactile hallucinations.
• Disorientation in space and self.

Delirium tremens often ends in death without proper treatment, including due to self-inflicted damage by the sick to himself. Hallucinations during the abolition of alcohol with delirium are threatening: often small, dangerous and terrible things appear - insects, devils.

Alcoholic delirium develops very sharply during the use of alcohol. Persons at stages 2 and 3 of alcoholism are most susceptible to it, after stopping alcohol intake for 2-5 days. Statistically, in order to reach this degree, a person must systematically consume a large amount of alcohol for 5-7 years, being at the 2nd or 3rd stage of the disease.

F10.5.2 Acute and subacute alcoholic hallucinosis
The code is assigned to alcoholic psychotic disorders, mainly hallucinatory. Acute and subacute alcoholic hallucinosis is characterized by the following symptoms:

• The state of acute mental disorder.
• Pronounced restlessness.
• Strong fear, anxiety, emotional distress.
• Attempts to take a direct part in painful experiences and hallucinations.

F10.5.1 Alcoholic psychotic disorder, predominantly delusional
This ICD-10 code is assigned for the following conditions that develop against the background of chronic alcoholism:

• Alcohol paranoia.
• Alcoholic paranoid.
• Alcoholic delirium of jealousy.

Alcoholic delusional psychotic disorder is characterized by the following symptoms:

• Strong feeling of fear.
• Brad on the topic of relationships and jealousy.
• Paranoia, intrusive thoughts about persecution.

F 10.6 (F10.5.3) - Alcoholic psychotic disorder, predominantly polymorphic, with outcome in amnestic syndrome
Disorders suitable for classification: alcoholic encephalopathy, Korsakov's psychosis.

• Disorientation, inadequate and unproductive behavior, misunderstanding of the location.
• The ability to remember events disappears: the patient may forget that he is married or has a child.
• Visual, tactile and auditory hallucinations.

At this stage of the disease, the alcoholic communicates with all people as if he sees them for the first time (if the person appeared during the development of psychosis). The process of atrophy of peripheral nerves that has begun leads to frequent unpleasant hallucinations: it seems to the patient that rats are running around his body, spiders and other insects are crawling.

Alcoholism. Classification.

Since 1998, Russia has been operating "International Statistical Classification of Diseases and Related Health Problems", abbreviated ICD - 10 .

Before that, the ICD was used - 9, which was called a little differently - "International Statistical Classification of Injury Diseases and Causes of Death" .

Already by the name, you can see that in the new classification, not only diseases have appeared, but also “health-related problems”. What is it and what is it for?

Naturally, we are interested in how this affected the attitude towards alcohol problems.

Very briefly. At the time of using the ICD - 9, all alcohol problems were solved only through a narcologist. If you drink, it means you are alcoholic. Alcoholism is a social disease and it was reflected in the status of a person. It was practically impossible to prove that you were “not an alcoholic”. It is quite clear that even if a person was aware of and critically assessed alcohol abuse, there was no voluntary appeal for help. Nobody wanted to be "registered".

A class appeared in ICD-10 Z. These are not diseases, these are health factors.

Z80-Z99 Potential health hazard associated with personal and family history and certain conditions affecting health

Z 71.4 - counseling and supervision for alcoholism

Z 50.2 - rehabilitation of persons suffering from alcoholism

Z 72.1 - drinking alcohol

Z 81.1 - family history of alcohol dependence

Most importantly, in class F "Mental and behavioral disorders due to alcohol use" , there is also a highlighted "diagnosis" - F 10.1 , which in its essence - "Alcohol use with harmful consequences" - does not indicate the presence of a mental disorder as a disease.

Now a person, realizing the factor - alcohol consumption, as affecting his health and social status, can turn not only to a narcologist, but also to a psychologist - psychological counseling and psychological correction. And to a psychotherapist for the purpose of preventive and rehabilitation assistance.

As for the main difference between these specialties. The psychotherapist has an additional function - he can prescribe medications. The psychologist only recommends medicines, over-the-counter and publicly available in the pharmacy network.

ICD classification - 10 (Order of the Ministry of Health of the Russian Federation No. 140 of 04/28/1998)

1. Acute alcohol intoxication (alcohol intoxication) in a severe degree

Code of the International Classification of Diseases (ICD-10) - F 10.0.

Symptoms: depression of consciousness (deep stupor, somnolence or coma), impaired autonomic functions (arterial hypotension, hypothermia, pallor or cyanosis of the skin and mucous membranes), passive body position.

2. Alcohol abuse (use with harmful health effects)
Code of the International Classification of Diseases (ICD-10) - F 10.1

This includes the systematic consumption of alcohol over the past 12 months, entailing damage to physical health, but not accompanied by the formation of dependence on alcohol. Negative social consequences are not considered here.

3. Chronic alcoholism (dependence on alcohol) - the initial stage, the exacerbation phase
Code of the International Classification of Diseases (ICD-10) - F 10.2.4.1.

Signs of the initial stage of alcohol dependence: pathological attraction to alcohol without a formed withdrawal syndrome, increased tolerance to alcohol, compensated neurasthenic and psychopathic disorders.

4. Chronic alcoholism (alcohol dependence) initial stage, maintenance treatment phase
Code of the International Classification of Diseases (ICD-10) - F 10.2.2.1.

Signs of pathological craving for alcohol, search for a situation associated with drinking alcohol, mood instability.

5. Chronic alcoholism (alcohol addiction) middle stage, exacerbation phase, withdrawal syndrome, severity - mild
Code of the International Classification of Diseases (ICD-10) - F 10.2.4.2., F 10.3.

Symptoms: asthenia, instability of emotions, sweating, interrupted sleep, poor appetite, mild hand tremor, low mood, obsessive craving for alcohol.

6. Chronic alcoholism (alcohol addiction) - middle stage, exacerbation phase, withdrawal syndrome, severity - medium


Symptoms: weakness, weakness, sweating, palpitations, dizziness, headache, restless sleep, lack of appetite, thirst, flatulence, depression, irritability, anxiety, tremor of the hands, eyelids, tongue, poorly controlled craving for alcohol.

7. Chronic alcoholism (alcohol addiction) - middle stage, exacerbation phase, withdrawal syndrome, severe
Code of the International Classification of Diseases (ICD-10) - F 10.2.4.2, F 10.3.

Symptoms: severe weakness, difficulty in contact, insomnia, night terrors, episodic illusions and hallucinations, ideas of guilt and relationship, headache, dizziness, tremor of the whole body, anxiety, restlessness, sweating and chills, palpitations, nausea, active craving for alcohol.

8. Chronic alcoholism (dependence on alcohol) - the middle stage, the period of maintenance treatment
Code of the International Classification of Diseases (ICD-10) - F 10.2.2.2.

Sustained satisfactory somatic and mental state, somatic complaints about well-being. Formally - the absence of a pathological craving for alcohol. Passive expression of attitudes towards a sober lifestyle.

9. Chronic alcoholism (dependence on alcohol) - the final stage, the exacerbation phase, severe alcohol withdrawal syndrome (mild and moderate disorders are not typical for the final stage)
Code of the International Classification of Diseases (ICD-10) - F 10.2.4.3, F 10.3.

Symptoms: flickering disorientation, difficulty in contact, insomnia, fears, episodic illusions and hallucinations, ideas of guilt and relationship, headache, dizziness, tremors of the whole body, anxiety, restlessness, sweating and chills, palpitations, nausea, active craving for alcohol.

10. Chronic alcoholism (dependence on alcohol) - the final stage; therapeutic remission against the background of taking aversive drugs
Code of the International Classification of Diseases (ICD-10) - F 10.2.3.3.

Partial reduction of somatic and neurological symptoms, persistent psychopathological disorders. Formal guidelines for treatment and sobriety.

11. State of alcohol withdrawal with delirium (alcoholic delirium, delirium tremens)
Code of the International Classification of Diseases (ICD-10) - F 10.4.

Acute psychotic disorder, disorientation in location and in self

12. Alcoholic psychotic disorder, predominantly hallucinatory (acute and subacute alcoholic hallucinosis)
Code of the International Classification of Diseases (ICD-10) - F 10.5.2.

Acute psychotic disorder, severe motor restlessness, attempt to participate in painful experiences, fear

13. Alcoholic psychotic disorder, predominantly delusional (alcoholic paranoid, alcoholic paranoia, alcoholic delusions of jealousy)
Code of the International Classification of Diseases (ICD-10) - F 10.5.1.

Acute psychotic disorder, delusional relationship, persecution, fear

14. Alcoholic psychotic disorder, predominantly polymorphic, with an outcome in amnestic syndrome (alcoholic encephalopathy, Korsakov's psychosis)
Code of the International Classification of Diseases (ICD-10) - F 10.5.3., F 10.6.

Misunderstanding by the patient of the location, inappropriate behavior and unproductive contact. Auditory and visual hallucinations. The ability to remember recent events disappears. Many people forget that they are married and have children. With the faces that appeared in his life during the development of psychosis, they communicate, as if seeing for the first time. As a result of atrophy peripheral nerves it often seems to the patient that rats are running on it and spiders are crawling.

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alcohol dependence syndrome

Definition and background[edit]

Alcoholism is a primary chronic progressive disease with a possible fatal outcome, the development and manifestation of which is influenced by genetic, psychosocial factors and environmental conditions. Alcoholism is characterized by loss of self-control, craving for alcohol, continued use of alcohol despite adverse consequences, cognitive impairment (denial of addiction to alcohol). These changes may be permanent or intermittent.

Alcoholism as a disease. Alcoholism is a complex disease with biological, psychological and social components. It is advisable to consider alcoholism as a disease from different points of view. If a person realizes that he is sick, it is easier to convince him of the need for treatment, as well as help him overcome overwhelming, sometimes obsessive guilt. In addition, one can speak more directly and openly about illness than about vice. With the idea that alcoholism is a disease, data on hereditary predisposition to alcoholism are also consistent. It occurs most often in men who start drinking early, develop tolerance and physical dependence rapidly, and exhibit antisocial behavior as early as childhood and adolescence. There is an assumption that the D 2 receptor gene is represented by a large number of A1 alleles and that a predisposition to alcoholism correlates with the presence of at least one of these alleles.

The concept of alcoholism as a disease does not mean that alcoholism is due to any one reason, which should be treated. In addition, one should not think that a patient with alcoholism is not able to control his drinking and his behavior. As with most diseases (diabetes, arterial hypertension), the behavior of the patient strongly affects the course of the disease. Even when alcohol abuse is due to another mental illness, over time it inevitably comes to the fore.

Alcoholism and mental illness. Alcoholism is often combined with other mental illness which can be either a cause or an effect. There is evidence that alcoholics are more likely to suffer from depression (see Chapter 22, paragraph III.B and Chapter 23), and their families have a higher frequency of affective disorders. At the same time, according to other data, the prevalence of affective disorders among alcoholics is the same as among the general population. Usually, depression develops as a result of constant alcohol abuse, less often, on the contrary, it leads to it. Often, transient depression occurs after the patient stops drinking. Often it is depression that prompts patients to seek help. Patients with alcoholism commit suicide more often (see Chapter 17, item II.B.3), especially after life losses and upheavals. Alcoholism is often combined with schizophrenia and other psychoses - involutional depression, organic psychosyndrome, MDP. Manic attacks are often combined with hard drinking. In specialized clinics for the treatment of patients with alcoholism, the most common comorbid diagnoses are MDP, depression and schizophrenia, and in narcological hospitals - depression and anxiety disorders. Careful diagnosis of comorbid psychiatric disorders is an essential prerequisite for proper treatment alcoholic patient.

An integrated approach is needed in both diagnosis and treatment. The patient should be managed by a doctor and a nurse who specializes in the treatment of alcohol withdrawal syndrome and alcoholism. Often patients with alcoholism show only general complaints, and therefore special vigilance is necessary for a correct diagnosis. Common concomitant conditions are arterial hypertension, pneumonia, gastrointestinal diseases, impotence, insomnia and neuropathies. From 12 to 60% of patients in therapeutic hospitals (depending on the type of institution and the contingent served) abuse alcohol. In these circumstances, the role of the general practitioner can hardly be overestimated.

A sensitive indicator of the effect of alcohol on the liver is the activity of serum gamma-glutamyl transferase. After the consumption of large amounts of alcohol, this activity, as a rule, remains elevated (more than 30 units / l) for 4-5 weeks. In the absence of other causes, increased gamma-glutamyl transferase activity may be a sign of alcoholism. In addition, it may indicate the concealed use of alcohol during treatment. At the same time, the activity of gamma-glutamyltransferase also increases with liver damage of another etiology, as well as with obesity, inflammatory diseases intestines, diseases thyroid gland, diabetes mellitus, pancreatitis, acute renal failure, trauma, taking high doses of benzodiazepines or phenytoin. Other biochemical indicators and their combinations are also used to detect alcoholism, but none of these methods has become generally accepted.

A psychiatrist should be involved in the diagnosis and treatment. In addition, psychologists and social workers play an important role in family work and social rehabilitation. Invaluable help can be provided by recovered patients, including members of the Alcoholics Anonymous society. They can not only give the most important advice, but also prove by their own example the reality of healing and contribute to the inclusion of the recovering person in the social environment.

Most psychiatrists conducting outpatient appointments consider the participation of a team of specialists inappropriate. In this case, the psychiatrist must take on several functions at once: identify possible somatic diseases and refer the patient to the appropriate specialist, organize family therapy, ensure that patients regularly attend meetings and actively participate in the activities of psychological support groups such as Alcoholics Anonymous.

Etiology and pathogenesis[edit]

Clinical manifestations[edit]

Alcohol dependence syndrome: Diagnosis[edit]

Diagnostic criteria for alcohol dependence are given in Table. 19.1. History taking usually begins with the questions: “Has anyone ever told you that you were abusing alcohol? Have you ever thought about it yourself?" An affirmative answer allows you to make a preliminary diagnosis of alcoholism. They also find out how much alcohol causes intoxication and whether this amount has increased recently (a sign of tolerance). The patient is asked in detail about his work, about relationships in the family, looking for signs of physical dependence (tremor, manifestations of withdrawal symptoms).

A system of standardized polling has been proposed. The patient is asked to answer four questions: “Do you ever feel like it’s time to stop drinking?”, “Are you bothered by others with their criticism about drinking?” didn't want to get drunk?" The probability of alcoholism with an affirmative answer to two or three questions reaches 90%.

The Michigan Test for Alcoholism, which consists of 25 questions aimed at identifying the psychosocial consequences of alcoholism, is widely used (abbreviated versions of 13 or 10 questions are also available). The McAndrew scale, which contains 49 items from the Minnesota Multivariate Personality Inventory (MMPI), is also widely accepted as a prediagnostic method.

Differential diagnosis[edit]

Alcohol Addiction Syndrome: Treatment[edit]

Treatment. The results of therapy depend on the patient's determination to stop drinking, on the duration of alcoholism and the amount of alcohol consumed, on psychological support and the availability of various methods of treatment. The highest rate of recovery (about 75%) was noted among those who admit their illness and receive the necessary financial and psychological support, including in the family.

A. Many people benefit from individual psychotherapy. With alcoholism, it has some features. In the initial stage, it is specific and momentary in nature: the main tasks are to help the patient cope with the immediate psychological and life difficulties that have arisen due to drunkenness, and prevent him from drinking again. Techniques aimed at restraining aggression, mental relaxation, etc. are also recommended. The first stage of psychotherapy is decisive in establishing therapeutic contact. The most effective at this stage is the active, leading position of the psychotherapist.

First of all, the question arises whether it is necessary to achieve a complete cessation of the use of alcoholic beverages. From our point of view, it is complete abstinence that should be the goal of treatment. Although some patients are able to limit their alcohol consumption after treatment, it is impossible to predict who will be able to drink moderately and who will not. There is reason to believe that the further the disease has gone, the less likely such self-control is.

When it comes to drinking episodes during treatment, we are flexible. It is unrealistic to expect that the patient will immediately stop drinking, although the goal - complete abstinence - remains unchanged. Separate drinks are not an indication for hospitalization. It is better if the psychotherapist finds out and discusses with the patient all the accompanying circumstances. As a result, the patient is better aware of which situations and mood patterns are fraught with a breakdown. We must proceed from the fact that alcoholism is a chronic disease and relapses are quite likely.

If the patient came to the treatment session in a state of intoxication, then if there is no need for hospitalization, he is sent home, providing, if necessary, escort and transport. Such episodes can provide useful information about how the patient behaves in a state of intoxication, but the session has to be postponed.

One of the primary tasks is to overcome the denial of alcoholism by the patients themselves. To admit one's dependence on alcohol, loss of self-control, one's own impotence means a blow to self-esteem. Sympathy, warm family relationships, participation in Alcoholics Anonymous often help overcome the denial reaction.

On the early stage treatment, the patient is told about the society "Anonymous alcoholics" and find out how he relates to the methods of his work. The better the doctor is familiar with this society, the easier it is for him to overcome the prejudices and negative attitudes of the patient.

From the very beginning, it is important to help the patient change their lifestyle. Although the relationship between work and rest regimen and alcohol abuse has not been proven, many believe that chronic overload and, as a result, constantly bad mood often push to drink alcohol. Another provoking factor is constant family quarrels.

Spiritual life is important. It has long been recognized that the acquisition of new values ​​in life facilitates abstinence from alcohol. Some religious groups have been successful in helping alcoholics.

Starting with psychological support and directive forms of psychotherapy, in the future they gradually move on to methods that help the patient understand himself, develop criticism of his condition, and strengthen his will.

In accordance with modern psychodynamic theories, the basis of drug addiction and alcoholism are the defects of the "Ego" (see Chapter 1, p. I.B). It is believed, for example, that the weakness of psychological defense mechanisms leads to anxiety, depression, anger and shame, which are drowned out by drugs and alcohol. Sometimes an important role is assigned to wounded pride. According to this point of view, some people react too painfully to criticism or loss of their dignity (especially in the eyes of idealized persons), in particular, with excessive conceit. Then feelings of anger and shame arise, and the person looks for a way out in alcohol or drugs. Other psychodynamic theories focus on a lack of "self-love", reduced stress tolerance, and the like.

B. Group psychotherapy for alcoholism is also quite effective, although it is difficult to give preference to any particular type of it. Group sessions have advantages over individual psychotherapy, in which some patients have too strong conflicting feelings towards the attending physician. There is also an opinion that a group is much better than one therapist at resisting attempts by one of its members to deny or justify drinking (psychological defense mechanisms such as denial and rationalization).

In group sessions, the patient shares thoughts and advice with other participants, sometimes helps them, and this increases his self-esteem and self-esteem. Examples of those who were able to overcome the craving for alcohol and lead a sustainable sober lifestyle, sometimes after repeated breakdowns, give hope for their own cure. The patient can discuss with other members of the group what he would be embarrassed to talk about in a different setting, while acquiring or restoring communication skills. Finally, group classes also play an educational role: the patient can receive important information for him about the nature of alcoholism and various methods of its treatment.

B. Family psychotherapy. It is important not only to learn as much as possible about the patient's family. Many experienced doctors consider family therapy as an important, and sometimes the main method of treatment. It can be carried out in different forms- in the form of sessions for the whole family, conversations with both spouses, sessions for several couples (or separately for groups of wives or husbands of patients). Apparently, a doctor who does not work in a specialized clinic should first of all get acquainted with the family situation in detail, and then decide on the need and scope of family psychotherapy.

There are organizations of relatives of alcoholics (for example, "Children of Alcoholics"). They appeared simultaneously with Alcoholics Anonymous (see Chapter 19, section III.D) and are similar in many respects to it. Members of these organizations recognize that the patient's relatives are powerless against his craving for alcohol, and only trust in God can save him from this addiction. As for the relatives themselves, their task is to achieve independence from the patient (which, of course, does not mean either indifference or hostility).

D. Alcoholics Anonymous is a community of about 1.6 million alcoholics, including former different countries. Its task is to help patients overcome alcohol addiction. The basis of the program of this society is the so-called "Twelve Steps" (see Table 19.2). As the patient ascends these steps, he recognizes the presence of a serious illness and comes to the need for a complete rejection of alcohol. The most important condition for healing is humility, the ability to accept the help of other people, self-knowledge. A person who follows the Twelve Steps program gradually gets rid of guilt and, helping fellow sufferers, learns altruism.

The Alcoholics Anonymous program is a powerful tool in the fight against alcoholism, although the society itself does not consider its program as a treatment. The Twelve Steps are similar in many ways to the stages of psychotherapy. The first steps help you realize your dependence on alcohol and recognize the loss of self-control, the subsequent ones encourage introspection. As a result, pathological defense mechanisms give way to mature forms of response.

Alcoholics Anonymous offers many practical suggestions that the physician can and should support. At an early stage of recovery, it is recommended to avoid significant life changes and new intimate relationships. The recovery plan is simple: 1) don't drink; 2) attend meetings of the society; 3) find a curator. The role of negative emotions in breakdowns is especially emphasized. Feelings of hunger, anger, loneliness and fatigue should be avoided, as these conditions encourage the use of alcohol. As the period of sobriety increases, more and more attention is paid to the impact on the character of the patient.

Alcoholics Anonymous is an invaluable resource for alcoholics and physicians. Narcologists should be aware of nearby local Alcoholics Anonymous groups and where they meet. These groups differ in the composition of participants (educational level, socioeconomic status), categorical attitudes, compatibility with various forms therapy and the possibility of participation of patients with comorbidities, especially those who need treatment psychotropic drugs. It is also useful to know about the existence of specialized groups (for example, for doctors, women, youth, sexual minorities).

Some physicians provide patients with information about Alcoholics Anonymous group meetings. It is very difficult for many people to decide to go to a meeting for the first time. Sometimes it is necessary to organize a telephone conversation or a personal meeting of the patient with an activist of the Alcoholics Anonymous society. Doctors who have recovered from alcoholism often provide this kind of help.

D. Medical treatment. Medicines are used to treat mental disorders associated with alcoholism. However, psychotropic drugs in these cases are prescribed with particular caution, given the tendency to abuse, the risk of overdose, toxicity, and interaction with alcohol. In addition, drugs are used to reduce the need for alcohol, treat withdrawal symptoms and intoxication, and eliminate positive reinforcement (the pleasure of drinking alcohol). To evaluate the efficacy and safety of some drugs (tricyclic antidepressants and other drugs metabolized by oxidation), it is necessary to monitor their plasma levels. Chronic alcohol use can induce the induction of some of the enzymes involved in drug metabolism. Below is information about the use of some drugs for alcoholism.

1. Tranquilizers. Benzodiazepines are certainly effective in withdrawal symptoms (see Chapter 20, paragraphs IV.B.1-2). Less clear is their role in alcohol abuse. Evidence is accumulating that alcohol abuse often occurs in the context of anxiety; it is not excluded that sometimes anxious states are the cause of alcoholism. Therefore, in cases where anxiety is not associated with alcohol withdrawal syndrome, it makes sense to prescribe drugs with an anxiolytic effect - first of all, those that are not likely to be abused (usually beta-blockers and buspirone). However, in panic disorder and some forms of social phobia, their effect is inconsistent and insufficient. Patients with alcoholism often begin to abuse benzodiazepines, but sometimes they are still indicated. The risk of abuse of some of them is especially high. First of all, these are drugs with a short action and a rapid development of a euphoric effect (for example, diazepam and alprazolam); they can increase cravings for alcohol in the initial stages of abstinence. Less dangerous are galazepam, chlordiazepoxide, oxazepam, the effect of which develops more slowly and is accompanied by less intense subjective sensations. Benzodiazepines are prescribed in small doses, and patients are constantly monitored.

2. Antidepressants. Depression in alcoholism is a serious complication requiring vigorous intervention. Depression often develops at the beginning of the period of abstinence, but usually it disappears after 2-3 weeks and is only rarely persistent. More often, prolonged depression is due to: 1) concomitant true unipolar depression; 2) alcoholic brain damage; 3) psychological and social consequences of drunkenness (breaking up with loved ones, job loss, loss of self-esteem, demoralization). From 6 to 21% of alcoholics commit suicide (the average for the general population is 1%; see Chapter 17, section II.B.3).

If a patient develops depression after cessation of alcohol consumption, then we usually limit ourselves to observation for 3 weeks and only then prescribe antidepressants. However, if there were depressive attacks even before the development of alcoholism (or during periods of prolonged abstinence) and the patient's condition in the clinical picture is similar to these attacks, then we prescribe antidepressants without waiting 3 weeks. There are no specific treatments for depression in alcoholism, although it is better to start with serotonin reuptake inhibitors (fluoxetine, sertraline, etc.), as they, according to some reports, reduce alcohol consumption during situational drinking and increase the period of abstinence.

Antidepressants are sometimes prescribed for anxiety. However, it must be remembered that in alcoholism, an overdose of tricyclic antidepressants or even one of the more modern antidepressants, such as amphebutamone, leads to a decrease in the threshold for convulsive readiness and can cause serious complications, even death. MAO inhibitors and serotonin reuptake inhibitors (fluoxetine, sertraline, etc.) are used when anxiety occurs against the background of depression or dysphoria, obsessive fears(e.g. social phobia), panic attacks. In these cases, tricyclic antidepressants, such as doxepin, are also indicated.

3. According to some reports, lithium reduces the likelihood of relapses and suppresses alcoholic euphoria. Nevertheless, lithium has not been used in uncomplicated alcoholism. It is prescribed for a combination of alcoholism with MDP or unipolar depression, with a family history of these diseases, as well as with a tendency to binge drinking. Occasionally, lithium is given to patients with uncontrolled rage attacks. With impulsive behavior, carbamazepine is sometimes effective (see also Chapter 24, paragraph IV.B).

4. Abuse of antipsychotics is almost never encountered, therefore, antipsychotics are better than benzodiazepines for anxiety and agitation in patients with alcoholism. On the other hand, treatment with antipsychotics is more often accompanied by side effects (late neuroleptic hyperkinesis, etc.). A comparative study showed that antipsychotics are more effective than benzodiazepines (the latter were used in low doses). These results cannot be considered completely reliable, since there is cross-tolerance to alcohol and benzodiazepines (but not to alcohol and antipsychotics).

5. Disulfiram (Antabuse) is used as an additional treatment for alcoholism. In combination with alcohol, disulfiram causes the so-called antabuse reaction, which in mild cases is manifested by a slight malaise, in severe cases - by a feeling of heat, a throbbing headache, a feeling of shortness of breath and shortness of breath, nausea, vomiting, sweating, chest pain, palpitations, arterial hypotension, fainting, dizziness, confusion and blurred vision. In especially severe cases, acute heart failure, convulsions, coma, respiratory arrest and death are possible.

Disulfiram (or its metabolites) inhibits aldehyde dehydrogenase, thereby disrupting the metabolism of ethanol (see Fig. 19.1). Acetaldehyde accumulates in the body, which causes the main symptoms of the Antabuse reaction. Some of the symptoms may also be due to inhibition of dopamine beta-hydroxylase, xanthine oxidase, succinyl dehydrogenase, and catalase.

The goal of disulfiram therapy is to achieve abstinence from alcohol. Keeping in mind that while taking disulfiram, even a small amount of alcohol can cause discomfort, the patient is unlikely to drink at will. The patient does not now have to overpower himself every time he has an irresistible desire to drink; he decides not to drink once, having drunk a disulfiram tablet. Knowing that disulfiram acts for 5-14 days, the patient will be forced to postpone the next drink, and during this time partial weaning from alcohol may occur. The use of disulfiram in a comprehensive treatment program can be extremely effective. At the same time, there are still no studies that would definitively confirm the effectiveness of disulfiram in alcoholism: it is difficult to compare a placebo with a drug whose effect is based on the expected unpleasant reaction. Nevertheless, the appointment of disulfiram in alcoholism is fully justified, especially at an early stage of treatment.

Disulfiram is contraindicated in severe heart disease and some psychoses. It can cause an exacerbation of schizophrenia, a manic and depressive attack, which is probably due to its effect on the enzymes for the synthesis and destruction of catecholamines. Disulfiram inhibits dopamine-beta-hydroxylase (this enzyme converts dopamine to norepinephrine), so at its initially low level, disulfiram can cause psychosis. With anomalies in other enzyme systems involved in the metabolism of neurogenic amines, behavioral disorders are also possible.

Before prescribing disulfiram, the patient is explained the goals of therapy. The doctor must be sure that the patient will not drink alcohol for 12 hours before taking disulfiram. During treatment with disulfiram, you should not ingest or externally any substances that contain ethanol (sauces, vinegar, medicinal tinctures, dental elixirs, lotions, sunscreens, perfumes, deodorants).

Patients should also be warned that some other drugs may cause an antabuse reaction. These are metronidazole (an antimicrobial agent), some other antimicrobial agents (in particular, chloramphenicol), some oral hypoglycemic agents (chlorpropamide, tolbutamide, etc.).

If the indications are correctly determined, the patient is set up for treatment, is socially stable, carefully fulfills the appointments, he does not have depression and suicidal intentions, then when using low doses of disulfiram (250 mg), the risk of severe reactions to alcohol is low. If such a reaction has developed, then the main goal of therapy is to maintain blood pressure and fight heart failure. Enter 1 g of ascorbic acid in/in; it acts as an antioxidant and blocks the conversion of ethanol to acetaldehyde, promoting the excretion of unchanged ethanol. Ephedrine and H 1 -blockers (eg, diphenhydramine, 25-50 mg) IV are also administered, although their mechanism of action is not entirely clear. It is necessary to monitor the level of potassium in the serum (possible hypokalemia).

Side effects of disulfiram are usually minimal. This is a garlic or metallic taste in the mouth in the first weeks of therapy, dermatitis, headache, drowsiness, decreased potency. Heavier side effects- hepatotoxic and neurotoxic (neuritis optic nerves, peripheral mono- and polyneuropathy). In the first weeks of treatment, it is necessary to monitor the activity of liver enzymes in the blood. Disulfiram inhibits the oxidative metabolism of many drugs.

Calcium carbimide also causes a reaction to alcohol, but milder, shorter and faster developing than disulfiram. Calcium carbimide causes less side effects and does not interfere with the metabolism of other drugs (the use of calcium carbide for the treatment of alcoholism is not approved by the FDA).

Prevention[edit]

Other [edit]

Congenital ethanol intolerance

The first stage of ethanol metabolism is the conversion to acetaldehyde with the participation of the liver enzyme alcohol dehydrogenase (see Fig. 19.1). Acetaldehyde is then converted to acetyl-CoA by aldehyde dehydrogenase type 2 (with a low Michaelis constant Km). It is this enzyme that is inhibited by disulfiram (see Chapter 19, p. III.D.5). Approximately half of Asians in the United States have a congenital aldehyde dehydrogenase type 2 deficiency and may develop an antabuse reaction in response to alcohol intake. Congenital intolerance to ethanol is one of the main reasons for the low consumption of alcohol by Asians. Deficiency of aldehyde dehydrogenase is genetically determined; the action of the gene is manifested both in the homo- and in the heterozygous state.

Sources (links)[edit]

1. Agarwal, D. P., Goedde, H. W. Alcohol metabolism, alcohol intolerance, and alcoholism. Berlin: Springer-Verlag, 1990.

2. Ciraulo, D. A., Shader, R. I. (eds.). Clinical manual of chemical dependence. Washington, DC: American Psychiatric, 1991.

3. Enomoto, N., Takase, S., et al. Acetaldehyde metabolism in different aldehyde dehydrogenase-2 genotypes. Alcohol Clinic. Exp. Res. 15:141-144, 1991.

4. Goldstein, D. B. Pharmacology of alcohol. New York: Oxford University Press, 1983.

5. Mendelson, J. H., Mello, N. K. (eds.). The diagnosis and treatment of alcoholism (3rd ed.). New York: McGraw-Hill, 1992.

6. Morse, R. M., Flavin, D. K. The definition of alcoholism. J.A.M.A. 268:1012-1014, 1992.

7. Sereny, G., Sharma, V., et al. Mandatory supervised Antabuse therapy in an outpatient alcoholism program: A pilot study. Alcoholism 10:290-292, 1986.

8. Tabakoff, B., Hoffman, P. L. Biochemical pharmacology of alcohol. In H. Y. Meltzer (ed.), Psychopharmacology: the third generation of progress. New York: Raven Press, 1987, pp. 1521-1533.

9. Uhl, G. R., Persico, A. M., Smith, S. S. Current excitement with D 2 dopamine receptor gene alleles in substance abuse. Arch. Gen. Psychiatry 49:157-160, 1992.

10. Vaillant, G. E. The Natural History of Alcoholism. Cambridge, MA: Harvard University Press, 1983.

What are alcohol substitutes? What are the signs of poisoning with such an alcoholic fake? How to help the victim? What are the consequences of such intoxication? We will analyze the answers to these questions in this article.

What applies to alcohol surrogates

Poisoning by alcohol surrogates in the international classification of diseases ICD-10 corresponds to codes T51.1 - T52.9.

They are divided into two groups: those surrogates of alcohol that may contain ethyl alcohol in their composition and those that may be without it. The first group includes:

1. Butyl alcohol. Death occurs after taking only 30 milliliters.
2. Hydrolysis and sulfite alcohols, which are obtained from wood. They are more toxic than ethanol due to the presence of a small amount of methyl alcohol in the composition.
3. Denatured alcohol or industrial alcohol. Contains some wood alcohol and aldehyde.
4. Polish contains several types of toxic alcohols.
5. The stain, together with ethanol, has dyes, from which the skin and mucous membranes of the patient become blue in color.

The second group or they are also called "false surrogates" is represented by:

• methyl alcohol;
• ethylene glycol.

Clinical symptoms of alcohol poisoning

The symptoms of poisoning with alcoholic surrogates differ depending on which group they belong to. They will be more favorable if they are alcoholic surrogates of the first group containing ethyl alcohol, and more severe and dangerous in case of methanol or ethylene glycol poisoning, so they should be considered in more detail.

Symptoms of poisoning with surrogates containing ethyl alcohol

• emotional and motor excitement;
• redness of the face;
• state of euphoria;
• sweating;
• increased salivation;
• feeling of mental and physical relaxation.

Then intoxication is replaced by symptoms of alcohol intoxication. The skin becomes pale. Frequent urge to urinate. The pupils dilate, the mouth feels dry. Increased mental and physical activity is accompanied by impaired coordination, movements become sweeping. The concentration of attention becomes reduced, speech is slurred. Criticism of one's words and actions is sharply reduced or completely absent.

Symptoms of methanol (wood alcohol) poisoning

Methyl alcohol is rapidly absorbed in the digestive system. About 75% of the absorbed poison is excreted in the breath, the rest - in the urine. The lethal dose is 50 to 150 milliliters. The main blow in case of poisoning falls on the nervous system and kidneys. There is a psychotropic effect (pathological changes in the psyche) and a neurotoxic effect, accompanied, among other things, by damage to the optic nerves and retina.

• nausea, vomiting;
• intoxication and euphoria are weakly expressed;
• visual impairment: flashing black dots before the eyes, blurred vision, diplopia (double vision) and even blindness;
• outwardly, in such patients, the pupils are dilated, sluggishly react to light;
• 1-2 days after poisoning, pain in the abdomen, lower back, aching muscles and joints appear;
• the temperature rises to 38⁰;
• dry skin and mucous membranes;
• low blood pressure;
• interruptions in the work of the heart;
• confusion;
• bouts of excitement, accompanied by convulsions;
• as the symptoms increase, the victim falls into a coma, paralysis of the limbs develops.

Ethylene glycol is also rapidly absorbed into

digestive tract. About 60% of the poison is broken down in the liver, about 20–30% is excreted by the kidneys. Therefore, it is these organs that will suffer most of all, up to the development of their acute insufficiency. In severe poisoning, signs of damage to the nervous system appear.

1. Early period. It lasts about 12 hours and is characterized by signs of intoxication with good health.
2. Toxic damage to the nervous system. There are: nausea, vomiting, headache, thirst, diarrhea, skin and mucous membranes become cyanotic. Pupils are dilated, body temperature rises, difficulty breathing, tachycardia, psychomotor agitation appear. Possible loss of consciousness with the development of convulsions.
3. The nephro- and hepatotoxic period develops on the 2-5th day from the onset of the disease. The clinic of hepatic and renal insufficiency is noted. Yellowness of the skin appears, which appears first on the sclera and lastly the palms turn yellow. Skin itching is characteristic, darkening of the urine may occur. Renal failure is manifested by a decrease in diuresis up to its absence.

Emergency care for poisoning with alcohol surrogates

In case of suspected poisoning by alcohol surrogates urgent care will depend on the initial state of the patient. If the patient is unconscious, then he should be laid on a flat hard surface, turn his head to one side so that there is no aspiration of vomit and call an ambulance. In case of violation of respiratory and cardiac activity, an ambulance is first called, and then an indirect heart massage and artificial respiration are already performed.

• take a sorbent;
• saline laxative;
• drink an enveloping broth, for example, jelly;
• emergency hospital admission.

Treatment of poisoning with alcohol substitutes in a hospital:

1. Gastric lavage through a tube. In case of intoxication with methanol, it is repeated for 3 days. Give sorbents.
2. Antidote treatment in both cases is the same: 5% ethanol is administered intravenously. In case of mild poisoning, 30% ethyl alcohol is allowed to be taken orally.
3. In case of ethylene glycol poisoning, calcium gluconate is administered to neutralize cleavage products. poisonous substance.
4. Forced diuresis is performed, which is based on the drip administration of a large number of solutions and diuretics in the absence of impaired renal function.
5. Removal of toxins from the blood is also carried out by hemodialysis.
6. Glucose with novocaine, prednisolone, vitamins of group B and C are administered.
7. In methanol poisoning, lumbar punctures are performed.
8. In severe cases of ethylene glycol intoxication, a kidney transplant may be necessary.

Consequences of alcohol poisoning

With methanol intoxication, a complete loss of vision is possible, which is not restored after the poison is removed from the body. Ethylene glycol-based surrogates lead to kidney failure. These patients usually die.

The problem of poisoning with alcoholic surrogates, unfortunately, remains relevant today. Many are faced with this disease, so knowing the signs of such intoxication will help not only provide emergency assistance to the victim in a timely manner, but also save his life!

Poisoning by alcohol and its surrogates? Symptoms and signs. First aid for alcohol poisoning, what to do?

Poisoning by alcohol surrogates code for ICb 10

Poisoning by alcohol substitutes

Acute poisoning with alcohol substitutes: signs and symptoms, diagnosis, treatment

doctor-medic.ru

Poisoning by ethanol and alcohol surrogates

Ethanol (ethyl alcohol), a well-known component of alcoholic beverages, is a transparent, volatile, water-soluble liquid with a characteristic odor for alcohols.

It is used extremely widely both in purified form and as part of many technical fluids, cosmetics, etc. Poisoning causes massive intake into the body.

ICD-10 T51 Toxic effect of alcohol T51.0 Toxic effect of ethanol T51.1 Toxic effect of methanol T51.2 Toxic effect of 2-propanol T51.3 Toxic effect of fusel oils T51.8 Toxic effect of other alcohols T51.9 Toxic effect of alcohol, unspecified T52 Toxic effect of organic solvents T52.3 Toxic effect of glycols T52.4 Toxic effect of ketones T52.8 Toxic effect of other organic solvents T52.9 Toxic effect of organic solvents, unspecified.

EPIDEMIOLOGY

EPIDEMIOLOGY A quarter of all acute poisonings are alcohol poisonings. More than 60% of all fatal poisonings also belong to this group.

CAUSES Risk factors: ■ Chronic alcoholism (about 90% of those hospitalized with acute alcohol poisoning suffer from chronic alcoholism). ■ Drinking alcohol on an empty stomach (food in the stomach slows down the absorption of alcohol). ■ Peculiar lifestyle: frequent events accompanied by a feast; the availability of alcohol, especially cheap ones. ■ Alcoholism in the family. The lethal concentration of ethanol (ethyl alcohol) in the blood is 5-8 g / l, the lethal single dose is 4-12 g / kg (300-500 ml of 96% ethanol), however, these figures are not the same for different people and largely depend on the acquired alcohol tolerance. Ethanol easily penetrates tissue membranes, is rapidly absorbed in the stomach (20%) and small intestine(80%). On average, after 1.5 hours, its concentration in the blood reaches its maximum level. The substance acts as a selective CNS depressant at low doses and as a general depressant at high doses, it has a psychotropic (narcotic) effect, which is accompanied by suppression of excitation processes in the CNS due to changes in neuronal metabolism, dysfunction of mediator systems, slowing down oxygen utilization processes. Metabolic toxicosis and acidosis (accumulation of ethanol biotransformation products) play a significant role in pathogenesis. The main endogenous product is the poisonous acetaldehyde, which is formed during all variants of the oxidative degradation of ethyl alcohol. If aldehyde dehydrogenase (an enzyme involved in the metabolism of alcohol) does not have time to transform it into acetate, a picture of severe intoxication develops. Acetaldehyde disrupts the circulation of adrenaline and other catecholamines in the brain and in the periphery, affects the cardiovascular system, liver, and kidneys. People of Asian origin are especially susceptible to the toxic effects of alcohol, since most of them have aldehyde dehydrogenase in their bodies in an inactive form. In such a situation, even small doses of alcohol can cause serious poisoning.

DIAGNOSTICS

DIAGNOSIS HISTORY AND PHYSICAL EXAMINATION Alcohol poisoning develops in stages. The clinic depends on the dose (Table 9-7). They say about acute ethanol poisoning when the condition of a person who has taken a large dose of alcoholic beverages deteriorates sharply, disturbances of consciousness appear, the ability to walk, perceive the environment is lost, stupor and coma occur.

Table 9-7. Stages of acute action of alcohol (alcohol intoxication) in intolerant persons (with changes according to K.M. Dubovski)

The concentration of alcohol in the blood,% mass / volume	Stage of alcohol exposure	Clinical manifestations
	Sobriety	There is no obvious influence. For an ordinary observer, the behavior is normal. Weak changes are detected by special tests
		Slight euphoria, sociability, talkativeness Increased self-confidence; weakening of inhibitory reactions
		Weakening of attention, prudence, self-control In tests - loss of ability for subtle operations
	Excitation	Emotional instability; weakening of inhibitory reactions Loss of judgment Weakening of memory and comprehension Decreased sensory response; increased reaction time Slight incoordination
	Confusion	disorientation, confusion; dizziness Increased emotionality (fear, anger, sadness, etc.) Disorder of sensory functions (diplopia, etc.), perception of colors, shapes, movements, sizes Increased pain threshold imbalance; quite pronounced disorder of coordination of movements; staggering gait; slurred speech
		Apathy; general inertia, approaching paralysis Noticeable weakening of response to any stimuli Loss of coordination of movements; inability to walk and stand Vomit; urinary and fecal incontinence Clouding of consciousness; deep sleep or stupor
		Complete loss of consciousness; anesthesiaSuppression or absence of reflexes Decrease in body temperature Urinary and fecal incontinence Circulatory and respiratory disorders
0.45 and above		Possible deathDeath from paralysis of the respiratory muscles

The symptomatology of an alcoholic coma is nonspecific and is a variant of a drug coma (see the article "Coma"). Characterized by obturation-aspiration disorders (retraction of the tongue, hypersalivation and bronchorrhea, aspiration of vomit), stridor, tachypnea, acrocyanosis, swelling of the cervical veins, coarse bubbling rales in the lungs, dilated pupils are possible. Hypothermia is noted. In the absence of medical care, the leading cause of death in prehospital stage- respiratory disorders. There may be various severe complications caused by myocardial damage up to necrosis, acute cardiac death. In case of ethanol poisoning in children, in addition to loss of consciousness, acidosis, hypoglycemia (especially in children under 5 years of age) and hypokalemia come to the fore. In young children, percutaneous intoxication has been described with the use of alcohol compresses.

ADDITIONAL EXAMINATION

ADDITIONAL EXAMINATION ■ ECG: decreased ST segment, negative T wave, extrasystole; with alcoholic cardiomyopathy, persistent rhythm and conduction disturbances, signs of myocardial damage are possible. ■ During the first examination of the patient, it is advisable to take venous blood for subsequent chemical analysis for the alcohol content, which may be required in the future (there should be no free space in the vial or test tube between the blood and the stopper; otherwise, the result of the study will be underestimated due to the evaporation of alcohol).

DIFFERENTIAL DIAGNOSIS

DIFFERENTIAL DIAGNOSIS ■ TBI. The difficulty lies in the fact that the likelihood of TBI in a person in a state of deep alcohol intoxication is extremely high. Even when falling out of the blue, due to lack of coordination, such persons receive severe head injuries. Diagnosis is helped by information received from others (it is important to compare the possible amount of alcohol consumed with the severity of the coma: a discrepancy may indicate head injury), detection of damage to the soft tissues of the head, anisocoria. ■ Stroke (acute cerebrovascular accident) may develop on its own or be provoked by alcohol (especially hemorrhagic stroke). The diagnosis is based on the identification of focal neurological symptoms (see the article "Stroke"). ■ Poisoning by alcohol surrogates, drugs, sleeping pills, tranquilizers or other substances, like ethanol, can cause coma (see below and the articles “Coma”, “Drug poisonings”). ■ Variants of coma in diabetes mellitus, diabetic (ketonemic), hyperosmolar and hypoglycemic coma (see articles "Coma diabetic (diabetic ketoacidosis)", "Coma hyperosmolar"). ■ Alcoholic ketoacidosis, which in turn has to be differentiated from diabetic coma. It develops 24–72 hours after alcohol withdrawal at the end of heavy drinking. The patient complains of nausea, vomiting, abdominal pain, refuses to eat. Rapidly increasing hypovolemia. Confusion appears, coma develops. Tachypnea and even Kussmaul respiration are noted as a response to ketoacidosis. Characteristic laboratory signs: normal or reduced blood glucose, ketonemia and ketonuria (due to the peculiar set of ketones before the start of treatment - the predominance of β-hydroxybutyrate - the reaction to ketones when using test strips may be weakly positive, despite the abundance of ketones in the urine). Treat such patients with a complete restoration of the BCC due to the infusion of dextrose without insulin and saline solutions. Electrolyte control is mandatory, as hypokalemia is possible. Additionally, thiamine is prescribed. It must be borne in mind that in the process of improving the patient's condition, the reaction to ketones in the urine will become more and more pronounced (as a result of the oxidation of β-hydroxybutyrate to acetoacetate) - this should not be regarded as a sign of aggravation of the pathology.

INDICATIONS FOR HOSPITALIZATION

TREATMENT INDICATIONS FOR HOSPITALIZATION Hospitalize persons with severe alcohol intoxication, accompanied by a coma, respiratory and circulatory disorders. Victims are taken to the intensive care unit or poison control center.

THERAPEUTIC MEASURES

THERAPEUTIC MEASURES ■ Since the use of analeptics in case of ethanol poisoning is contraindicated (due to the risk of developing a convulsive syndrome; there are only insufficiently confirmed clinical data on the possible use of flumazenil - 3 mg intravenously), in all cases, accompanied by severe respiratory and circulatory disorders, it is necessary to resort to resuscitation. A situation with respiratory arrest with continued cardiac activity is very likely. The onset of clinical death requires the entire complex of cardiopulmonary resuscitation. ■ The implementation of basic resuscitation will greatly facilitate the presence of electromechanical or mechanical suction, since the victim usually has abundant salivation and bronchorrhea, if dehydration has not developed before.

■ Gastric lavage through a tube is necessary, but is possible only after ensuring complete protection of the respiratory tract by intubation, which is carried out by the resuscitator on the spot or already in the hospital. In this regard, all activities of the first stage of assistance should be carried out very quickly.

DRUG THERAPY

DRUG THERAPY ■ At the stage of providing first qualified medical aid, you can begin to implement forced diuresis. To do this, infusion therapy is started through venous access and furosemide is administered (see the article "Poisoning, General Aspects"). ■ Maintenance therapy for ethanol poisoning includes the use of dextrose solutions without soluble insulin (if the victim is not diabetic) to prevent hypoglycemia and ketoacidosis. ■ Parenteral preparations of potassium, magnesium, thiamine, pyridoxine, ascorbic acid, etc. are also shown. ■ As an auxiliary measure, it may be necessary to use atropine (1 ml of a 0.1% solution subcutaneously) to reduce hypersalivation and bronchorrhea. ■ Severe hemodynamic disorders accompanied by arterial hypotension require, in addition to the introduction of an additional amount of fluid, the use of catecholamines (see articles on shock) and possibly prednisolone at a dose of 90-120 mg intravenously.

POSSIBLE COMPLICATIONS

POSSIBLE COMPLICATIONS ■ Periods of psychomotor agitation with short episodes of auditory and visual hallucinations (during recovery from an alcoholic coma). ■ Aspiration of the contents of the stomach with the development of atelectasis and a detailed picture of Mendelssohn's syndrome (asthma-like condition and pulmonary edema occurring 2-5 hours after aspiration).

FORECAST The prognosis depends not so much on the dose of alcohol, but on the timeliness of the assistance provided (98–99% of deaths occur at the prehospital stage). In chronic alcoholics, whose poisoning occurs against the background of encephalopathy, hormonal changes, cardiomyopathy, kidney, liver, lung damage, hypomagnesemia, hypovitaminosis, it is logical to expect a more severe clinical picture and a worse prognosis.

Poisoning by alcohol substitutes is a type of intoxication caused by the intake of low-quality alcoholic beverages containing technical compounds or toxic impurities. Often occurs in people suffering from addiction or adolescents who want to get drunk and at the same time purchase a product at a low price. Accompanied by disorders of the digestive, nervous, cardiovascular systems. There is a high probability of death, therefore, it requires emergency care and urgent hospitalization in the toxicology department. It has its own ICD 10 code - T51.

What applies to alcohol surrogates?

According to the classification, they are divided into two groups: true and false. The former include alcoholic beverages that contain ethanol, but also toxic impurities: esters, heavy metals, harmful dyes. The second type includes those products based on any other alcohol: methyl, isopropyl and others. Poisoning in this case is much more difficult, since not only metabolites are considered poisonous, but also the main compound.

Surrogate substitutes are usually drunk by people suffering from alcoholism and teenagers who do not have the means to purchase high-quality but expensive products. The following compounds are considered the causes of intoxication:

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• methylated spirits;
• varnishes;
• wood stain;
• medicinal medicines (tinctures);
• cosmetics;
• household accessories in the form of solutions, aerosols;
• moonshine.

There are also poisonings due to drinking brake fluid, de-icers and other similar substances.

Clinical picture with intoxication

Symptoms of the disease are different, vary depending on what the patient has taken. The manifestations of pathology when drinking a certain chemical component are described in detail below.

Surrogates containing ethyl alcohol

The first thing that the victim feels is euphoria and emotional excitement, which they achieve during the gatherings. Further, the clinic is supplemented by the following symptoms:

• excessive sweating;
• increased production of saliva in the oral cavity;
• pallor of the skin;
• increase in pupil diameter;
• dizziness;
• impaired coordination of movements;
• nausea;
• vomit;
• diarrhea;
• pain in the abdomen.
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Perhaps a change in consciousness, the appearance of delusional disorders, hallucinations.

Methanol (wood alcohol)

They are more toxic, death is possible with the use of fifty milliliters of a surrogate, however, it all depends on the sensitivity of the victim's body. Signs of poisoning are:

• depressive syndrome;
• nausea;
• vomit;
• decreased visual acuity up to its complete loss;
• increase in body temperature;
• convulsions;
• weakness;
• disturbance of consciousness, its absence.

Often disturbed by disorders of the cardiovascular system, namely tachycardia, arterial hypotension, pain behind the sternum.

Symptoms of ethylene glycol poisoning

The clinic is divided into three periods. At first, the patient does not make any complaints, feels only a slight euphoria. Further, after 10–12 hours, signs such as:

• unbearable thirst;
• nausea;
• dry mucous membranes;
• headaches;
• cyanosis;
• vomiting that does not bring relief;
• convulsive syndrome.

If proper measures are not taken, kidney, liver or heart failure is formed on the second or third day. The skin acquires a yellow tint, the volume of urine excreted decreases. The man dies in agony.

Diagnosis of intoxication

Should be organized immediately.

The doctor initially collects an anamnesis of the disease, life, conducts a general examination, pays special attention to the smell from the mouth, the consciousness of the victim, and the skin. After that, laboratory and instrumental examination methods are prescribed. The most informative are:

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• general urine analysis;
• general and biochemical blood test;
• electrocardiogram;
• Ultrasound of the abdominal cavity, heart;
• CT and MRI;
• electroencephalogram.

An ECG is usually performed by SMP doctors, which makes it possible to identify disorders that threaten the patient's life and stop them in time.

First aid

Carrying out manipulations at the early stages of poisoning with alcohol surrogates will avoid the formation of complications and death. The algorithm of actions includes the following items:

• washing the stomach with soda solution and pressing on the root of the tongue;
• sorbent intake;
• use of a saline laxative;
• calling a doctor for emergency hospitalization.

During the procedures, it is forbidden to give additional medicines, worsening of the course of poisoning is possible.

Antidote

It all depends on which surrogate the person has accepted. If intoxication is caused by the true type, then the condition is stopped with the help of pyrazole derivatives. In cases where the disease has formed due to methyl alcohol, ethanol is injected intravenously.

Treatment Methods

Therapy is prescribed by a narcologist after a complete examination. The main goal of taking medications is to detoxify the body, reduce clinical manifestations and reduce the risk of complications.

In most cases, the following groups of drugs are prescribed:

• saline solutions;
• diuretics;
• nootropics;
• neuroleptics;
• vitamins;
• sorbents;
• antacids;
• analgesics;
• antispasmodics.

Treatment is sometimes supplemented with glucocorticoids, beta-blockers, atropine. Mechanical purification of blood is possible with the help of hemodialysis, plasmapheresis. Rehabilitation of the patient takes place at home within one month.

Possible consequences

According to statistics, with timely diagnosis and adequate therapy, the prognosis is favorable. Otherwise, complications such as:

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• blindness;
• cerebral edema;
• renal, liver failure;
• mental disorders;
• acute alcoholic hepatitis;
• pancreatitis;
• hypovolemic shock;
• acidosis.

The most terrible consequence of poisoning with a surrogate is considered to be a fatal outcome.

Prevention

• purchase products in specialized trusted stores;
• observe the conditions of storage and transportation;
• reduce the amount of alcohol consumed.

If you buy alcohol - do not skimp. Champagne for 150 rubles or cognac for 300, most likely, is not made from the best raw materials and not in the best conditions.

Summary

Such pathologies, unfortunately, in medical practice meet constantly, their frequency is growing every year. If earlier everything was attributed to the illiteracy of the population, low financial income, now poisoning even with “elite” alcoholic beverages is not ruled out. That is why doctors recommend not to drink at all, and if you drink alcohol, then only high-quality and purchased at proven points.

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Intoxication with alcohol substitutes

Poisoning by alcohol surrogates ranks first among all intoxications with which victims go to medical institutions. This is a very dangerous phenomenon, which can not only provoke severe complications, but also lead to death. Alcohol surrogate poisoning - ICD code 10:

• T51.0 - ethyl alcohol;
• T51.1 - methyl alcohol;
• T51.2 - isopropyl alcohol;
• T51.3 - fusel oils;
• T51.8 - other alcohols;
• T51.9 - alcohol, unspecified.

Classification of surrogates

The toxicology of poisoning with alcohol and its surrogates distinguishes two types of substances: those produced on the basis of ethanol and those made with the use of impurities. The first group includes the following:

1. ethanol made using hydrolysis from wood;
2. denatured alcohol;
3. cosmetic lotions, cologne;
4. glue BF - the composition includes polyvinyl acetal, phenol-formaldehyde resin, dissolved in acetone, alcohol;
5. varnish - a mixture of ethanol with butyl, amyl, acetone;
6. nigrosine - stain containing ethanol, dyes. It is used for processing wood, coloring leather products in blue.



The second variety includes chemicals that do not contain ethanol. They are made using ethylene glycol, methyl alcohol with the addition of various impurities.

Symptoms

Symptoms of poisoning by various alcohol surrogates differ from each other. If you experience any signs of intoxication with a dangerous substitute for alcoholic beverages, you should immediately contact a medical institution for professional help. Otherwise, everything can end badly.

Surrogate with ethanol

Ethyl alcohol is a substance found in any alcoholic beverage. Ethanol poisoning is accompanied by the following symptoms:

• Gastrointestinal tract: pain in the abdomen, feeling of nausea, vomiting, stool disorder;
• CNS: strong excitability, feeling of euphoria, dilated pupils, auditory and visual hallucinations, incoherent speech (resembling the speech of a mute), loss of coordination of movements, increased sweating;
• cardiovascular system: weakness, redness or pallor of the skin on the face, rapid pulsation, reduced intravenous pressure;
• respiratory system: acute respiratory failure, shortness of breath;
• kidney: frequent urination, or its stop;
• liver: pain on the right side in the ribs, yellowness of the skin.

Severe poisoning with surrogates can cause a coma.

Ethyl alcohol, after penetration into the body, is absorbed into the walls of the gastrointestinal tract. With the flow of blood fluid, it quickly spreads throughout the body. At low doses of ethanol, the liver is able to cope with its processing. If ethyl alcohol was consumed in large quantities, the body ceases to perform its functions and poisoning occurs with dangerous alcohol surrogates.

methanol

The kidneys and central nervous system suffer the most from methyl alcohol. It has a psychotropic, neurotoxic effect. The following signs of intoxication with surrogate alcohol occur:

• feeling of nausea, vomiting;
• "dots" before the eyes;
• double vision;
• in acute situations - complete blindness;
• pupil dilation;
• no response to light.



After a couple of days, the clinical picture worsens. Arises pain syndrome throughout the body. There is dryness of the mucous membranes, skin. Functionality of the cardio organ is impaired, intravenous pressure is lowered. The temperature is very high. Seizures and coma may occur.

ethylene glycol

This substance is included in the components of brake fluids, antifreeze. With intoxication, acute liver failure, cerebral edema occurs. The following toxicological symptoms are observed:

• in the first 12 hours, only slight intoxication is observed;
• after that, nausea, vomiting, migraine, stool disorders begin;
• cyanosis of the skin, mucous membranes;
• high body temperature;
• violation of the heart rhythm;
• strong excitability;
• difficulty breathing;
• loss of feelings;
• convulsions;
• dark color of urine.



If the urgent necessary assistance is not provided in case of poisoning by alcohol substitutes, death will occur.

Moonshine

With moonshine intoxication, the following symptoms occur:

• feeling of nausea, vomiting, stool disorders;
• dizziness, up to loss of consciousness;
• increased body temperature;
• intense thirst, dry mouth;
• labored breathing;
• jumps in intravenous pressure;
• chills, increased sweating.

In severe cases, seizures may occur. The victim loses his sight. First, there are visual and auditory hallucinations. After that, the person may fall into a coma.

Diagnostic studies

Before prescribing adequate treatment, the specialist makes full examination the victim. First of all, he conducts a visual inspection. After that, he collects an anamnesis of the pathology: the stage of alcoholism, the substances used, the presence of concomitant diseases, and so on.

Additional diagnostic methods are also assigned. This is necessary to study the heart rhythm, the amount of a toxic element in the blood. Research is complicated by the fact that the poisoned most often end up in the clinic already in a coma. But modern medicine does not stand still, with the right first aid and modern hospitalization, the patient can be saved.



emergency measures

Timely first aid can save a person's life. Therefore, it is necessary not to get confused in an emergency and do everything right. First of all, call a team of medical workers, and then proceed to action:

1. Provide air supply to the victim. To do this, open all windows and vents. Remove the patient to fresh air if possible. Unbutton the collar, remove the tie, belt, corset.
2. Lay the victim on a horizontal surface on their side. Extend your lower arm forward. Control that the poisoned person does not choke on the outgoing liquid, does not choke on his own tongue.
3. If the patient is conscious, he needs to flush the gastrointestinal tract. To do this, let the poisoned person drink plenty of fluids. After that, provoke a gag reflex by pressing on the beginning of the tongue with your fingers or a spoon. Repeat the action until the escaping liquid becomes clear. The stomach is well washed with water-salt, slightly pink potassium permanganate solutions.
4. If the victim is unconscious, bring a cotton pad soaked in ammonia to his nose. Rubbing the earlobes, tickling the tip of the nose will also help to come to your senses.
5. After the release of vomit, the water-salt balance is disturbed. To bring it back to normal, it is necessary to give the patient sorbents. For example, Activated carbon.
6. If the patient has been poisoned by ethylene glycol or methyl alcohol, give the victim some vodka or other quality alcoholic drink to drink.
7. If the victim is cold, wrap him in a blanket.

When the heartbeat and breathing stop, it is necessary to perform an indirect massage of the cardiac organ and perform artificial ventilation of the lungs.

What Not to Do

In a pathological condition, it is forbidden to do the following:

• turn a person upside down;
• place the victim under a cold shower or bath;
• force the patient to be physically active;
• provoke vomiting if the poisoned person is in an insensible state;
• give any medicines, with the exception of sorbents;
• leave a person alone, unattended;
• refuse hospitalization in a hospital, even if the victim is better.

If this is not taken into account, the patient can be harmed.

Therapy

Therapeutic measures are carried out in stationary conditions, in the intensive care unit in the toxicology department. Treatment of acute poisoning with alcohol substitutes should be carried out under round-the-clock supervision of medical workers.

1. The hospital detoxifies the body with a special probe. Alcohol 5% is introduced. Diuretics are prescribed, the blood fluid is cleared.
2. In case of intoxication with ethylene glycol, calcium gluconate is prescribed. They use a solution of glucose with novocaine, vitamin complexes B and C. In case of poisoning with methyl alcohol, spinal punctures are performed.
3. After cleansing the body, a special diet must be followed. Nutrition should be light and balanced. There is a complete rejection of alcoholic beverages, even of good quality.



Effects

Alcohol dependence is a serious disease that must be treated without fail. Otherwise, regular intoxication with alcohol and its surrogates can lead to serious consequences, up to death:

• acute hepatitis;
• pancreatitis;
• cirrhosis of the liver;
• liver failure;
• the occurrence of thoughts of suicide;
• vascular-vegetative disorders;
• vision loss;
• hand tremor and other severe pathologies.

If you cannot get rid of alcoholism on your own, contact a drug treatment clinic for help. They will not only cleanse the body, but also help to cope with addiction on a psychological level.