Poisoning with drugs microbial 10. X31 Exposure to excessively low natural temperature. X69 Intentional self-poisoning by and exposure to other and unspecified chemicals and poisons

Frequency. In recent years, especially in Russia, there has been a constant increase in the number of household poisonings. In addition, criminal acute poisonings are more often recorded. Acute poisoning - 200-300 people (3-5% of all patients) per 100,000 population per year (for comparison, MI - 70-80 per 100,000). Every fifth patient with poisoning ends up in a hospital in critical condition. Accidental poisonings account for about 80%, suicidal - 18%, professional - 2% of poisonings. Currently, about 120 non-fatal and 13 fatal suicidal poisonings per 100,000 inhabitants per year are recorded worldwide. Mental illness is the cause of 10-15 % suicidal poisoning. The predominant age.. 13-35 years.. In Western Europe and the United States, about 50% of poisonings occur in children (in Russia - no more than 8%). The main reason is the reception of drugs. Predominant sex.. Suicidal poisoning - female.. Random household poisoning(especially alcohol and drug intoxication) - male.
Etiology. There are over 500 toxic substances that cause the largest number of acute poisonings.
Risk factors. Alcoholism, substance abuse, drug addiction. Frequent stress, unfavorable family environment, material and domestic problems. The tension of modern living conditions, causing in some people the need for a constant intake of sedatives. Mental illness. Poorly controlled sale of drugs, uncivilized advertising. Self-treatment, turning to all sorts of healers, charlatans, out-of-hospital termination of pregnancy. Occupational hazards (chronic poisoning). Improper storage of drugs and chemicals at home (more often leads to poisoning in children).

Classifications of poisoning
. Depending on the cause and place of occurrence .. Accidental ... Industrial ... Household: self-medication, drug overdose, alcohol and drug intoxication, carbon monoxide, mushroom poisoning (pale toadstool, fly agaric, etc.), bites of reptiles, insects .. Medical errors. Deliberate... Criminal... Suicidal.
. Poisoning can be single, group (often family), multiple, mass (BOV, industrial poisoning).
. Depending on the way the poison enters the body.

According to the clinical picture .. Acute poisoning occurs with a single intake of poison into the body and is characterized by an abrupt onset and pronounced specific symptoms .. Chronic poisoning develop with prolonged, often intermittent intake of poisons in subtoxic doses. Subacute poisoning (with a single injection of poison into the body, the clinical development of poisoning is slowed down) is rarely observed.
. Depending on severity.. Light.. Moderate.. Heavy.. Extremely heavy.

Causes

Pathogenesis- acute poisoning can be considered as a chemical injury that occurs upon contact or ingestion toxic dose chemical substance.
. Clinical stages acute poisoning .. Toxicogenic (early - from 1 hour to 2-3 days) - a specific effect on the body of a toxic substance (impaired function of membranes, proteins and other toxicity receptors) .. Somatogenic - adaptive reactions of the body aimed at eliminating homeostasis disorders (pituitary - adrenal reaction, lysosomal reaction, centralization of blood circulation, reaction of the blood coagulation system); trace lesions various bodies arising after the removal or destruction of the toxic agent.

Toxicological classification of poisons .. Neurotoxic effect (violation mental activity, toxic coma, suffocation, convulsions and paralysis) - drugs (cocaine, opium, lysergic acid diethylamide), sleeping pills, alcohol and its surrogates, carbon monoxide, FOS (chlorophos, karbofos), nicotine; anabasin, BOV (vi-X, bi-zet, sarin), isoniazid derivatives. Pulmonotoxic effect (toxic pulmonary edema) - nitrogen oxides, BOV (phosgene, diphosgene) .. Hepatotoxic effect (toxic hepatopathy) - chlorinated hydrocarbons (dichloroethane), poisonous mushrooms (pallid toadstool), phenols, aldehydes ) - salts of heavy metals, ethylene glycol, oxalic acid. ) .. Skin - resorptive action (local inflammatory and necrotic changes in combination with general toxic effects) - dichloroethane, hexachloran, BOV (mustard gas, lewisite), acids and alkalis, arsenic and its compounds, mercury (sublimate) .. Tear and irritant effect (irritation of external mucous membranes) - chloropicrin, BOV (si - es), a pair of concentrated acids and alkalis.

Clinical diagnostics It is aimed at identifying symptoms specific to a substance or a group of substances of effects on the body. Timely recognition of acute poisoning is often very difficult: the doctor usually cannot use auxiliary research methods or consultations (lack of time due to the need to provide urgent medical care), the ambiguity of the causative factor, the complexity of the situation (especially in case of criminal poisoning), the unwillingness of the patient or those around him to provide necessary data (for example, in case of drug addiction, substance abuse).
. In most cases, with a careful study of clinical symptoms, anamnesis (among accompanying persons, relatives, the victim), it is possible to approximately establish the type of toxic substance that caused poisoning (alcohol, hypnotics, cauterizing liquids, etc.).

At the scene, it is necessary to find out the cause of poisoning, the type of toxic substance, the route of entry into the body (drug sets, empty or whole vials, bottles, ampoules, syringes, characteristic odor), the time of poisoning, the concentration of the toxic substance in the solution, its amount. This and other information (concomitant alcohol consumption, whether there was vomiting, etc.) can be decisive not only in determining the diagnosis, but also in prescribing medical measures.
. The value of anamnestic data should not be overestimated, especially in suicidal poisoning.
. Medicines, other chemicals, food leftovers found at the scene of the incident should be sent along with the patient to the place of his hospitalization.

Leading symptom complexes of acute poisoning
. The smell emanating from the patient and his secretions, in many cases allows you to verify the type of poisoning: .. Alcoholic - poisoning with alcohol (ethanol, methanol) .. Ammonia - poisoning with aqueous ammonia, uremia .. "Disinfection" - poisoning with phenol and carbolic acid compounds .. Rotten radish - poisoning selenium anhydride (selenium dioxide) and other derivatives of selenium. Bitter almonds - poisoning with hydrocyanic acid and cyanides; nitrocyclohexane .. Pear - poisoning with chloral hydrate .. Decayed apples - poisoning with acetone, solvents for varnishes and paints; hyperglycemic coma, ketoacidosis .. The smell of freshness with an ozone tint - potassium permanganate poisoning .. Kerosene - chlorine - poisoning with organochlorine compounds .. Horse sweat - saturation of the body with penicillin and its derivatives .. Unpleasant specific, with a metallic taste in the mouth and salivation - mercury poisoning oxide .. Stale fish, raw liver - liver failure, hepatic coma.. Acute irritant - paraldehyde poisoning .. Burnt meat - pneumonia caused by Klebsiella .. Sharp menthol - poisoning with menovazine, menthol alcohol .. Shoe paint - nitrobenzene poisoning .. Turpentine ("resinous smell") - poisoning with turpentine, turpentine-containing polishes and solvents .. Sweet - liquor - poisoning with dichloroethane .. Alcohol - fusel - poisoning with antifreeze .. Alcohol - sweet - poisoning with brake fluid (ethylene glycol) .. Rotten eggs (from the mouth and from feces) - poisoning with carbon disulfide, hydrogen sulfide, mercaptans; putrefactive dyspepsia .. Vinegar - poisoning with vinegar, acetaldehyde .. Violet (from urine) - turpentine poisoning .. Chlorine (acute, "prickly" smell) - poisoning hydrochloric acid.. Garlic - poisoning with phosphorus, arsenic, tellurium and their compounds (to differentiate from the smell of eaten garlic) .. Ether - poisoning with ether, ethylene oxide, ethylene chlorohydrin.
. Leather.. Hyperemia, hyperthermia of the skin - poisoning with atropine, belladonna; sometimes - with botulism .. Traces of multiple injections, small hematomas (especially in the area of ​​\u200b\u200bthe elbow or on the hips) - suspicion of drug addiction, morphinism (however, they also occur in patients with diabetes, bronchial asthma, etc.) .. Bullous detachment of the skin occurs when severe poisoning with trichlorethylene, hexachlorobenzene, barbiturates .. Increased sweating - poisoning with FOS, salicylates, muscarine-like substances, mushrooms .. Skin color in case of poisoning: iodine - pale; boric acid, carbon monoxide - bright red; picric acid, quinacrine, nitric acid - yellow; silver salts - bluish - black; bromides - brown; aniline, cyanides, nitrates, iodine carbonate - cyanotic.
. Eye symptoms .. Pupil constriction (miosis) - poisoning with opiates, FOS, drugs containing physostigmine, pilocarpine, ipecac, chloral hydrate, etc. .. Pupil dilation (mydriasis) - poisoning with atropine, cocaine, ether, chloroform, antihistamines, papaverine hydrochloride, etc. ... Nystagmus is a characteristic sign of severe poisoning with barbiturates, ethanol, carbon monoxide, glycols.. FOS poisoning is accompanied by lacrimation.. In case of methanol poisoning, hyperemia of the optic disc often develops. Conjunctivitis is typical for marijuana poisoning.
. Oral cavity and tongue.. Abundant salivation - poisoning with FOS, strychnine, salicylates, salts of thallium, arsenic, mercury, mushrooms, nicotine .. Dry mucous membranes - poisoning with atropine, ephedrine, dope, opiates .. Poisoning with caustic substances - inflammatory changes in the mucous membrane .. In case of poisoning salts of mercury, lead, bismuth and arsenic, the periodontal areas of the gums acquire a gray tint.
. Gastrointestinal tract. Most poisonings (not only oral ones) are characterized by the appearance of nausea, vomiting, impaired bowel function (diarrhea or constipation). salts of arsenic, heavy metals (iron, copper).. Constipation - in case of poisoning with opiates, lead salts. characteristic tension of the anterior abdominal wall, pain on palpation, violent intestinal motility .. Feces acquire a blue-green hue when poisoned with boric acid.

. Respiratory system. In acute poisoning, it develops rapidly respiratory failure, caused by hypoxia and hypoxemia, inhibition of the function of the respiratory center, impaired function of the respiratory muscles, aspiration-obstructive processes in the respiratory tract. KShchr changes (in most cases - towards acidosis) .. Slow breathing - poisoning with opiates, alcohol and its surrogates, tranquilizers, antihistamines .. Rapid breathing - poisoning with carbon monoxide, acetylsalicylic acid, gasoline, etc. .. Toxic pulmonary edema occurs in case of poisoning with gases (chlorine, phosgene, nitrogases, etc.), FOS, barbiturates, heroin, etc.

. CCC. Syndromes of toxic damage to the heart and blood vessels are initially expressed by the development of primary toxic shock (with impaired blood clotting and toxic coagulopathy). Then comes the secondary somatogenic collapse. Acute toxic myocardial dystrophy develops .. Tachycardia - poisoning with alcohol, atropine, acetylsalicylic acid, ephedrine, theophylline, etc. sympathomimetics.
. Liver damage. The most aggressive effect on the liver is chlorinated hydrocarbons (dichloroethane, carbon tetrachloride), organochlorine pesticides, carbolic acid, phosphorus, toadstool poison, vinegar essence, FOS. The hepatic coma quickly develops, in parallel, the hemorrhagic syndrome grows.
. Kidney damage. The most aggressive nephrotoxins are ethylene glycol, salts of mercury, chromium, lead, oxalic acid, potassium dichromate (chrompeak), arsenic compounds, dichloroethane. The victims quickly develop toxic nephropathy with acute renal failure. Stage I acute renal failure - symptoms of poisoning predominate; renal dysfunction may not appear immediately, but after 2-4 days; main criterion AKI - diuresis and urine density .. Stage II AKI - oliguria, anuria, hyperkalemia, hyperazotemia, metabolic acidosis, increased creatinine in the blood and urine .. In most cases, there is a combined damage to the kidneys and liver (toxic hepatopathy with toxic nephropathy).
. Psychoneurological disorders. Acute poisoning is usually accompanied by a syndrome of mental, neurological and somato-vegetative changes. Disorders of coordination of movements (ataxia) - poisoning with ethanol, barbiturates, atropine, nicotine, hallucinogens. Coma - poisoning with hypnotics, tranquilizers, antihistamines, narcotic and sedatives; coma can be the result of severe poisoning with acids, paraldehyde, methanol, ethylene glycol, salts of heavy metals, FOS. convulsive twitches of individual muscle groups are characteristic of poisoning with nicotine, lithium salts, strychnine, camphor, FOS, cholinergic drugs. , boric acid, salicylates .. Personality changes - poisoning with hallucinogens (especially LSD), ethanol, barbiturates, antihistamines.

Diagnostics

Laboratory research. Specific toxicological studies for the emergency detection of toxic substances in the biological media of the body (blood, urine, cerebrospinal fluid) .. Isolation of toxic substances from biological material ... Extraction of poisons with organic solvents (barbiturates, alkaloids, FOS) ... Distillation (alcohols, organic solvents etc.) ... Mineralization (metals) ... Destruction (heavy metals, etc.) .. Gas-liquid chromatography.. Thin-layer chromatography.. Spectrophotometry. Specific studies in order to determine the characteristic changes in the biochemical composition of the blood (for example, methemoglobinemia in case of poisoning with aniline and nitrites, a decrease in the activity of blood cholinesterases in case of FOS poisoning). Non-specific biochemical studies for the diagnosis of toxic damage to the functions of the liver, kidneys and other systems (for example, the determination of blood levels of bilirubin, creatinine, urea, residual nitrogen, etc.).

Special Studies. EEG ( differential diagnosis poisoning with psycho- and neurotropic toxic substances, especially in victims who are in a coma, as well as to determine the severity and prognosis of poisoning). ECG (assessment of the nature and degree of toxic damage to the heart, diagnosis of rhythm and conduction disorders). Oxygenometry and spirography. Fibrobronchoscopy (emergency diagnosis and treatment of chemical burns of the upper respiratory tract) . Emergency FEGDS (assessment of the degree and type of chemical burn of the esophagus and stomach). In the emergency diagnosis of toxic damage to the liver and kidneys, radioisotope methods are essential.

Treatment

TREATMENT
Acute poisoning is characterized by sudden development of clinical symptoms and syndromes. The adaptive mechanisms of the patient's defenses do not have time to mobilize, so it is impossible to delay in providing assistance!
Tactics of conducting- all victims with clinical signs of acute poisoning are subject to urgent hospitalization in specialized toxicological centers. Accelerating the removal of toxic substances from the body (active detoxification). Specific (antidote) therapy. Symptomatic therapy.

Active detoxification of the body
. Prevention of absorption of the poison. Emetics (apomorphine, tincture of ipecac) or induction of vomiting by irritation of the posterior pharyngeal wall. Contraindications ... Early childhood (up to 5 years) ... Poisoning with cauterizing poisons ( replay acid or alkali in the esophagus can aggravate the burn) ... Soporous or unconscious state .. Gastric lavage through a tube is especially important at the pre-hospital stage. For gastric lavage, 10-30 liters of water at room temperature are used in portions of 300-500 ml. The first portions of the contents of the stomach are kept for examination. In case of severe poisoning (especially with narcotic poisons and FOS) - repeated gastric lavages every 4-6 hours (because it is possible that the poison may re-enter the stomach from the intestine as a result of reverse peristalsis and reflux of bile containing a number of non-metabolized substances into the stomach); the procedure is completed in the absence of toxins in the wash water. You can add to the water: activated carbon; egg whites (from three eggs per 2 liters of water); magnesium oxide (burnt magnesia -20 g per 1 liter of water); antidote (if the poison is known); enterosorbents (enterosorb, polyphepam.). In coma, the stomach should be washed after tracheal intubation, which completely prevents aspiration of vomit ... Indications ... Acute oral poisoning with any toxic substance (in case of severe poisoning with highly toxic compounds such as chlorinated hydrocarbons or FOS there is practically no emergency gastric lavage) ... A short period of time (no more than a day) from the moment of taking the poison (barbiturates, amitriptyline, FOS are found in the contents of the stomach 12 hours or more after their ingestion, dichloroethane - up to 9 hours, acetic acid - up to 12 o'clock) ... Relative contraindications... Convulsions or convulsive readiness ... Poisoning by acids, alkalis or other caustic substances (currently it is believed that the danger of introducing a probe in these cases is exaggerated, on the contrary, the use of this method at the prehospital stage can reduce the prevalence of chemical burns and reduce mortality) ... Soporous or unconscious state when tracheal intubation is impossible (gastric lavage should be postponed until the hospital) ... Patient resistance ... Complications ... Insertion of a probe into the trachea with damage to the vocal cords; in case of untimely diagnosis - the introduction of a lavage fluid into the lung (acute respiratory failure, death) ... Aspiration of lavage water and stomach contents ... Tears in the mucous membrane of the pharynx, esophagus, stomach ... Injury of the tongue, complicated by bleeding and aspiration of blood ... Damage to teeth when using a mouth expander ... Prevention of complications ... The probe should be lubricated with vaseline oil; the size of the probe should correspond to the physical data of the patient ... Toilet of the oral cavity ... With an increased pharyngeal reflex - the introduction of atropine ... In patients in an unconscious state, obligatory intubation of the trachea with a tube with an inflatable cuff ... It is necessary to make sure that the probe is in the stomach cavity (when it enters the trachea - a pronounced cough, air flow during breathing) ... Complete removal the last portion of the lavage, which is achieved by inserting the probe at different depths and moderate pressure on the epigastric region (aspiration of the lavage is possible when leaving the coma, when the endotracheal tube is removed after the restoration of reflexes) .. Adsorption of the toxic substance and removal of the toxic substance from the intestine .. Adsorbents (for example, activated charcoal, carbolene) are administered immediately after gastric lavage and at a later date (with secondary excretion of the substance into the intestine) at a dose exceeding the expected amount of toxic substance by 5-10 times (usually 20-30 g) .. Laxatives (sodium or magnesium sulfate, p - p sorbitol with activated charcoal; in case of poisoning with dichloroethane, carbon tetrachloride, chloroform, instead of a saline laxative, 100 ml of vaseline oil is administered through a probe) is used for poisoning with a substance that is slowly absorbed in the intestines, ineffectiveness or untimely washing stomach. Laxatives have no independent significance for accelerated detoxification of the body ... Cleansing enema (the use is debatable: it is possible to increase the absorption of toxins; a high risk of developing hyperosmolar coma; ineffective in the first hours after poisoning) ... Pharmacological (10-15 ml 4% r - ra potassium chloride at 40% r - re glucose i / v and 2 ml pituitrin i / m) and electrical stimulation of the intestine (using a special apparatus) ... Direct probing of the intestine and the introduction of special solutions (intestinal lavage) .. With inhalation In case of poisoning, the victim should be taken out to clean air, the airways should be open, and oxygen should be inhaled. Treatment is prescribed depending on the type of substance that caused the poisoning. If toxic substances come into contact with the skin, washing skin running water.. When toxic substances are introduced into the cavity (into the rectum, vagina, bladder) should be washed with enemas, douching, etc.

Acceleration of the excretion of a toxic substance from the body.. Forced diuresis... Compensation for hypovolemia and water load: plasma-substituting solutions (polyglucin, hemodez), 5% glucose solution in a volume of 1-1.5 liters IV drip... The introduction of a diuretic: 30% r - r urea or 15% r - r mannitol in / in a stream at a dose of 1 g / kg; furosemide 80-200 mg IV ... Continued water load with rami electrolytes; the rate of administration of r - ra should correspond to the rate of diuresis (800-1200 ml / h) ... Sodium bicarbonate (4% r - r 500-1500 ml / day in / in drip) - in case of poisoning with chemicals with an acidic reaction r - ditch , barbiturates, salicylates, hemolytic poisons; 5% r - r ascorbic acid IV - in case of poisoning with phencyclidine, amphetamine and fenfluramine ... The method is contraindicated in cardio - vascular insufficiency, impaired renal function with oliguria, azotemia .. Plasmapheresis is performed using centrifuges or special separators. Usually, about 1.5 liters of plasma is removed, replacing it with saline solutions or fresh frozen plasma. poisons (clearance) is 5-6 times greater than the method of forced diuresis ...

Conditions for carrying out: sufficient concentration of the poisonous substance in the plasma; easily destructible connection of poison with protein; free passage of a poisonous substance through the dialysis membrane ... Contraindication - acute cardiovascular failure .. Peritoneal dialysis is used to remove toxic substances that can be deposited in fatty tissues or bind firmly to plasma proteins. Sterile dialysis fluid, heated to 37 ° C, in an amount of 2 liters is injected into the abdominal cavity through a sewn-in fistula and replaced every 30 minutes. The method can be applied in acute cardio - vascular insufficiency. Contraindications: pronounced adhesive process in abdominal cavity And late dates pregnancy .. Replacement of the recipient's blood with the donor's blood is indicated for acute poisoning with chemicals that cause the formation of methemoglobin, a long-term decrease in cholinesterase activity, and massive hemolysis. Contraindication - acute cardio - vascular insufficiency.

Specific (antidote) therapy is effective in the early phase of acute poisoning - from the first hours to 2-3 days (in case of poisoning with salts of heavy metals - up to 8-12 days); used subject to reliable diagnosis of the type of intoxication. The main mechanisms of action of antidotes. Inactivating effect on a toxic substance in the gastrointestinal tract (for example, the introduction of various sorbents into the stomach). Interaction with a toxic substance in the internal environment of the body (for example, sodium dimeracoptopropanesulfonate, tetacin - calcium, disodium salt of ethylenediaminetetraacetic acid, penicillamine for the formation of soluble compounds with metals and their excretion in the urine). Influence on the metabolism of toxic substances (for example, ethyl alcohol in case of poisoning methyl alcohol and ethylene glycol prevents the formation of toxic metabolites). Enzyme reactivation (for example, cholinesterase reactivators [trimedoxin bromide] for FOS poisoning). Antagonism (eg, atropine and acetylcholine, neostigmine methyl sulfate and pachycarpine). Reducing the toxic effect of animal toxins (antitoxic serums).

Symptomatic therapy, maintenance of vital important functions.
. Respiratory disorders .. The obstructive form occurs as a result of retraction of the tongue, aspiration of vomit, severe bronchorrhea and salivation. It is necessary to clean the oral cavity and pharynx, remove the tongue with a tongue holder and insert the air duct. With significant salivation and bronchorrhea - 1 ml of 0.1% r-ra atropine. Upper respiratory tract burns require immediate lower tracheostomy. central form develops against the background of a deep coma and is manifested by the absence or apparent insufficiency of independent respiratory movements. Ventilation required after endotracheal intubation. Pulmonary form occurs with the development of a pathological process in the lungs (toxic pulmonary edema, acute pneumonia, etc.). In severe poisoning with impaired respiratory function, early antibiotic therapy is indicated. In case of toxic pulmonary edema (vapors of ammonia, chlorine, concentrated acids, phosgene and nitrogen oxide poisoning), intravenous prednisolone 30-60 mg (repeated if necessary), 100-150 ml of 30% r-ra urea (or furosemide 80-100 mg), oxygen therapy is carried out. Early oxygen therapy and specific antidote therapy are needed.

CVS dysfunctions. / in drip until normalization of blood pressure and CVP (sometimes up to 10-15 l / day) ... Prednisolone in / in up to 500-800 mg / day ... In metabolic acidosis - 300-400 ml of 4% solution of sodium bicarbonate in / in drip ... In case of poisoning with cauterizing poisons - cupping pain syndrome(narcotic analgesics, neuroleptanalgesia) ... In case of poisoning with cardiotoxic poisons (quinine, pachycarpine, etc.), severe bradycardia, cardiac conduction disturbances are possible; injected in / in 1-2 ml of 0.1% r-ra atropine, 5-10 ml of 10% r-ra calcium chloride .. Degenerative changes in the myocardium (late complications of poisoning). Prescribe medications to improve metabolic processes myocardium (vitamins, cocarboxylase, triphosadenine, etc.).
. Psychoneurological disorders .. In psychosis - chlorpromazine, haloperidol, sodium oxybate, etc. .. With convulsive syndrome- restoration of airway patency, anticonvulsants (diazepam up to 40 mg intravenously or intramuscularly). IN severe cases- anesthesia with muscle relaxants .. With toxic cerebral edema - diuretics, antihypoxants, prednisolone .. With malignant hyperthermia - lytic mixtures (chlorpromazine, promethazine, NSAIDs), craniocerebral hypothermia, repeated lumbar punctures.
. Kidney damage (toxic nephropathy) occurs when poisoning with nephrotoxic poisons (antifreeze, sublimate, dichloroethane, etc.), hemolytic poisons (acetic acid, copper sulfate), prolonged toxic shock against the background of other poisonings .. Plasmapheresis and hemodialysis in early period acute poisoning with nephrotoxic poisons .. Alkalinization of plasma and urine with simultaneous forced diuresis (poisoning with hemolytic poisons) .. Hemodialysis - with hyperkalemia, high levels of urea in the blood (over 2 g / l).
. Liver damage (toxic hepatopathy) occurs with acute poisoning with hepatotoxic poisons (dichloroethane, carbon tetrachloride), some vegetable poisons and drugs (male fern, mushrooms, akrikhin) .. The most effective method of treatment is massive plasmapheresis (remove 1.5-2 liters of plasma) .. Hepatoprotectors (for example, ascorbic acid, thiamine, riboflavin, pyridoxine, acetylcysteine, essentiale) .. Hemosorption .. In severe cases - hemodialysis.

Course and forecast. They depend on the type, concentration and amount of the toxic substance, the route of its entry into the body, the timeliness and adequacy of the medical care provided. In general, mortality is high (acute poisonings account for about 30% of all cases of violent death, second only to mechanical damage in frequency).
Prevention. Informing the public about the main toxic substances, symptoms of poisoning, principles of providing emergency care. Drugs should be stored in places inaccessible to children, adolescents and people with unstable mentality. The complexity of packaging design strong drugs(in the US, it halved the number of poisonings among children).
Abbreviations. BOV - chemical warfare agents. FOS - organophosphorus agents

ICD-10. T36-T50 Poisoning with drugs, medicines and biological substances. T51-T65 Toxic effect of substances, predominantly non-medical

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

1. Rise in phosphate levels.
2. Synthesis of lactic acid.

1. Associated blood loss.

Symptoms and initial signs of intoxication

• night sweats;
• decrease in the level of red blood cells;

1. Regular examination by an oncologist.

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• Symptoms and initial signs cancer intoxication

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ICD-10: F11.0 - Acute intoxication

Chain in classification:

5 F11.0 Acute intoxication

Explanation of the disease with code F11.0 in the MBK-10 reference book:

A condition caused by the use of a psychoactive substance, manifested in disorders of consciousness, cognition, perception, emotions and behavior, or other psychophysiological functions and reactions. These disorders are directly related to acute pharmacological action substances and after a while completely disappear, except in cases where tissue damage and other complications occur. Complications may include trauma, aspiration of vomit, delirium, coma, and convulsions. The nature of complications depends on the pharmacological class of the substance and the method of its administration. Acute intoxication with alcoholism Bad trips (drug intoxication) Alcoholic intoxication NOS Pathological intoxication Disorders in the form of trance and obsession with intoxication caused by psychoactive substances

Cancer intoxication: is it possible to reduce pain and discomfort?

Cancer intoxication appears in those people whose cancer has already passed to the last stage. It is very important to prevent such a condition, but if it develops, proper treatment may reduce severe symptoms and make life easier for the patient.

concept

Oncological diseases without treatment or with its untimely onset always lead to the development of severe, irreversible changes in the body.

A fatal outcome in a person can occur due to the failure of one or more organs, but at the terminal stage of the pathology, another complication occurs, potentially life-threatening.

It is directly related to the ongoing cancer process, is a natural feature of the development oncological tumors. We are talking about cancer toxicity.

As in the case of other types of poisoning (poisons, heavy metals, etc.), this type of intoxication leads to multiple organ damage and severe weakening immune protection and the whole organism.

There is no special code according to the ICD for cancer intoxication: it is only a complex of symptoms inherent in a particular type of tumor, therefore it can vary in intensity, time of occurrence, duration, localization of cancer, age of a person.

The closer the neoplasm is to the vital organs, the more difficult the last stages of its development are, but the faster the death can occur.

Causes of pathology

As already noted, the immediate cause of this complication is the decay of a malignant tumor, as well as its metastases, which can cover literally the entire body.

Toxic decay products accumulate in the blood, lymph, tissues, and disrupt all natural metabolic processes.

The process of development of intoxication in oncopathologies is sequentially described below:

1. Education begins to uncontrollably and rapidly increase in size.
2. The blood supply to the tumor is disrupted, as the rate of new capillaries (neovascularization) lags behind the rate of growth of the malignant tumor itself.
3. Due to the lack of supply vessels, some of the cancer cells die.
4. Necrotic tissue breaks down, penetrating into the bloodstream.
5. All types of metabolism are disturbed.
6. First of all, the work of the kidneys changes, chronic renal failure occurs, which provokes a further aggravation of the dysfunction of the entire excretory system.
7. Intoxication increases, mineral metabolism is disturbed, which changes the activity of the nervous system and heart.
8. Further, severe types of anemia develop with the mass death of red blood cells.
9. Death can occur due to the failure of vital organs against the background of poisoning, or from blood poisoning and other septic complications.

Among other things, the causes of a person's serious condition may be due to chemotherapy, especially high-dose chemotherapy. Many drugs have a cumulative effect, which in one way or another provoke poisoning. But refusal of treatment is unlikely to give long-term relief, because the tumor will progress in growth.

Symptoms of cancer intoxication

The time of onset of clinical signs of cancer intoxication is individual in each case and depends on the type of disease, but, as a rule, this condition develops only in the presence of a large tumor.

The severity of all the symptoms listed below is highly dependent on the volume of toxins that have entered the human blood, as well as on the presence of infectious complications or bleeding.

Most often, patients with oncopathologies are characterized by such symptoms of intoxication from the decay of the tumor:

• Poor tolerance to any load
• A sharp drop in performance
• severe weakness
• Dyspeptic symptoms - nausea, vomiting, diarrhea, constipation
• Poor response to meat food
• Loss of appetite or cravings for previously unfamiliar foods
• Strong weight loss
• Paleness, yellowness of the skin, "bruises" under the eyes
• Dryness of the skin
• Nocturnal hyperhidrosis
• Subfebrile fever
• Frequent feverish conditions

From the side of the nervous system, the patient may be disturbed by:

• Vestibular disorders (dizziness)
• Headaches that are clearly localized or widespread
• Emotional instability
• depression
• Irritability
• Sleep disorders

During chemotherapy, the signs of poisoning of the body first increase, as the tumor cells die at an accelerated pace and enter the bloodstream. Also, severe intoxication is due to the side effects of the drugs themselves, because on many healthy tissues drugs are also destructive.

Diagnostics

Usually, the state of serious poisoning of the body does not become news to the patient: by this stage, the diagnosis is almost always already made.

But in some clinical cases when intoxication from oncology begins early (for example, with an aggressively growing tumor), it is possible to carry out a primary diagnosis already at the 3-4 stage of the disease.

To make a diagnosis, many modern methods are used - laboratory, instrumental.

To determine the underlying pathology and select the necessary treatment methods, CT or MRI, biopsy of the tumor or the area of ​​metastases, PET, and scintigraphy may be of decisive importance.

Some types of tumors are easily detected by ultrasound, but an accurate conclusion can only be given after receiving the results of a histological examination.

As for the diagnosis of cancer intoxication, it is mainly carried out by conducting a series of blood and urine tests.

Since toxins change the ongoing biochemical processes, many analyzes will have serious deviations (for example, a decrease in erythrocytes and hemoglobin, serum iron, an increase in the amount of uric acid, C-reactive protein, leukocytes, ESR, etc.).

How to remove cancer intoxication?

First of all, the patient needs pathogenetic treatment, which will be aimed at eliminating the tumor, therefore, at stopping its decay. Performed whenever possible surgical removal neoplasms or metastases, in the absence of such, chemotherapy, radiation treatment gives positive results.

The therapy of intoxication itself is symptomatic and therapeutic, and it has the following goals:

1. Removal of toxins from the body.
2. Correction of metabolic disorders.
3. Reducing the intensity of symptoms that occur during chemotherapy.

A good effect is given by extracorporeal methods of treatment - hemosorption, plasmapheresis, which can quickly purify the blood and reduce intoxication. In renal failure, hemodialysis is used.

Among the medicines, there are those that have a beneficial effect on the human condition and work purposefully against unpleasant symptoms:

1. Antiemetics.
2. Laxative or strengthening drugs, enemas.
3. Enterosorbents.
4. iron preparations.
5. Complexes of vitamins, minerals.
6. Analgesics, non-steroidal anti-inflammatory drugs.
7. Sedatives, antidepressants, tranquilizers, antipsychotics.

With cancer intoxication, it is important to eat fully, but not to consume heavy, fatty, junk food. Diet - dairy and vegetable with the addition of lean meat, fish, enrichment of the menu with protein shakes is often used. Special functional nutrition for cancer patients is also used.

Some people successfully use folk remedies against their severe problem - an infusion of flax seeds, pine needles, enemas with chamomile infusion, with soda.

Forecast and prevention

Of course, the prognosis for a severe or terminal stage of oncopathology cannot be favorable. If intoxication is already taking place, then the process is too running, the consequences will be serious.

However, even in the last stages of many cancers, a person's life can be extended by several months or years, so treatment should be done in any case, without succumbing to a passive mood and depression.

To prevent cancer intoxication, it is necessary to prevent the transition of the disease to this stage. To do this, it is important to correct all emerging violations, regularly undergo medical examinations and other planned examinations, eat well, engage in feasible sports, and stop smoking.

Intoxication

ICD-10 code

Related diseases

Intoxication by source ‘Diseases and Syndromes’

Titles

Description

* Unlike the word poisoning, the word intoxication in Russian has a narrower, professional meaning, and describes the phenomenon itself, but not external influences (compare: "Rasputin's poisoning").

Symptoms

* The first period is the period of generalized reaction. It has various course options: toxicosis with encephalic syndrome, toxic encephalopathy neurotoxicosis, intestinal toxicosis, toxicosis with dehydration (toxicosis with intestinal syndrome), Kishsh toxicosis (hypermotile toxicosis), fulminant form of toxicosis, Waterhouse-Frideriksen syndrome (toxicosis with acute adrenal insufficiency).

* The second period - the period of localization of the pathological process can be characterized by the following options - Reye's syndrome (toxicosis with liver failure), Gasser's syndrome, Hemolytic-Uremic syndrome (toxicosis with acute renal failure) and toxicoseptic condition.

In children, risk factors for toxicosis are birth trauma or the presence of congenital and hereditary diseases of the central nervous system, metabolic disorders, previous vaccinations, previous infections.

During a generalized reaction, neurological disorders dominate in the picture of toxicosis, the state of "unnatural" sleep alternates with periods of excitement. With the development of a coma, a complete loss of consciousness may occur.

The cardiovascular system will be dominated by peripheral blood flow disorders, "marbling" of the skin, tachycardia, loud, clapping heart sounds, decreased blood pressure, diuresis. Dysfunctions of the gastrointestinal tract in toxicosis are manifested by vomiting, diarrhea, intestinal paresis, anorexia.

Damage to the liver and kidneys with toxicosis is characteristic and constant. Indispensable components of the clinical picture of toxicosis are the pathology of water-electrolyte metabolism deviations in the acid-base state. Hemorrhagic syndrome expressed in varying degrees: from single petechiae on the skin and mucous membranes to profuse bleeding indicating disseminated intravascular coagulation.

Causes

Treatment

The complex of methods for the treatment of poisoning includes the following:

* First aid, resuscitation, if possible - immediate removal of poison from the body, accurate identification of the cause of poisoning, the introduction of specific antidotes;

Cancer intoxication: what to do and how to alleviate?

Cancer intoxication is the process of poisoning the body of a cancer patient with decay products malignant neoplasm. This set of symptoms occurs in late stages oncological disease. Tumor intoxication is considered a natural state of cancer development or the result of active anticancer therapy.

Why does cancer intoxication occur in the body?

A malignant neoplasm is characterized by rapid infiltration growth, which requires an increased amount of proteins, fats and saccharides. An increase in tumor volume and an insufficient number of blood vessels in the tumor provoke the development of hypoxia in mutated tissues. Oxygen deficiency, in turn, leads to local death pathological cells. Such substances, entering the circulatory system, have a toxic effect on the entire body.

With cancer, the process of intoxication can also be triggered as a result of chemotherapy. Such a pathological condition is observed in the first days after the start of oncological drugs.

Cancer intoxication is the cause of death in the later stages of such a lesion. In such cases, doctors state that the cancer patient has an extreme degree of cachexia (progressive weight loss).

Cancer intoxication of KSD: pathogenesis of the syndrome

During malignant decay, the following processes occur in the circulatory system of a cancer patient:

1. Ascending percentage uric acid.
2. Increase in the amount of potassium ions.
3. Rise in phosphate levels.
4. Synthesis of lactic acid.
5. Decreased calcium concentration.

These substances penetrate into the blood from dead tissues. cancerous tumor. Urea crystals deposited in renal tubules, provoke acute kidney failure. This process is complicated by progressive dehydration of the body. An excessive amount of phosphates lowers the level of calcium ions, which, in turn, is manifested by overexcitation of the central nervous system. Potassium in an increased concentration negatively affects the functioning of the heart muscles, which is diagnosed as an arrhythmia.

According to international classification diseases (MCB), the severity of the course of malignant intoxication contribute to:

1. General somatic condition of a cancer patient.
2. Activity destructive processes in a malignant neoplasm.
3. Traumatic surgical interventions.
4. Features of the clinical picture.
5. Associated blood loss.
6. Chronic inflammatory processes.

Symptoms and initial signs of cancer intoxication

The manifestations of oncological intoxication are varied. It is this fact that complicates the timely diagnosis of such a pathological condition. The main signs of an intoxication symptom include:

• progressive general malaise;
• frequent and causeless fatigue;
• violations nerve functions in the form of apathy, mental overexcitability, depressive states, etc.;
• on the part of the skin, one can observe cyanosis, sharp pallor, spots on the body with cancer;
• dryness (both epithelium and mucous membranes);
• night sweats;
• rapid loss of body weight;
• dyspeptic pathologies: nausea, vomiting, constipation or diarrhea;
• chronic subfebrile body temperature;
• periodic migraines, which are accompanied by bouts of dizziness;
• regular viral and bacterial diseases;
• decrease in the level of red blood cells;
• cardiac arrhythmias and vascular thrombosis.

How to treat tumor intoxication?

For all cancer patients, doctors, first of all, recommend strictly following a diet that includes foods with a sufficient content of minerals and vitamins. Also, the daily diet of cancer patients should be regulated by protein, fat and carbohydrate parts. The principle of nutrition, in this case, corresponds to the fractional principle, when the patient eats often, but in small portions.

Maintaining water balance is one of the fundamental recommendations. A sufficient amount of water consumed daily helps to improve the metabolic process in the body and the speedy removal of toxic products.

Also during this period, the cancer patient needs to carry out adequate physical activity. The patient can consult with a physiotherapist in this regard.

Drug therapy of cancer intoxication is palliative in nature and includes the use of the following drugs:

1. Antiemetics in tablet or injectable form.
2. For constipation, as a rule, experts recommend laxatives in the form of tablets or suppositories. In case of ineffectiveness of such therapy, patients are shown intestinal enemas, which mechanically cleanse the gastrointestinal tract from tumor decay products.
3. Sorbents. During the period of intoxication, it is simply necessary to use means for binding and removing toxic substances.
4. iron injections. The indication for this therapy is progressive anemia.
5. Analgesic drugs, which, in addition to stopping pain attacks, reduce the hyperthermia of a cancer patient.
6. Means for regulating the heart rhythm are prescribed by an oncologist after consultation with a cardiologist.
7. Sedation is achieved with the help of sedative pharmacological drugs.

Cancer intoxication mkb 10: prevention

Timely detection of intoxication syndrome is achieved by the following methods:

1. Regular examination by an oncologist.
2. Dynamic monitoring of the biochemical content of the circulatory system.
3. Control of the functioning of the heart and kidneys.

Very often, cancer intoxication ends with the development of acute renal or heart failure. This is fraught with a fatal outcome for a cancer patient. Maintain maximum patient life expectancy terminal stages oncology is possible provided that this dangerous condition is detected in a timely manner.

It is important to know:

comments 5

Oncologists came to my mother regularly (polyclinic 8 in Moscow. They prescribed tamoxifen. But no one warned of possible intoxication. Even when cachexia began, they did not provide any help. They did not prescribe any sorbents. They did not advise any drugs. They themselves began to look for medicines and advice in Internet, but it was already very late.

Nobody helped my mom either. In addition to tramal and sleeping pills, they did not recommend anything. Cruel people. It is very important to maintain the quality of life no matter how much a person has left. Why do people go into this profession? They take places in institutions. Without love. And compassion for people there is nothing to do. What you and I went through, you wouldn't wish on your enemy. A long and painful death. I don't know when I'll be fine.

Lyudmila, I offer my condolences!

I am a general practitioner. My name is also Ludmila. I know perfectly well what pain is and how hard it is from hopelessness. My mother-in-law died 32 years ago (lung cancer), 11 months ago my father died (stomach cancer with metastases to many organs). I also tried my best to help my family.

Indeed, there is no possibility, precisely the possibility of medicine, to fully alleviate the suffering of cancer patients, except for the prescription of painkillers.

Of course, it would be nice if cancer patients in the last stage of the disease received treatment and were observed in hospices for such patients. But they simply do not exist in such numbers. In my work activity I have little opportunity to carry out infusion therapy with drugs that support electrolyte balance and detoxification agents (I work in the village). This year, 3 such patients died of cancer, and we tried our best to alleviate their suffering. But what about in a city of many thousands or millions of people, when there are hundreds of such patients. Of course, hospices are needed, and in much greater numbers. Doctors and nurses are not cruel people. It is also hard for them, knowing that at that level of medicine they can only prescribe painkillers ... Understand me and accept my words. You will feel better, even from the thought that you tried to do what you can for your mother. And forgive us doctors. It is not easier for us, but much more difficult because of your pain.

Lyudmila, my mommy, is young and the best in the world..49 years and 3 days before the DR did not live up to..left August 27, 2017

She left home for a long and painful year and 9 months chained to the bed.

The two of us and God. all

Hold on and strength to you. I know that I will never recover. Doctors refused us 5 years ago ... what do you want about them when the patient is dying.

I consider those doctors whom I have encountered simply to be butchers.

Doctors, except for pain relief, can’t do anything. Alas

Good afternoon! My dad has oncology, soft palate, now it’s already spoken. He is now suffering from intoxication, we were given a referral to remove it, when we arrived at the hospital they told us there were no places, even at daytime, and it was said that there was nothing special to help here, that is, we are not so important patients, there are people who can help. I tried for two days and what do you think they put him in, but already when they discovered pneumonia. And with his diagnosis, it hurts him to eat, he can’t even drink water! We have been fighting this disease for a year and a half and very often faced with the indifference of doctors, we even had to complain to our governor, thanks to him he helped, but the treatment did not bring results. And we live in Kaliningrad, so we don’t even have a cancer center, but they build a stadium every year!

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The information on this site is provided for informational purposes only! It is not recommended to use the described methods and recipes for the treatment of cancer on your own and without consulting a doctor!

Cancer intoxication, symptoms, causes

In the last stages of cancer, patients experience intoxication. These pathological changes occur due to the destruction of malignant tumors and the cancerous course of the disease in all organs of the body. Signs of intoxication as a result of cancer have their own distinctive processes. Treatment in this case is performed using a blood purification procedure.

Development system

In oncological diseases, the development of intoxication is inevitable. This is due to the fact that with cancerous tumors, the development of normal metabolism is disrupted in the tissues and biological fluids of the body, harmful endogenous substances accumulate. Cancer poisoning in the microbial-10 does not have its own encoding, and it is encrypted to the first conclusion. The MKB cipher is significant for establishing a conclusion on a document from the hospital.

Intoxication caused by internal processes during cancer affects the body for several reasons at once:

• Metabolism is disturbed.
• Decomposition of a cancerous tumor.
• The concentration of drugs used during therapy.

An operation, inflammatory processes, the area where the cancer is located, which helps the doctor to establish the international classifier of the disease - the code, has an unambiguous significance in the development of internal intoxication in a cancerous tumor.

Clinical picture

Symptoms in the development of cancer intoxication can be very different.

The characteristic signs of an internal toxic process in the body depend on:

• The period of development of cancer, which is displayed in the coding of the microbial.
• The location of the oncological tumor.
• An indicator of the malfunction of an organ affected by oncological action.
• The use of chemotherapy.

Symptoms of intoxication of the body with cancer are as follows:

• Severe weakness and the person gets tired quickly;
• Frequent nausea and vomiting.
• Lack of appetite or complete aversion to food.
• Skin tone changes. In people with cancer, the skin may be pale, yellowish, or bluish in color.
• The mucous membranes are dry.
• The person sweats a lot.
• Periodically, the temperature rises and falls, the patient has a fever.
• Soreness in muscles and joints.
• Inhibited state.
• Headaches and dizziness.
• Symptoms of cancer poisoning are irritability, frequent mood changes, lack of sleep.

Signs of poisoning oncological diseases are also associated with a general decrease in the body's immune forces, which is expressed in the form of periodic infectious diseases.

The deterioration of the patient's health is also associated with a violation of the functioning of those organs in which the development of cancer cells occurs. If the patient has a violation of the activity of organs during cancer, then it goes as a separate diagnosis, which has its own designation microbial.

If a patient with internal intoxication of the body is not provided with medical care, this can cause the patient's heart to stop, because the organs cannot cope with the double work.

During chemotherapy, the symptoms manifest themselves more actively, because the destruction of cancer cells due to the course of the procedures affects.

Setting the diagnosis

According to the blood tests of a sick person, it is possible to determine the presence of oncological intoxication and to identify its degree. The doctor at the reception should assume intoxication in the body according to the extracts of the oncologist of the microbial code.

The same code entry makes it possible to determine the place of development of the cancer focus, in the variant when the patient does not know anything about his illness. The disease is diagnosed by the impaired functioning of the immune, endocrine and nervous systems.

Therapy

Poisoning the body with decaying cells from a cancerous disease contributes to the deterioration of the health of a patient whose diagnosis is determined by the microbial code, which means oncological disease.

If internal poisoning is not treated, the symptoms worsen, leading to lethal outcome. The main treatment of the patient is not complete without sorption drugs, whose work is aimed at:

• Removal of toxic substances that were formed during the interaction of cancer cells and organs from the body of a sick person.
• Control of the penetration of tumor cells into the liver, kidneys, stomach, lungs and other organs.
• Capture of produced endogenous poisons.

Naturally in medical practice In the treatment of cancer patients, enterosorbents, application sorption and blood purification from toxins are used to get rid of signs of intoxication.

Therapy for each patient is selected according to individual parameters, which include age, weight, severity of the disease, time from the diagnosis, taking into account the medication for the underlying disease.

[Cm. above subcategories of scene codes]

Note. Updated list medicines and other substances classified under three-character entries, see the Table of Drugs and Chemical Substances in Alphabetical index. The presence of alcohol together with the substances listed below can be identified by using additional codes Y90-Y91.

Included:

• accidental overdose,
• incorrect prescription of the drug,
• taking it by mistake or inattention
• accidents in the use of medicines, medicaments and biological substances in therapeutic and surgical procedures
• poisoning not specified as accidental or intentional

Excluded:

• administration of a medicinal product with intent to kill or commit suicide, to cause harm or in other circumstances classified in X60-X69, X85-X90, Y10-Y19
• appropriate for the purpose, correctly administered in therapeutic or prophylactic doses drug as cause of adverse reaction (Y40-Y59)

X40 Accidental poisoning and exposure to non-opioid analgesics, antipyretics and antirheumatic drugs

Includes: 4-aminophenol derivatives non-steroidal anti-inflammatory drugs pyrazolone derivatives salicylates

X41 Accidental poisoning and exposure to anticonvulsants, sedatives, hypnotics, antiparkinsonian and psychotropic drugs, not elsewhere classified

Includes: antidepressants barbiturates hydantoin derivatives iminostilbenes methaqualone compounds antipsychotics psychostimulants succinimides and oxazolidinediones tranquilizers

X42 Accidental poisoning by and exposure to drugs and psychodysleptics [hallucinogens], not elsewhere classified

Includes: cannabis (derivatives) cocaine codeine heroin lysergide mescaline methadone morphine opium (alkaloids)

X43 Accidental poisoning and exposure to other drugs affecting the autonomic nervous system

Includes: parasympatholytic [anticholinergic and antimuscarinic agents] and antispasmodics parasympathomimetic [cholinergic] agents sympatholytic [antidrenergic] agents sympathomimetic [adrenergic] agents

X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

Included: agents primarily affecting smooth and skeletal muscle and the respiratory system anesthetics (general) (local) drugs affecting: cardiovascular system. gastrointestinal tract hormones and their synthetic substitutes systemic and hematological agents

systemic antibiotics and other anti-infectives therapeutic gases vaccines substances that affect water balance, and drugs that affect mineral metabolism and uric acid metabolism

X45 Accidental poisoning and exposure to alcohol

Included: alcohol: . NOS. butyl. ethyl [ethanol]. isopropyl. methyl [methanol]. propyl fusel oil

X46 Accidental poisoning by and exposure to organic solvents, halogenated hydrocarbons and their vapors

Includes: benzene and its homologues carbon tetrachloride [tetrachloromethane] chlorofluorocarbons petroleum (derivatives)

X47 Accidental poisoning and exposure to other gases and vapors

Included: carbon monoxide tear gas engine (motor vehicle) exhaust gas nitrogen oxides sulfur dioxide household gas Excludes: metal fumes and fumes (X49.-)

X48 Accidental poisoning and exposure to pesticides

Included: fumigants fungicides herbicides insecticides rodenticides wood dressings Excludes: fertilizers and plant nutrition (X49.-)

X49 Accidental poisoning by and exposure to other and unspecified chemicals and poisons

Inclusions: corrosive aromatics, acids and caustic alkalis glues and adhesives metals, including fumes and fumes dyes and paints fertilizers and plant nutrients poisons NOS poisonous foodstuffs and poisonous plants soaps and detergents Excludes: contact with poisonous animals and plants (X20 -X29)

Accidental poisoning and exposure to toxic substances ICD code X40-X49

In the treatment of accidental poisoning and exposure to toxic substances, drugs are used:

The International Statistical Classification of Diseases and Related Health Problems is a document used as a leading framework in public health. ICD is normative document, ensuring the unity of methodological approaches and international comparability of materials. The International Classification of Diseases of the Tenth Revision (ICD-10, ICD-10) is currently in force. In Russia, health authorities and institutions carried out the transition of statistical accounting to the ICD-10 in 1999.

Chemical Poisoning: First Aid

Chemical poisoning: symptoms, first aid and prevention

First aid for poisoning and dangerous chemicals

Accidental poisoning and exposure to poisonous substances (X40-X49)

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ICD code: X40-X49

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Accidental poisoning and exposure to alcohol Accidental poisoning and exposure to pesticides

[Cm. above subcategories of scene codes] Note. For an updated list of drugs and other substances classified under three-digit entries, see the Table of Drugs and Chemical Substances in the Alphabetical Index. The presence of alcohol together with the substances listed below can be identified by using additional codes Y90-Y91. Incl.: accidental overdose, misprescribing of a drug, taking it by mistake or inattention accidents in the use of drugs, medicaments and biological substances in therapeutic and surgical procedures poisoning not specified as accidental or intentional , with intent to cause harm or under other circumstances classified in X60-X69, X85-X90, Y10-Y19 appropriate, correctly administered in therapeutic or prophylactic doses of the drug as the cause of the adverse reaction (Y40-Y59)

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ICD-10, X40-X49, accidental poisoning and exposure to poisonous substances

More about the ICD-10 classifier

Date of placement in the database 22.03.2010

Relevance of the classifier: 10th revision of the International Classification of Diseases

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Home → EXTERNAL CAUSES OF MORBIDITY AND DEATH → OTHER EXTERNAL CAUSES OF INJURIES DURING ACCIDENTS → ACCIDENTAL POISONING AND EXPOSURE TO TOXIC SUBSTANCES

Code Description

X40	Accidental poisoning and exposure to non-opioid analgesics, antipyretics and antirheumatic drugs
X41	Accidental poisoning and exposure to anticonvulsants, sedatives, hypnotics, antiparkinsonian and psychotropic drugs, not elsewhere classified
X42	Accidental poisoning and exposure to drugs and psychodysleptics [hallucinogens], not elsewhere classified
X43	Accidental poisoning and exposure to other drugs that affect the autonomic nervous system
X44	Accidental poisoning and exposure to other and unspecified drugs, medicaments and biological substances
X45	Accidental poisoning and exposure to alcohol
X46	Accidental poisoning and exposure to organic solvents, halogenated hydrocarbons and their vapors
X47	Accidental poisoning and exposure to other gases and vapors
X48	Accidental poisoning and exposure to pesticides
X49	Accidental poisoning and exposure to other and unspecified chemicals and poisons

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Poisoning in humans by combustion products

The risk of getting poisoned due to inhalation of various combustion products lies in wait for a person not only at the time of fires. Intoxication is possible in other cases. Burning grass or spending a lot of time around a fire can also lead to big problems, and sometimes to a quick death.

Combustion products are gaseous, solid or liquid toxic substances resulting from combustion. Their composition depends on what specifically burned, and the conditions in which this process took place.

When burned, inorganic and organic substances form CO, SO2, CO2, P2O5 and so on.

With incomplete combustion, alcohols, acetones, sulfuric gas, carbon monoxide, etc. are released into the air. As a result, the air is filled with caustic poisonous smoke, consisting of the smallest solid particles of the combustible substance.

According to ICD 10 (International Classification of Diseases), such poisoning corresponds to code T 59.

Causes of intoxication

You can be poisoned by smoke and the products of combustion contained in it if they enter the respiratory tract during breathing.

The most dangerous are hydrogen cyanide and carbon monoxide released during combustion. Carbon monoxide stops the production of hemoglobin, and the transport of oxygen to the organs stops. As a result, death occurs from hypoxia (oxygen deficiency).

See also: carbon monoxide poisoning

Hydrogen cyanide leads to poisoning, disrupting the metabolism in tissues and the flow of oxygen into the blood.

You can inhale and get poisoned by substances formed during combustion in such cases:

• in case of fire;
• during the burning of last year's foliage;
• due to smoldering of wiring, fabric, furniture, etc. (when complete combustion is prevented by insufficiently high temperature or lack of oxygen in the air);
• while in the garage with the doors closed and the engine running;
• due to a malfunction of the furnaces or when they are fired with an insufficiently open damper;
• problems with gas stoves or heating appliances.

The combustion of any materials leads to the release of harmful gases into the air, inhaling which can be poisonous. But even when extinguishing a fire, the danger of poisoning by combustion products is no less:

• When interacting with water, many gases react with it and form caustic acids (sulphurous, nitric) and ammonia. These products of combustion damage the bronchi, quickly accumulate in the lungs and severely burn the mucous membranes of the respiratory tract.
• When extinguishing a fire with a fire extinguisher, highly toxic phosgene is formed. Poisoned by this gas, a person can die from rapidly developing pulmonary edema, especially since there is no antidote to phosgene.

When burning rubber, plastic, paints and varnishes, as well as foam rubber and plywood, poisonous products of their combustion are formed - phosgene, cyanide, dioxin, etc. And if a person managed to be helped in time when poisoning with these products, there is no guarantee that he will not subsequently develop cancer or severe allergies.

Symptoms

To understand that the deterioration began precisely because of the products of combustion will help characteristics:

• lacrimation;
• "heaviness" in the head;
• pain in the temples and frontal region of the head;
• sudden hyperemia of the face;
• growing weakness;
• noise in ears;
• acceleration of the heartbeat;
• shortness of breath, shortness of breath;
• muscle pain both in tension and at rest (myalgia);
• vomiting as a symptom of almost all poisonings;
• chest pain;
• burning in throat;
• irresistible coughing;
• loss of consciousness;
• overexcitation or drowsiness (if the poisoned person falls asleep in a smoky room, without emergency assistance death will come in a dream).

The danger is that signs of poisoning can sometimes appear only after a few hours. But even the symptoms that appear immediately sometimes suddenly subside and even completely disappear after a day. However, this does not mean that the poisoning went away on its own. Miracles do not happen in such cases, and a deceptive sense of relief can actually hide the onset of pulmonary edema.

If first aid in case of poisoning for some reason is not received, the patient's condition worsens:

• breathing becomes painful, uneven;
• redness of the face is replaced by cyanosis;
• if help is not provided, the person dies.

With a strong degree of severity of poisoning, in addition to the listed signs, the following are sharply manifested:

• frequent breathing;
• convulsions;
• hallucinations (as a result of long-term toxic effects of medium-concentrated gases);
• rave;
• the rapid development of heart and lung failure (it happens that after stopping breathing, the heart still continues to beat for some time);
• coma.

Sometimes there is simply no time for first aid, even if you start acting right away. For example, after just a few breaths of carbon monoxide at a concentration of 1.2%, fatal poisoning occurs instantly: a person loses consciousness and dies after 3 minutes, and the survival rate in such cases is zero.

How to help

You need to start providing emergency first aid with an ambulance call. It is important to do this in any case, even if mild form poisoning. Then immediately, without delay, take action:

• remove (or take out) the victim to fresh air from the room where the poisoning occurred;
• unfasten, tear or cut tight clothing (especially on the chest - a collar, scarf, tie, etc.) to allow the poisoned person to breathe more freely;
• give sorbents (Polysorb, activated carbon, Atoxil) diluted in a small amount of water;
• drink strong sweet tea;
• give ascorbic acid (at least 2 pieces);
• wipe your face and chest with a cloth soaked in cool water on your forehead - cold compress;
• if the poisoned person has a fever, apply moderately hot heating pads;
• in case of loss of consciousness, bring a cotton swab dipped in ammonia, or rub it with whiskey;
• at great weakness and in a state on the verge of losing consciousness, lay the victim on his side, clean his mouth and nose from vomit with a handkerchief (if there was vomiting);
• control the pulse;
• if breathing or heartbeat stops, urgently proceed to resuscitation measures ( indirect massage heart, artificial respiration).

All first aid measures for poisoning due to inhalation of combustion products should be carried out quickly, and only in the fresh air. Otherwise, the degree of poisoning will increase, and the person providing assistance will receive intoxication from the inhalation of gases generated during combustion.

Treatment

Whether it is necessary to hospitalize the poisoned person and how to treat him - the doctors will determine, depending on the results of the examination of the victim, when the symptoms and treatment are compared from a professional point of view. And if the decision is made in favor of the hospital, then the patient will undergo the appropriate procedures there:

• pure oxygen in the first hours after poisoning to displace gases and their compounds with hemoglobin;
• then - an air mixture with 40-50% oxygen;
• at severe poisoning- pressure chamber;
• in acute CO poisoning - antidote Acizol intramuscularly to improve oxygen transport;
• sedation when overexcited;
• the drug Eufillin with obvious obstruction of the respiratory tract;
• antibiotics to prevent pneumonia;
• with convulsions - Barbamil (intravenously, slowly), Phenazepam intramuscularly, magnesium sulfate 25%;
• in heart failure intramuscularly Cordiamin, glucose solution with Strofantin intravenously and slowly, caffeine solution subcutaneously;
• if there are signs of cerebral edema or suspicion of it - a "cocktail" of Promedol, Aminazin and Diphenhydramine or Pipolfen intramuscularly;
• in case of coma and for the prevention of cerebral edema - a number of drugs (ascorbic acid with glucose, Prednisolone, Insulin, calcium gluconate (chloride), Furosemide, etc.);
• prevention of toxic pulmonary edema;
• hormonal drugs (corticosteroids, etc.);
• vitamin therapy.

ICD 10. CLASS XX. EXTERNAL CAUSES OF MORBIDITY AND DEATH (X00-Y09)

X00-X09 Exposure to smoke, fire and flame
X10-X19 Contact with hot and incandescent substances (objects)
X20-X29 Contact with poisonous animals and plants
X30-X39 The impact of the forces of nature
X40-X49 Accidental poisoning and exposure to toxic substances
X50-X57 Overexertion, travel and deprivation
X58-X59 Incidental exposure to other and unspecified factors
X60-X84 Intentional self-harm
X85-Y09 Attack

EXPOSURE TO SMOKE, FIRE AND FLAME (X00-X09)

[Cm

Included: fire caused by lightning
Excluded: arson ( X97. -)
secondary fire caused by the explosion ( W35-W40)
traffic accident ( V01-V99)

X00 Exposure to uncontrolled fire (fire) in a building or structure

collapse)
Fall from a) burning building or
Hit by an object dropped from a structure
jumping out)
ignition)
fire)
Meltdown) furnishings, furniture
Smoldering)

X01 Exposure to uncontrolled fire (fire) outside a building or structure

Includes: forest fire

X02 Exposure to controlled fire in a building or structure

Inclusions: exposure to fire in:
fireplace
ovens

X03 Exposure to controlled fire outside a building or structure

Inclusions: exposure to campfire fire

X04 Damage due to ignition of flammable substances

Included: ignition:
gasoline
kerosene
gasoline

X05 Ignition or meltdown damage to nightwear (shirts)

X06 Ignition or melt damage to other clothing and accessories

Included: ignition )
melting) of plastic ornaments

X08 Exposure to other specified sources of smoke, fire and flame

X09 Exposure to unspecified sources of smoke, fire and flame

Included: ignition NOS
burning NOS

CONTACT WITH HOT AND HOT SUBSTANCES (OBJECTS) (X10-X19)

[See the above subcategories of scene codes]

Excluded: impact:
excessively high natural temperature ( X30. -)
fire and flame X00-X09)

X10 Contact with hot drinks, food,
fats and cooking oils

X11 Contact with hot tap water

Included: with hot water in:
bucket
tub
hot water flowing from:
hose
crane

X12 Contact with other hot liquids

Included: with water warmed on the stove
Excluded: with hot (liquid) metal ( X18. -)

X13 Exposure to steam and hot vapours.

X14 Exposure to hot air and gases

Inclusions: inhalation of hot air and gases

X15 Contact with hot household appliances

Included: with:
oven
electric or gas stove
samovar, kettle
saucepan (glass) (metal)
cooker
toaster
Excluded: with heaters ( X16. -)

X16 Contact with hot heating appliances,
heating radiators and pipes

X17 Contact with hot engines, machines and tools

Excluded: from:
with hot heaters, radiators
and pipes ( X16. -)
hot appliances ( X15. -)

X18 Contact with other hot metals

Included: with liquid metal

X19 Contact with other and unspecified hot and incandescent substances and objects

Excludes: with objects not normally hot, e.g. objects that are red-hot due to a house fire
(X00-X09)

CONTACT WITH POISONOUS ANIMALS AND PLANTS (X20-X29)

[See the above subcategories of scene codes]

Included: with chemicals emitted by:
animals
insects
poisons secreted through teeth, hairs, needles, tentacles
and other animal apparatus for ejecting poison
Excludes: eating poisonous animals or plants ( X49. -)

X20 Contact with poisonous snakes and lizards

Included: with:
cobra
gyurza
efoy
cottonmouth
viper
gila-tooth
mamba
rattlesnake
sea ​​snake
snake (venomous)
Excluded: with lizard (non-poisonous) ( W59. -)
with a snake (non-poisonous) ( W59. -)

X21 Contact with poisonous spiders

Included: with black widow spider
with a tarantula

X22 Scorpio Contact

X23 Contact with hornets, wasps and bees

Included: with "yellow jacket"

X24 Contact with centipedes and poisonous millipedes (tropical)

X25 Contact with other specified venomous arthropods

Included: with ants
with caterpillars

X26 Contact with poisonous marine animals and plants

Included: with:
coral polyps
jellyfish
nematocysts
sea:
anemones
cucumbers
hedgehogs
Excluded: with non-poisonous marine animals ( W56. -)
with sea snakes X20. -)

X27 Contact with other specified poisonous animals

X28 Contact with other specified poisonous plants

Inclusions: entry of toxic substances or toxins through the skin
when pricked with thorns, needles or other ways
Excludes: eating poisonous plants ( X49. -)
puncture wound NOS caused by thorns or needles
plants ( W60. -)

X29 Contact with unspecified poisonous plants and animals

Includes: sting (poisonous) NOS
bite venomous NOS

IMPACT OF THE FORCES OF NATURE (X30-X39)

[See the above subcategories of scene codes]

X30 Exposure to excessively high natural temperature

Included: excessively high outside temperature as a cause
sunstroke
heat exposure NOS
Excludes: exposure to excessively high temperatures of artificial origin ( W92. -)

X31 Effects of excessively low natural temperature

Included: excessively low outside temperature as a cause of:
chills NOS
frostbite of the leg or arm
impact:
cold NOS
weather conditions
Excludes: exposure to artificial cold ( W93. -)
dry ice contact W93. -)
inhalation of liquefied gas ( W93. -)

X32 Exposure to sunlight

X33 Lightning Victim

Excluded: fire caused by lightning ( X00-X09)
lightning-induced fall tree injury
or another object ( W20. -)

X34 Earthquake Victim

X35 Victim of a volcanic eruption

X36 Victim of snowfall, landslide and their ground movements

Included: mudflows associated with natural disasters
Excluded: earthquake ( X34. -)
traffic accident caused by a collision with a stationary snowfall or landslide ( V01-V99)

X37 Victim of the Devastating Storm

Included: blizzard
downpour
cyclone
hurricane
tornado
heavy rains
demolition of the vehicle from the road during
storm
Excluded: failure of a dam or other artificial structure causing ground movements ( X36. -)
traffic accident after
storm ( V01-V99)

X38 Flood Victim

Included: flood:
caused by a distant storm
caused by snowmelt during natural disasters
caused directly by the storm
Excludes: flood caused by failure of a dam or other
artificial structure ( X36. -)
tidal wave:
NOS ( X39. -)
caused by a storm X37. -)

X39 Effects of other and unspecified forces of nature

Includes: natural radiation NOS
tidal wave NOS
Excludes: external influence NOS ( X59. -)

ACCIDENTAL POISONING AND EXPOSURE TO TOXIC SUBSTANCES (X40-X49)

[See the above subcategories of scene codes]

Note An updated list of medicines and other
substances classified in three-character categories,
see Table of Drugs and Chemical Substances in the Alphabetical Index The presence of alcohol together with the substances listed below can be identified by using additional codes
Y90-Y91.
Inclusions: accidental overdose, misuse of the drug, taking it by mistake or inattention, accidents in the use of drugs, medicaments and biological substances in
therapeutic and surgical procedures poisoning, not specified as accidental or intentional
Excludes: administration of a drug for the purpose of murder or suicide, for the purpose of causing harm or for other
circumstances classified under headings X60 -X69 , X85 -X90 , Y10 -Y19
drug appropriate for the purpose, correctly administered in therapeutic or prophylactic doses
agent as the cause of an adverse reaction ( Y40-Y59)

X40 Accidental poisoning and exposure to non-opioid analgesics, antipyretics and antirheumatic drugs

non-steroidal anti-inflammatory drugs
pyrazolone derivatives
salicylates

X41 Accidental poisoning and exposure to anticonvulsants, sedatives, hypnotics, antiparkinsonian and psychotropic drugs, not elsewhere classified

Includes: antidepressants
barbiturates
hydantoin derivatives
iminostilbenes
methaqualone compounds
antipsychotics
psychostimulants
tranquilizers

X42 Accidental poisoning by and exposure to drugs and psychodysleptics [hallucinogens], not elsewhere classified

cocaine
codeine
heroin
lysergide
mescaline
methadone
morphine
opium (alkaloids)

X43 Accidental poisoning and exposure to other drugs affecting the autonomic nervous system

sympatholytic [antidrenergic] agents

X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

actions)
drugs that affect:
cardiovascular system
gastrointestinal tract


vaccines

uric acid

X45 Accidental poisoning and exposure to alcohol

Included: alcohol:
NOS
butyl
ethyl [ethanol]
isopropyl
methyl [methanol]
propyl
fusel oil

X46 Accidental poisoning by and exposure to organic solvents, halogenated hydrocarbons and their vapors

chlorofluorocarbons
oil (derivatives)

X47 Accidental poisoning and exposure to other gases and vapors

Included: carbon monoxide
tear gas
facilities)
nitrogen oxides
sulfur dioxide
household gas
X49. -)

X48 Accidental poisoning and exposure to pesticides

Includes: fumigants
fungicides
herbicides
insecticides
rodenticides
Excluded :( X49. -)

X49 Accidental poisoning and exposure to other and unspecified
chemicals and toxic substances

alkalis
glues and adhesives
metals, including fumes and vapors
dyes and paints
fertilizers and plant nutrition products
poisons NOS
soaps and detergents
Excludes: contact with poisonous animals and plants ( X20-X29)

OVERVOLTAGE, TRAVEL AND DESTRUCTION (X50-X57)

[See the above subcategories of scene codes]

Excluded: assault ( X85-Y09)
traffic accidents ( V01-V99)

X50 Overexertion and jerky or repetitive movements

Included: lifting:
heavy object
weights
marathon run
rowing

X51 Travel and movement

X52 Prolonged stay in a state of weightlessness

Included: weightlessness in a (simulated) space vehicle
means

X53 No food

Included: lack of food as a cause of:
exhaustion
malnutrition
starvation
Y06. -)

X54 Lack of water

Included: lack of water as a cause of:
dehydration
exhaustion
Excludes: as a result of neglect or neglect ( Y06. -)

X57 Deprivation, unspecified

Included: poverty

OCCASIONAL EXPOSURE TO OTHER AND UNSPECIFIED FACTORS (X58-X59)

[See the above subcategories of scene codes]

X58 Influence of other specified factors

X59 Exposure to unspecified factor

Includes: accident NOS
adverse effects NOS

INTENTIONAL SELF-HARM (X60-X84)

[See the above subcategories of scene codes]

Includes: intentional self-harm by poisoning or
injury
suicide (attempt)

X60 Intentional self-poisoning and exposure to non-opioid analgesics, antipyretics and antirheumatic drugs

Includes: 4-aminophenol derivatives
non-steroidal anti-inflammatory drugs
pyrazolone derivatives
salicylates

X61 Intentional self-poisoning by and exposure to anticonvulsants, sedatives, hypnotics, antiparkinsonian and psychotropic drugs, not elsewhere classified

Includes: antidepressants
barbiturates
hydantoin derivatives
iminostilbenes
methaqualone compounds
antipsychotics
psychostimulants
succinimides and oxazolidinediones
tranquilizers

X62 Intentional self-poisoning and exposure to narcotics and psychosleptics [hallucinogens], not elsewhere classified

Includes: cannabis (derivatives)
cocaine
codeine
heroin
lysergide
mescaline
methadone
morphine
opium (alkaloids)

X63 Intentional self-poisoning and exposure to other drugs acting on the autonomic nervous system

Includes: parasympatholytic [anticholinergics and antimuscarinics] and antispasmodics
parasympathomimetic [cholinergic] agents
sympatholytic [antiadrenergic] agents
sympathomimetic [adrenergic] agents

X64 Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

Includes: agents primarily affecting smooth and skeletal muscle and the respiratory system
anesthetics (general action) (local
actions)
drugs that affect:
cardiovascular system
gastrointestinal tract
hormones and their synthetic substitutes
systemic and hematological agents
systemic antibiotics and other anti-infective agents
therapeutic gases
topical preparations
vaccines
substances that affect the water balance, and medicinal
agents affecting mineral metabolism and metabolism
uric acid

X65 Intentional self-poisoning and exposure to alcohol

Included: alcohol:
NOS
butyl
ethyl [ethanol]
isopropyl
methyl [methanol]
propyl
fusel oil

X66 Intentional self-poisoning by and exposure to organic solvents, halogenated hydrocarbons and their vapors

Includes: benzene and its homologues
carbon tetrachloride [tetrachloromethane]
chlorofluorocarbons
oil (derivatives)

X67 Intentional self-poisoning and exposure to other gases and vapors

Included: carbon monoxide
tear gas
engine exhaust gas (motor vehicle
facilities)
nitrogen oxides
sulfur dioxide
household gas
Excluded: metal fumes and fumes ( X69. -)

X68 Intentional self-poisoning and exposure to pesticides

Includes: fumigants
fungicides
herbicides
insecticides
rodenticides
wood stains
Excluded: fertilizers and plant nutrition products ( X69. -)

X69 Intentional self-poisoning by and exposure to other and unspecified chemicals and poisons

Includes: corrosive aromatics, acids and caustic
alkalis
glues and adhesives
metals, including fumes and vapors
dyes and paints
fertilizers and plant nutrition products
poisons NOS
poisonous foods and poisonous plants
soaps and detergents

X70 Intentional self-harm by hanging, strangulation and strangulation

X71 Intentional self-harm by immersion and drowning

X72 Intentional self-harm by firing a handgun

X73 Intentional self-harm by firing a rifle, shotgun and large caliber firearms

X74 Intentional self-harm by firing another and unspecified firearm

X75 Intentional self-harm by explosives

X76 Intentional self-harm by smoke, fire and flame

X77 Intentional self-harm from steam, hot vapours, and hot objects

X78 Intentional self-harm with a sharp object

X79 Intentional self-harm with a blunt object

X80 Intentional self-harm by jumping from a height

Enabled: deliberately falling from one level to another

X81 Intentional self-harm by jumping under or lying in front of a moving object

X82 Intentional self-harm by motor vehicle crash

Included: intentional collision with:
motor vehicle
by train
by tram
Excluded: through an aircraft accident ( X83. -)

X83 Intentional self-harm through other specified activities

Includes: intentional self-harm by:
exposure to caustic substances, excluding poisonous
aircraft crash
electric shock

X84 Intentional self-harm by unspecified act

ASSAULT (X85-Y09)

[See the above subcategories of scene codes]

Includes: murders
damage caused by another person for the purpose of causing
injury or killing by any means
Excludes: damage due to:
statutory actions ( Y35. -)
military action ( Y36. -)

X85 Assault with drugs, medicaments and biological agents

Included: killing by poisoning:
biological substances
medicines
medicines

X86 Assault with caustic substances

Excluded: using corrosive gases ( X88. -)

X87 Assault with pesticides

Inclusions: using wood stains
Excluded: with the use of plant nutrition and fertilizers ( X89. -)

X88 Assault using gases and vapors

X89 Assault using other specified chemicals and poisons

Inclusions: using plant nutrition products and
fertilizer

X90 Assault with unspecified chemical or poisonous substance

Includes: murder by poisoning NOS

X91 Assault by hanging, strangulation and strangulation

X92 Assault by drowning and immersion

X93 Assault by firing a handgun

X94 Assault by rifle, shotgun and large caliber firearms

X95 Assault by firing another and unspecified firearm

X96 Assault by explosives

Excluded: by using an incendiary mixture ( X97. -)

X97 Smoke, fire and flame attack

Included: arson
usage:
cigarettes
incendiary mixture

X98 Assault with steam, hot vapors and hot objects

X99 Assault with a sharp object

Includes: injury NOS

Y00 Assault with a blunt object

Y01 Attack by pushing from a height

Y02 Attack by pushing under or placing the victim in front of a moving object

Y03 Assault by running over with a motor vehicle

Includes: intentional strike or run over by a motor vehicle
means

Y04 Assault by physical force

Included: fight or fight without weapons
Excluded: attack by:
strangulation ( X91. -)
immersion in water X92. -)
weapon use ( X93-X95, X99. — , Y00. -)
Y05. -)

Y05 Sexual assault with physical force

Includes: rape (attempt)
sodomy (attempt)

Y06 Deprivation of care or neglect

Y06.0 Spouse or partner
Y06.1 parent
Y06.2 Acquaintance or friend
Y06.8 Other specified persons
Y06.9 unspecified person

Y07 Other forms of ill-treatment

Includes: mental cruelty
physical cruelty
sexual cruelty
torment
Excludes: deprivation of supervision and care ( Y06. -)
sexual assault with physical force Y05. -)

Y07.0 Spouse or partner
Y07.1 parent
Y07.2 Acquaintance or friend
Y07.3 Officials
Y07.8 Other specified persons
Y07.9 unspecified person

Y08 Assault by other specified means

Y09 Assault by unspecified method

Includes: political assassination (attempt) NOS
human extermination (attempt) NOS
homicide (non-random)
lethal damage inflicted (attempt) NOS

Gashigullin R.I., Khalitov F.Ya.
First City clinical Hospital Kazan

The volumes of diagnostic and therapeutic measures presented in the table are advisory in nature and are an attempt to standardize medical care for the most common acute poisonings.

Nosological forms of poisoning according to ICD-10 are combined into a group of poisonings familiar to doctors, taking into account the uniformity of diagnostic and therapeutic measures, complications, comparability of treatment terms. The identification of syndromes is due to the specificity of diagnostic and therapeutic measures for them.

Table of volumes of diagnostic and therapeutic measures for acute poisoning

N	Diagnosis by groups of toxic substances and severity of poisoning	ICD-10 code	Duration of treatment	Recommended scope of examination	Recommended amount of treatment	Result
GROUPS OF TOXIC SUBSTANCES
1.	Alcohol withdrawal syndrome with severe somatic manifestations.	F10.3	3	CBC, TAM, hematocrit, blood electrolytes, chemotoxicological analysis, blood amylase or urine diastasis, ECG, neuropathologist consultation, psychiatrist consultation	forced diuresis, alkalinization of urine, electrolyte correction, sedatives. According to the indications of syndromic therapy.	Relief of somatic manifestations of abstinence
2.	Mild alcohol intoxication.	F10.0	2			Recovery of the patient
3.	Alcoholic intoxication of moderate degree.	F10.0	2		Cleansing the gastrointestinal tract, forced diuresis, alkalinization of urine, antidotes (CNS stimulants). According to the indications of syndromic therapy.	Recovery of the patient
4.	Severe alcohol intoxication.	F10.0	3		Cleansing the gastrointestinal tract, forced diuresis, correction of acid-base balance, electrolytes, vitamins, antidotes (CNS stimulants). According to indications, syndromic therapy, anticoagulants, glucocorticoids, antibiotics.	Recovery of the patient in 90-95% of cases.
5.	Mild alcohol poisoning.		2	KLA, OAM, chemotoxicological analysis, hematocrit. According to indications, blood electrolytes and other studies, consultation of a neurologist.	Cleansing the gastrointestinal tract, forced diuresis, alkalinization of urine, antidotes (CNS stimulants). According to the indications of syndromic therapy.	Recovery of the patient
6.	Poisoning by surrogates of alcohol of moderate degree.	T51.0, T51.2, T51.3, T51.8, T51.9	2	KLA, TAM, hematocrit, chemotoxicological analysis, consultation with a neurologist. According to indications, blood electrolytes, ALT, AST, other studies and consultations.	Cleansing the gastrointestinal tract, forced diuresis, alkalinization of urine, antidotes (CNS stimulants). According to the indications of syndromic therapy.	Recovery of the patient
7.	Severe alcohol poisoning.	T51.0, T51.2, T51.3, T51.8, T51.9	3	KLA, TAM, hematocrit, chemotoxicological analysis, blood electrolytes, ALT, AST, bilirubin, ECG, neurologist consultation. According to indications, coagulogram, urea, Ro-graphy of the lungs, other studies and consultations.	Cleansing the gastrointestinal tract, forced diuresis, correction of acid-base balance, electrolytes, vitamins, antidotes (CNS stimulants), antibiotics, hepatoprotectors. According to indications, syndromic therapy, anticoagulants, glucocorticoids.	Recovery of the patient in 90-95% of cases with alcohol poisoning and 50-70% of cases with poisoning by surrogates.
8.	Mild mushroom poisoning.	T62.0	3	KLA, OAM, hematocrit, ALT, AST, free hemoglobin (morels, lines). According to the indications of other studies and consultations.	Cleansing the gastrointestinal tract, detoxification (forced diuresis, early HS in case of suspected poisoning with pale grebe), antidotes (if any), vitamins, glucocorticoids, hepatoprotectors, glucose preparations, antienzymes, enterosorbents. According to indications, correction of acid-base balance and electrolytes, syndromic therapy.	Recovery of the patient
9.	Moderate mushroom poisoning.	T62.0	8	KLA, OAM, hematocrit, electrolytes, bilirubin, ALT, AST, free hemoglobin (morels, lines). According to indications other researches and consultations.	Cleansing the gastrointestinal tract, detoxification (efferent methods, forced diuresis), early HS with suspected pale grebe, antidotes (if available), vitamins, glucocorticoids, hepatoprotectors, glucose preparations, antienzymes, correction of acid-base balance and electrolytes, antispasmodics, enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient
10.	Severe mushroom poisoning.	T62.0	18	KLA, TAM, hematocrit, electrolytes, amylase, bilirubin, ALT, AST, coagulogram, total protein, ECG, urea, free hemoglobin (morels, lines), consultation of the chief toxicologist. According to indications other researches and consultations.	Cleansing the gastrointestinal tract, detoxification (efferent methods, forced diuresis), early HS with suspicion of pale toadstool, antidotes (if available), vitamins, glucocorticoids, hepatoprotectors, glucose preparations, antienzymes, anticoagulants, vascular preparations, correction of acid-base balance and electrolytes, antispasmodics, enterosorbents. According to indications syndromic therapy, antibiotics.	Recovery of the patient in 30-80% of cases.
11.	poisoning lung medication degree.		3		Cleansing the gastrointestinal tract, forced diuresis, antidote therapy (if any). According to indications correction of electrolytes, syndromic therapy.	The recovery of the patient.
12.	Poisoning by medicines of an average degree.	T36-T39, T41, T44, T45, T47-T50	3	KLA, OAM, chemotoxicological analysis, hematocrit. According to the indications of other studies.		The recovery of the patient.
13.	Severe drug poisoning.	T36-T39, T41, T44, T45, T47-T50	6	UAC, OAM, chemotoxicological analysis, hematocrit, ECG, blood electrolytes, consultation with a neurologist. According to indications, coagulogram, total protein, blood urea, ALT, AST, bilirubin, Ro-graphy of the lungs, other studies and consultations.	Repeated cleansing of the gastrointestinal tract, detoxification (efferent methods, forced diuresis), antidote therapy (if any), glucocorticoids, alkalization of urine, enterosorbents, vitamins. According to indications, syndromic therapy, anticoagulants, etc.
14.	Mild psychotropic drug poisoning.	T42, T43	3	KLA, OAM, chemical toxicological analysis.	Cleansing of the gastrointestinal tract, forced diuresis, antidote therapy. According to the indications of syndromic therapy.	The recovery of the patient.
15.	Poisoning by drugs of psychotropic action of an average degree.	T42, T43	4	KLA, OAM, chemical toxicological analysis. According to the indications of hematocrit, blood electrolytes, ECG.	Cleansing of the gastrointestinal tract, forced diuresis, antidote therapy, alkalization of urine, enterosorbents. According to indications syndromic therapy, antibiotics.	The recovery of the patient.
16.	Poisoning with drugs of psychotropic action of a severe degree.	T42, T43	6	UAC, OAM, chemotoxicological analysis, hematocrit, blood electrolytes, ECG, neuropathologist consultation. According to the indications, coagulogram, total protein, blood urea, ALT, AST, bilirubin, Ro-graphy of the lungs, etc. studies, consultation of other specialists.	Repeated cleansing of the gastrointestinal tract, detoxification (efferent methods, forced diuresis), UVI blood, antidote therapy, antibiotics, anticoagulants, vitamins, alkalization of urine, enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient in 80-95% of cases.
17.	Poisoning by drugs that act on the cardiovascular easy degree.	T46	3	KLA, OAM, ECG, chemotoxicological analysis. According to the indications of hematocrit, blood electrolytes.	Cleansing the gastrointestinal tract, forced diuresis, antioxidants, antidotes (if any), glucocorticoids, drugs that improve metabolism in the myocardium, vitamins, enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
18.	Poisoning by drugs acting on the cardiovascular system of a moderate degree.	T46	4	UAC, OAM, ECG, chemotoxicological analysis, hematocrit, blood electrolytes. According to indications, coagulogram, ALT, AST, Ro-graphy of chest organs, ultrasound of the heart, etc. studies, consultations of specialists.	Cleansing the gastrointestinal tract, detoxification (forced diuresis), antioxidants, glucocorticoids, electrolyte correction, antidotes (if any), drugs that improve metabolism in the myocardium, vitamins, enterosorbents. According to indications hemosorption, syndromic therapy.	The recovery of the patient.
19.	Poisoning with drugs acting on the cardiovascular system of a severe degree.	T46	7	UAC, OAM, ECG, chemotoxicological analysis, hematocrit, blood electrolytes, coagulogram, ultrasound of the heart. According to the indications of ALT, AST, total protein, blood urea, bilirubin, Ro-graphy of the chest organs, etc. studies, consultations of specialists.	Repeated cleansing of the gastrointestinal tract, detoxification (earlier use of efferent methods, forced diuresis), antioxidants, electrolyte correction, acid-base balance, vascular agents, antidotes (if available), anticoagulants, drugs that improve metabolism in the myocardium, vitamins, glucocorticoids, enterosorbents. According to the testimony of adrenomimetics and other types of syndromic therapy.	Recovery of the patient in 90% of cases.
20.	Poisoning with metals and their compounds, arsenic and its compounds of mild degree.	T56, T57.0	5	KLA, TAM, hematocrit, blood electrolytes, free hemoglobin, ALT, AST, bilirubin, urea, chemotoxicological analysis. According to other studies.	Purification of the gastrointestinal tract in case of oral poisoning, early hemodialysis, forced diuresis, alkalization of urine, antidotes, vitamins, glucocorticoids. In case of oral poisoning, additional antispasmodics, antacids and enveloping, enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
21.	Poisoning by metals and their compounds, arsenic and its compounds of moderate degree.	T56, T57.0	10	KLA, TAM, hematocrit, blood electrolytes, coagulogram, free hemoglobin, ALT, AST, bilirubin, urea, chemotoxicological analysis, X-ray examination of the gastrointestinal tract or FGDS in case of oral poisoning, surgeon's consultation in case of oral poisoning. According to indications other researches and consultations.	Purification of the gastrointestinal tract in case of oral poisoning, early hemodialysis, forced diuresis, alkalization of urine, antidotes, electrolyte correction, vitamins, hepatoprotectors, glucocorticoids, antioxidants, anticoagulants. In case of oral poisoning, additional antispasmodics, analgesics, antacids and enveloping antibiotics, antiulcers, enterosorbents. According to indications, antienzymes, vascular drugs, syndromic therapy.	The recovery of the patient.
22.	Severe poisoning with metals and their compounds, arsenic and its compounds.	T56, T57.0	18	KLA, TAM, hematocrit, blood electrolytes, coagulogram, free hemoglobin, ALT, AST, bilirubin, urea, total protein, chemotoxicological analysis, Ro-graphy of the lungs, ECG, in case of oral poisoning, X-ray examination of the stomach or FGDS, surgeon's consultation. According to indications other researches and consultations.	Purification of the gastrointestinal tract in case of oral poisoning, early hemodialysis, forced diuresis, alkalinization of urine, antidotes, antibiotics, electrolyte correction, vitamins, hepatoprotectors, glucocorticoids, anticoagulants, antioxidants, antienzymes. In case of oral poisoning, additional antispasmodics, analgesics, antacids and enveloping, antiulcer drugs, vascular drugs, enterosorbents. According to the indications of syndromic treatment.	Recovery of the patient in 35-70% of cases.
23.	Mild methanol and ethylene glycol poisoning.	T51.1 T52.3	4	KLA, TAM, hematocrit, urea, blood electrolytes, chemotoxicological analysis. According to indications other researches and consultations.	Cleansing the gastrointestinal tract, early hemodialysis, forced diuresis, alkalinization of urine, correction of electrolytes, antidotes (ethanol), enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
24.	Moderate methanol and ethylene glycol poisoning.	T51.1 T52.3	5	KLA, TAM, hematocrit, urea, creatinine, AST, ALT, blood electrolytes, chemotoxicological analysis, neuropathologist consultation. According to indications other researches and consultations.	Cleansing of the gastrointestinal tract, early hemodialysis, forced diuresis, alkalinization of urine, correction of electrolytes, antidotes (ethanol), glucocorticoids, vitamins, vascular drugs, antibiotics, enterosorbents. According to indications, anticoagulants, hepatoprotectors and other types of syndromic therapy.	The recovery of the patient.
25.	Severe methanol and ethylene glycol poisoning.	T51.1 T52.3	10	KLA, TAM, hematocrit, coagulogram, bilirubin, AST, ALT, urea, creatinine, blood electrolytes, chemotoxicological analysis, ECG, neurologist consultation. According to the indications Ro-graphy of the lungs, other studies and consultations.	Cleansing of the gastrointestinal tract, early hemodialysis, forced diuresis, alkalization of urine, correction of electrolytes, antidotes (ethanol), antibiotics, anticoagulants, glucocorticoids, hepatoprotectors, vascular preparations, vitamins, enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient in 30-60% of cases.
26.	Mild drug poisoning.	T40	1	KLA, TAM, HIV, chemotoxicological analysis.	Oral cleansing of the gastrointestinal tract, forced diuresis, antidotes. According to the indications of syndromic therapy.	The recovery of the patient.
27.	Moderate drug poisoning.	T40	2	KLA, TAM, HIV, chemotoxicological analysis. According to the testimony of hematocrit, blood electrolytes, other studies and consultations.	Cleansing the gastrointestinal tract when taken orally, antidotes, forced diuresis, enterosorbents when taken orally. According to the indications of mechanical ventilation, vitamins, anticholinergics and other types of syndromic therapy.	The recovery of the patient.
28.	Severe drug poisoning.	T40	3	KLA, TAM, HIV, chemotoxicological analysis, hematocrit, blood electrolytes, ECG, neurologist consultation. According to indications, coagulogram, ALT, AST, Ro-graphy of the lungs and other studies, consultation of other specialists.	Cleansing the gastrointestinal tract when taken orally, antidotes, vitamins, mechanical ventilation, detoxification (forced diuresis), analeptics, antibiotics, alkalinization of urine, enterosorbents when taken orally. According to indications, hemosorption, anticoagulants, glucocorticoids, anticholinergics, etc. syndromic therapy.	Recovery of the patient in 80-95% of cases.
29.	Mild corrosive poisoning.	T54	7	KLA, OAM, hematocrit, free hemoglobin, fibroesophagogastroscopy, surgeon's consultation. According to indications, X-ray examination of the gastrointestinal tract and lungs, blood electrolytes, ALT, AST, coagulogram.	Gastric cleansing, forced diuresis, alkalization of urine, anticholinergics, analgesics, enveloping drugs, antacids, glucocorticoids, antibiotics, vitamins, antiulcer drugs. According to the indications of syndromic therapy.
30.	Poisoning by corrosive substances of an average degree.	T54	13	KLA, TAM, hematocrit, coagulogram, free hemoglobin, blood electrolytes, X-ray examination of the gastrointestinal tract, surgeon's consultation. According to indications other researches and consultations.	Gastric cleansing, forced diuresis, alkalization of urine, anticholinergics, analgesics, antioxidants, enveloping drugs, antacids, glucocorticoids, electrolyte correction, antibiotics, vitamins, antiulcer drugs, vascular drugs. According to the testimony of anticoagulants, antienzymes, syndromic therapy.	Cupping systemic manifestations, restoration of patency of the esophagus.
31.	Severe corrosive poisoning.	T54	18	KLA, OAM, hematocrit, coagulogram, free hemoglobin, blood electrolytes, ALT, AST, bilirubin, urea, x-ray examination of the gastrointestinal tract and lungs, fibroesophagogastroscopy, ECG, surgeon's consultation. According to indications other researches and consultations.	Gastric cleansing, forced diuresis, alkalinization of urine, anticholinergics, analgesics (including narcotics), enveloping drugs, antacids, glucocorticoids, electrolyte correction, antibiotics, antioxidants, vitamins, antiulcer drugs, vascular drugs, restoration of airway patency, parenteral nutrition. Treatment of burn disease. According to indications, plasmapheresis, anticoagulants, antienzymes, syndromic therapy.	Recovery in 55-80% of cases. Relief of systemic manifestations, restoration of esophageal patency.
32.	Mild solvent poisoning.		3	KLA, OAM, AST, ALT, chemical toxicological analysis. According to other studies.	Cleansing the gastrointestinal tract, forced diuresis, glucose preparations, vitamins. According to the indications of syndromic therapy.	The recovery of the patient.
33.	Medium solvent poisoning.	T52 except for T52.3, T53.6, T53.7, T53.9	5	KLA, TAM, hematocrit, AST, ALT, bilirubin, chemotoxicological analysis, urea, blood electrolytes. According to the indications of the coagulogram, consultation with a neurologist, other examinations and consultations.	Cleansing the gastrointestinal tract, forced diuresis, vitamins, hepatoprotectors, glucose preparations, glucocorticoids, vascular preparations, enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
34.	Severe solvent poisoning.	T52 except for T52.3, T53.6, T53.7, T53.9	10	KLA, OAM, hematocrit, AST, ALT, chemotoxicological analysis, bilirubin, urea, coagulogram, blood electrolytes, ECG, neurologist consultation. According to indications other researches and consultations.	Repeated cleansing of the gastrointestinal tract, detoxification (efferent methods, forced diuresis), correction of electrolytes, alkalization of urine, vitamins, hepatoprotectors, glucocorticoids, glucose preparations, vascular preparations, antioxidants, antibiotics, enterosorbents. According to the testimony of anticoagulants, antienzymes, syndromic therapy.	Recovery of the patient in 60-80% of cases.
35.	Poisoning with toxic substances, mainly non-medical purposes of a mild degree.	T55, T65	3	UAC, OAM, chemical toxicological study. According to indications other researches and consultations.	Cleansing the gastrointestinal tract, forced diuresis, antidotes (if any). According to the indications of enterosorbents, syndromic therapy.	Recovery of the patient
36.	Poisoning by toxic substances, mostly non-medical purposes of moderate degree.	T55, T65	4	KLA, TAM, hematocrit, chemotoxicological study, blood electrolytes, ALT, AST, ECG. According to indications other researches and consultations.	Cleansing the gastrointestinal tract, forced diuresis, antidotes (if any), enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient
37.	Poisoning by toxic substances, mainly non-medical purposes, of a severe degree.	T55, T65	6	KLA, TAM, hematocrit, chemotoxicological study, blood electrolytes, ALT, AST, bilirubin, urea, coagulogram, ECG. According to indications, consultation of a neurologist, other examinations and consultations.	Cleansing the gastrointestinal tract, detoxification (efferent methods, forced diuresis), antidotes (if any), correction of acid-base balance and electrolytes, antibiotics, anticoagulants, vitamins, enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient in 50-80% of cases.
38.	Poisoning with toxic substances contained in the eaten foods of a mild degree.		2	KLA, OAM, hematocrit, amylase, ALT, AST. According to the indications of others. Research and consultation.	Cleansing the gastrointestinal tract, forced diuresis, antidote therapy (if available), enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
39.	Poisoning by toxic substances contained in the eaten foods of moderate degree.	T61, T62 except for T62.0	3	KLA, OAM, hematocrit, electrolytes, amylase, bilirubin, ALT, AST. According to the indications of others. Research and consultation.	Cleansing the gastrointestinal tract, forced diuresis, antidote therapy (if available), vitamins, antispasmodics, correction of acid-base balance and electrolytes, enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
40.	Poisoning by toxic substances contained in the eaten foods of a severe degree.	T61, T62 except for T62.0	6	KLA, OAM, hematocrit, electrolytes, amylase, bilirubin, ALT, AST, coagulogram, urea, ECG. According to the indications of other studies and consultations.	Cleansing the gastrointestinal tract, detoxification (forced diuresis, efferent methods), glucocorticoids, anticoagulants, vitamins, antidote therapy (if available), correction of acid-base balance and electrolytes, antibiotics, enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient in 70-95% of cases.
41.	Poisoning by toxic fumes and vapors of mild degree.	T59	3	KLA, TAM, hematocrit, R-graphy of the lungs, ECG, neuropathologist's consultation in case of poisoning with neurotoxic gases and vapours.	Dehydration therapy, antidotes (if available), antioxidants and glucocorticoids for gas poisoning, vitamins, oxygen therapy. According to indications, antibiotics, correction of acid-base balance and electrolytes, syndromic therapy.	The recovery of the patient.
42.	Poisoning by toxic fumes and vapors of moderate degree.	T59	5	CBC, TAM, hematocrit, coagulogram, Ro-graphy of the lungs, ECG, neuropathologist's consultation in case of poisoning with neurotoxic gases and vapors. According to indications other researches and consultations.	Dehydration therapy, antidotes (if available), antibiotics, antioxidants and glucocorticoids in case of poisoning with irritating gases, oxygen therapy, vitamins, acid-base balance and electrolytes correction. According to the indications of syndromic therapy.	The recovery of the patient. Residual effects of lesions of the eyes, respiratory tract, lungs; encephalopathy.
43.	Severe poisoning with toxic fumes and vapors.	T59	10	KLA, TAM, hematocrit, blood electrolytes, coagulogram, Ro-graphy of the lungs, ECG, consultation of a neurologist in case of poisoning with neurotoxic gases and vapours. According to indications other researches and consultations.	Dehydration therapy, antidotes (if available), antibiotics, antioxidants and glucocorticoids in case of poisoning with irritating gases, oxygen therapy, vitamins, correction of acid-base balance and electrolytes, vascular drugs, drugs that improve metabolism in the central nervous system. According to the indications of mechanical ventilation, syndromic therapy.	Recovery of the patient in 50-85% of cases. Residual effects of lesions of the eyes, respiratory tract, lungs; encephalopathy.
44.	Mild carbon monoxide poisoning.	T58	3	KLA, OAM, hematocrit, carboxyhemoglobin, neuropathologist's consultation.	Dehydration therapy, drugs that improve metabolism in the central nervous system, vitamins, analeptics, oxygen therapy. According to the indications of syndromic treatment.	Recovery of the patient
45.	Moderate carbon monoxide poisoning.	T58	4	KLA, OAM, hematocrit, carboxyhemoglobin, ECG, consultation with a neurologist. According to other studies.	Dehydration therapy, drugs that improve metabolism in the central nervous system, cytochrome, vitamins, analeptics, oxygen therapy. According to the indications of syndromic treatment.	Recovery of the patient
46.	Severe carbon monoxide poisoning.	T58	8	KLA, TAM, hematocrit, carboxyhemoglobin, blood electrolytes, coagulogram, Ro-graphy of the lungs, ECG, total protein, urea, ALT, AST, neuropathologist consultation. According to indications other researches and consultations.	Hyperbaric oxygenation, dehydration therapy (osmotic diuretics, saluretics), cytochrome, glucocorticoids, anticoagulants, antibiotics, drugs that improve metabolism in the central nervous system, vitamins, vascular drugs, analeptics, oxygen therapy, correction of acid-base balance and electrolytes. According to the indications of syndromic treatment.	Recovery of the patient in 70-85% of cases. Residual effects of encephalopathy.
47.	Mild organophosphorus insecticide poisoning.	T60.0	3	KLA, TAM, hematocrit, electrolytes, cholinesterase activity, ECG.	Cleansing the gastrointestinal tract, forced diuresis, antidotes (cholinesterase reactivators, anticholinergics), correction of blood potassium, enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient
48.	Moderate organophosphorus insecticide poisoning.	T60.0	5	KLA, TAM, hematocrit, electrolytes, cholinesterase activity, coagulogram, Ro-graphy of the lungs, ECG. According to the indications of other studies and consultations.	Repeated cleansing of the gastrointestinal tract, hemosorption (hemodialysis), forced diuresis, UVI blood (magnetic blood treatment), antidotes (cholinesterase reactivators, anticholinergics), electrolyte correction, antibiotics, enterosorbents. According to indications syndromic therapy, anticoagulants.	Recovery of the patient
49.	Severe organophosphorus insecticide poisoning.	T60.0	7	KLA, TAM, hematocrit, electrolytes, cholinesterase activity, coagulogram, ALT, AST, bilirubin, total protein, Ro-graphy of the lungs, ECG, neurologist consultation. According to the indications of other studies and consultations.	Repeated cleansing of the gastrointestinal tract, hemosorption (hemodialysis), forced diuresis, antidotes (cholinesterase reactivators, anticholinergics), UVI blood (magnetic blood processing), correction of electrolytes and acid-base balance, antibiotics, anticoagulants, adrenomimetics, vitamins, oxygen therapy, drugs that improve metabolism in the myocardium and central nervous system , enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient in 40-65% of cases.
50.	Mild chlorinated hydrocarbon poisoning.	T53.0-T53.5	5	KLA, TAM, hematocrit, coagulogram, urea, bilirubin, chemotoxicological analysis, ALT, AST, blood electrolytes. According to indications other researches and consultations.	Purification of the gastrointestinal tract, early hemodialysis in case of oral poisoning, forced diuresis, antioxidants, vitamins, hepatoprotectors, glucocorticoids, glucose preparations, enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
51.	Moderate poisoning with chlorinated hydrocarbons.	T53.0-T53.5	7	KLA, TAM, hematocrit, coagulogram, urea, bilirubin, chemotoxicological analysis, ALT, AST, blood electrolytes, ECG. According to indications other researches and consultations.	Cleansing the gastrointestinal tract, early hemodialysis, forced diuresis, antidotes, anticoagulants, antioxidants, antienzymes, vitamins, hepatoprotectors, glucocorticoids, glucose preparations, vascular preparations, urine alkalization, enterosorbents. According to the indications of syndromic therapy.	The recovery of the patient.
52.	Severe poisoning with chlorinated hydrocarbons.	T53.0-T53.5	10	KLA, TAM, hematocrit, coagulogram, urea, bilirubin, chemotoxicological analysis, ALT, AST, blood electrolytes, ECG, neurologist consultation. According to indications other researches and consultations.	Repeated cleansing of the gastrointestinal tract, early hemodialysis, forced diuresis, antidotes, anticoagulants, antioxidants, antienzymes, vitamins, hepatoprotectors, glucocorticoids, glucose preparations, vascular preparations, alkalization of urine, electrolyte correction, antibiotics, enterosorbents. According to the indications of syndromic therapy.	Recovery of the patient in 20-50% of cases.
53.	Mild snake and insect bites.	T63.0, T63.4	3	KLA, OAM, hematocrit, coagulogram. According to the testimony of a surgeon's consultation.	forced diuresis, antidote therapy (anti-snake serum), tetanus toxoid, antibiotics, analgesics, antihistamines, anti-inflammatory drugs, local treatment. According to indications, vascular drugs, anticoagulants, syndromic therapy.	Relief of general and reduction of local manifestations.
54.	Bites of snakes and insects of moderate degree.	T63.0, T63.4	5	KLA, TAM, hematocrit, coagulogram, blood electrolytes, surgeon's consultation. According to the indications of other studies and consultations.	Forced diuresis, antidote therapy (anti-snake serum), tetanus toxoid, anticoagulants, rheological and vascular drugs, antibiotics, analgesics, antihistamines, anti-inflammatory drugs, glucocorticoids, correction of acid-base balance and electrolytes, local treatment. According to the indications of syndromic therapy.
55.	Severe snake and insect bites.	T63.0, T63.4	7	KLA, TAM, hematocrit, coagulogram, blood electrolytes, ALT, AST, bilirubin, urea, total protein, surgeon's consultation. According to the indications of other studies and consultations.	Forced diuresis, antidote therapy (anti-snake serum), tetanus toxoid, anticoagulants, rheological and vascular drugs, antibiotics, analgesics, antihistamines, anti-inflammatory drugs, glucocorticoids, topical treatment. According to the indications of syndromic therapy.	Relief of general and reduction of local manifestations
SYNDROMES
1.	Violation of external respiration of toxic etiology.	J68.3		Ro-graphy of the lungs, ECG. According to the testimony of a neurologist consultation.	Restoration of airway patency, oxygen therapy, antibiotics, bronchodilators, percussion massage. According to indications, sedatives or analeptics, mechanical ventilation, muscle relaxants.	Improvement of external respiration. Reducing signs of hypoxia.
2.	Acute intoxication psychosis, mild form.	F09		Consultation of a psychiatrist and neuropathologist, according to the indications of other specialists.	Forced diuresis, hemodez, vitamins, sedatives.	Normalization of consciousness
3.	Acute intoxication psychosis, severe form.	F09		Hematocrit, fundus, echoes, blood electrolytes, cerebrospinal fluid examination, consultation with a psychiatrist and neuropathologist. According to indications other researches and consultations.	Detoxification (efferent methods, forced diuresis), hemodez, dehydration, vitamins, drugs that improve metabolism in the central nervous system, vascular drugs, sedatives, correction of acid-base balance and electrolytes, prevention of inflammatory and trophic complications, bowel cleansing.
4.	Acute toxic hemolysis.	D59.4		KLA, OAM, free blood hemoglobin, coagulogram, hematocrit, blood potassium, urea.	Forced diuresis, plasmapheresis, blood alkalization, vitamins, antioxidants, glucocorticoids, glucose preparations, osmotic diuretics, anticoagulants, vascular drugs. According to indications, transfusion of erythrocyte mass, exchange replacement of blood.	Normalization of free hemoglobin, preservation of diuresis.
5.	Edema of the brain.	G93.6		CSF examination, blood electrolytes, hematocrit, consultation with a neurologist. According to indications other researches and consultations.	Dehydration therapy, vascular drugs, glucocorticoids, vitamins, drugs that improve metabolism in the central nervous system. According to indications, therapeutic lumbar puncture.	Disappearance of symptoms of cerebral edema. Residual effects of encephalopathy.
6.	Positional compression syndrome	T79.5		TAM, TAM, blood electrolytes, hematocrit, free myoglobin, urea, creatinine, ALT, AST, bilirubin, ECG, Ro-graphy of the lungs when localized on the trunk. According to indications, consultation of a surgeon, neurologist, other examinations and consultations.	Forced diuresis, rheopolyglucin, anticoagulants, glucocorticoids, calcium chloride, vascular drugs, analgesics, antihistamines, vitamins, local treatment (compresses, physiotherapy, exercise therapy, massage).	Relief of edema and pain syndrome, improvement of the function and sensitivity of the affected area.
7.	Mild toxic hepatopathy.	K71.1		ALT, AST, bilirubin, prothrombin index, alkaline phosphatase.	Hepatoprotectors, vitamins, glucose preparations, choleretic.	Normalization of transaminases.
8.	Toxic hepatopathy of moderate degree.	K71.1		ALT, AST, bilirubin, prothrombin index, hematocrit, total protein, alkaline phosphatase, liver ultrasound.	Hepatoprotectors, vitamins, glucose preparations, antienzymes, glucocorticoids, antioxidants, gemodez, vascular preparations, forced diuresis, bowel cleansing.	Recovery of liver function. Decreased activity of transaminases.
9.	Severe toxic hepatopathy.	K71.1		ALT, AST, bilirubin, prothrombin index, hematocrit, total protein, urea, blood platelets, blood electrolytes, hemoglobin, erythrocytes, alkaline phosphatase, liver ultrasound.	Detoxification (hemosorption, peritoneal dialysis, forced diuresis), hepatoprotectors, vitamins, glucose preparations, hemodez, antienzymes, glucocorticoids, antioxidants, vascular preparations, protein preparations, gastrointestinal tract cleansing, enterosorbents, antibiotics.	Improved liver function. Residual manifestations of hepatopathy.
10.	Toxic cardiomyopathy.	I42.7		ECG, blood potassium, hematocrit, EchoCS, Ro-cardiometry, AST. According to indications other researches and consultations.	Drugs that improve metabolism in the myocardium, potassium preparations, vitamins, antioxidants, glucocorticoids, inotropic drugs, retabolil, glucose preparations. According to indications cardiac glycosides.	Normalization of indicators of the state of the heart. Residual effects of cardiomyopathy.
11.	Toxigenic collapse.	I95.2, I95.8		ECG, erythrocytes, hemoglobin, hematocrit, amylase, blood electrolytes, Ro-graphy of chest organs, surgeon's consultation, stool blood test.	Plasma substitutes, crystalloid infusions, glucocorticoids, adrenomimetics, analeptics	Normalization of blood pressure.
12.	toxic coma.	R40.2				Recovery of consciousness. Residual effects of encephalopathy.
13.	Mild toxic nephropathy.	N14		OAM, blood urea, hematocrit.		Improved kidney function on urine tests.
14.	Toxic nephropathy of moderate degree.	N14		OAM, blood urea and creatinine, hematocrit, blood electrolytes, renal ultrasound.	Diuretics, glucose preparations, vitamins, calcium chloride, vascular preparations, glucocorticoids.	Normalization of the blood urea index, improvement of kidney function according to urine tests.
15.	Severe toxic nephropathy (ARN).	N17.0		KLA, TAM, blood urea and creatinine, hematocrit, blood electrolytes, total protein, renal ultrasound, renal Ro-graphy.	Hemodialysis, anticoagulants, antibiotics, retabolil, glucose preparations, vitamins, calcium chloride, vascular preparations, glucocorticoids. According to diuretics.	Restoration of diuresis, decrease in urea and blood creatinine. Residual effects of nephropathy.
16.	Toxic pulmonary edema.	J68.1		Hematocrit, Ro-graphy of the lungs, ECG.	Glucocorticoids, vascular drugs, saluretics, calcium chloride, vitamins, antihistamines, cardiac glycosides, oxygen therapy, narcotic analgesics, sedatives, mechanical ventilation in the PEEP mode.	Relief of pulmonary edema.
17.	Toxic stool.	R40.1		Blood sugar, hematocrit, fundus examination, consultation with a neurologist. According to indications other researches and consultations.	Dehydration therapy, drugs that improve metabolism in the central nervous system, glucose drugs, vascular drugs, glucocorticoids, vitamins.	Normalization of consciousness. Residual effects of encephalopathy.
18.	Toxic convulsive syndrome.	R56.8		Fundus of the eye, hematocrit, consultation with a neurologist, according to the indications of other specialists.	Anticonvulsants (relanium, magnesia, GHB, sodium thiopental, etc.), dehydration therapy, drugs that improve metabolism in the central nervous system, vitamins, therapeutic lumbar puncture.	Relief of seizures. Residual effects of encephalopathy.
19.	toxic shock	R57		KLA, hematocrit, coagulogram, blood electrolytes, urea, ALT, AST, ECG, total protein.	Plasma substitutes, correction of acid-base balance and electrolytes, crystalloid infusions, glucose preparations, glucocorticoids, adrenomimetics, anticoagulants, vitamins, rheopolyglucin, cardiac glycosides, oxygen therapy.	Shock elimination. Normalization of hemodynamics. Residual effects of shockogenic lesions of organs and systems.

In cases of suicidal poisoning, consultation with a psychiatrist is mandatory. In cases of poisoning with chemicals used in the workplace (in the organization, at work), the patient must consult an occupational pathologist.

The category of complexity of diagnosis and treatment of poisoning and individual syndromes is determined depending on the severity of the condition: mild degree- 3 category, average degree severity - 4th category, severe degree - 5th category.

Treatment of non-specific complications - surgical, therapeutic, neurological, etc. ( gastrointestinal bleeding, pneumonia, neuritis, etc.) - carried out according to relevant standards.