Etiology and Classification of Poisoning

Etiology and Predisposing Factors

The development of poisoning is closely related to social, psychological, and domestic conditions. Several key factors increase the risk of intoxication:

• Substance use disorders: alcoholism, drug addiction, and various forms of substance abuse.
• Psychoemotional stress: frequent stressful situations, dysfunctional family environments, and severe financial and domestic hardships.
• Severe living conditions: constant tension provokes the development of mental disorders and creates a need for psychotropic medications. Under such conditions, individuals are more likely to seek help from untrained practitioners and resort to clandestine abortions, which drastically increases the risk of severe toxic damage.
• Domestic negligence: improper storage of medications and aggressive chemical products at home. This factor is the absolute dominant cause of acute poisoning in the pediatric population.

Classification by Origin and Routes of Entry

For accurate diagnosis and treatment planning, intoxications are differentiated by several key criteria. Based on the cause and setting, intoxications are classified as accidental, intentional, suicidal, and criminal. A separate group includes medical errors and occupational intoxications.

Special attention is paid to domestic poisonings, which are most commonly associated with:

• attempts at self-medication;
• accidental or intentional drug overdose;
• severe alcohol and drug intoxications;
• carbon monoxide inhalation.

According to the route of entry into the body, the following forms are distinguished:

1. Oral (per os) — ingestion of poison, most typical for domestic settings.
2. Inhalation — breathing in toxic gases or vapors.
3. Percutaneous (per cutis) — penetration through the skin, including venomous snake, animal, and insect bites.
4. Injection — introduction of a toxin directly into tissues or the bloodstream.
5. Cavitary — entry of a toxic substance into the rectum, vagina, or external auditory canal.

Classification by Clinical Course and Severity

Depending on the rate of development of the pathological process and the frequency of toxic exposure, poisonings are divided into three types:

• Acute. Occur upon a single entry of poison into the body. They are characterized by a sudden, sharp onset and prominent, specific clinical symptoms.
• Subacute. Like acute poisonings, they usually develop after a single exposure to a toxin, but the pathological process forms and manifests more slowly.
• Chronic. Form as a result of prolonged or intermittent (regular) exposure to subtoxic (small) doses of a poison that gradually exhaust compensatory mechanisms.

By the severity of clinical manifestations, intoxications are traditionally categorized as mild, moderate, severe, and extremely severe.

Main Stages of Poisoning

In the clinical course of acute poisonings, two sequential stages are clearly distinguishable, each with its own pathophysiological features.

1. Toxigenic Stage This is the initial phase characterized by the direct toxic effect of the substance on organs and tissues. During this period, specific clinical manifestations proper to the particular poison predominate.

2. Somatogenic Stage This stage occurs after the elimination, destruction, or sequestration of the poison. Signs of activated adaptive reactions of the body come to the forefront, aimed at restoring disrupted homeostasis. Key manifestations of this stage include:

• pronounced stress response;
• centralization of blood circulation (redistribution of blood to protect vital organs);
• hemostatic system response (changes in blood clotting).