A case of a favorable outcome of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree, complicated by the development of acute respiratory failure and exotoxic shock (clinical observation)

Introduction. The article considers a case of a favorable outcome of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree, complicated by the development of acute respiratory failure and exotoxic shock.

Clinical observation. An episode of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree (baclofen, (4-amino-3-(4-chlorophenyl) is presented-butyric acid — ethylglucuronide >2000 mg/ml), methadone 83 mg/ml, methylenedioxypyrovaleron 57 ng/ml, complicated by the development of exotoxic shock in a 32-year-old patient. The clinical picture of acute poisoning was manifested by depression of consciousness to the level of coma II, acute respiratory failure, mixed respiratory and metabolic acidosis (pH 7.18; partial pressure of carbon dioxide 64.0 mmHg, lactic acidosis up to 5 mmol/l), swelling of the brain, exotoxic shock (BP — 60/20 mmHg, heart rate — 110 beats per minute).

Intensive therapy included: respiratory, infusion, detoxification, anticoagulation, antibacterial therapy, correction of acid-base state disorders, water-electrolyte balance, nutritional support, normalization of metabolic disorders through the use of a substrate antihypoxant. The calculation of the required amount of sodium bicarbonate was carried out according to the Mellengaard-Astrup formula: the amount of mmol of sodium bicarbonate is equal to the product of VE • body weight in kg • 0.3. According to the calculation, the amount of required bicarbonate was 195 mmol, that is, in terms of 5% bicarbonate solution — 195 ml.

Conclusion. As a result of basic resuscitation care in the form of artificial lung ventilation, correction of mixed respiratory and metabolic acidosis by using sodium bicarbonate, infusion therapy to correct hypovolemia, ensuring optimal perfusion of organs and tissues, elimination of key links of hypoxia by using cytoflavin, improvement of rheological properties of blood and symptomatic therapy allowed for a favorable outcome of severe poisoning with a mixture of narcotic and psychoactive substances complicated by the development of exotoxic shock.

Compliance with ethical standards. The study was approved by the Local Ethics Committee of the I.I. Janelidze St. Petersburg Research Institute of SP Protocol No. 1 of 12.02.2022.

Author contribution:
Narzikulov R.A. — concept and design of the study, collection and processing of material, writing of the text;
Lodyagin A.N. — concept and design of the study, editing;
Sinenchenko A.G., Batotsyrenov Ch.B. — collection and processing of material;
Lisitsyna I.A., Zapadnikov N.D., Rustamov B.R. — writing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Conflict of interest. The authors declare that there are no conflicts of interest.

Financing. The study had no sponsorship.

Received: January 23, 2023 / Accepted: May 26, 2023 / Published: June 30, 2023