Clinical Presentation and Diagnosis
Symptoms of acute intoxication develop rapidly and affect vital organ systems. Diagnosis relies on identifying a characteristic triad of symptoms indicating profound nervous system depression.
Key manifestations include:
- Comatose state — the patient does not respond to external stimuli.
- Slow, shallow breathing — a direct consequence of respiratory center depression.
- Bradycardia — a significant decrease in heart rate.
An essential diagnostic sign is marked miosis (pronounced pupillary constriction). However, a serious clinical trap exists here: if asphyxia (acute oxygen deprivation) develops against the background of inadequate ventilation, the pupils paradoxically dilate. This fact must be considered when examining critically ill patients.
Principles of Emergency Therapy
The management of acute poisoning is strictly guided by two main objectives. The success of resuscitation depends on how rapidly and concurrently these tasks are performed:
- Removal of the toxin from the body to prevent its further absorption.
- Restoration of vital functions, primarily adequate pulmonary ventilation, as respiratory arrest is the direct cause of death.
Detoxification: Toxin Elimination
To halt toxin entry into the bloodstream, the gastrointestinal tract must be thoroughly cleansed. The procedure includes two stages:
1. Gastric Lavage Performed using specialized solutions to neutralize the substance:
- Potassium permanganate solution (0.05% concentration) — reacts with the drug, causing its chemical oxidation.
- Suspended activated charcoal in warm water — ensures reliable adsorption of toxin molecules onto its surface.
2. Bowel Cleansing Immediately after gastric lavage is completed, a saline laxative is administered to the patient. This accelerates the evacuation of residual toxin from the intestines and prevents its delayed absorption.
Restoration of Respiration
Combating respiratory failure requires both pharmacological and mechanical interventions.
For specific therapy, the pharmacological antagonist naloxone is used. It acts as a direct opioid receptor blocker. Naloxone is administered intramuscularly or intravenously, allowing rapid displacement of the toxin from its receptors and reversal of respiratory center depression.
In cases of profound pulmonary depression where medical support is insufficient, immediate resuscitative measures are initiated — the patient is placed on mechanical ventilation (MV).