Intestinal Lavage in the Complex Treatment for Corrosive Poisoning

   BACKGROUND. The high incidence of various complications and the persistent mortality remain relevant to the search for new approaches in the treatment of victims with poisoning by corrosive substances.

   OBJECTIVE. To increase the effectiveness of the therapeutic complex in case of corrosive poisoning by adding intestinal lavage.

   MATERIAL AND METHODS. We examined 73 patients (34.3 % of women and 65.7 % of men) with acute oral poisoning by acetic acid (35.6 % of the total number of patients) and alkali — NaOH (64.4 %) aged from 27 to 65 years (43 (33.0; 56.0) years). Endoscopic examination before the start of treatment in all the patients revealed 2–3^rd degree chemical burns of the mucous membrane of the mouth, pharynx, esophagus and stomach. The treatment of 38 patients (study group) included intestinal lavage using an enteral solution in a volume of 4.5 liters in the first 6 hours after taking the poison. The comparison group consisted of 35 patients who received standard therapy. The groups were identical in age, sex, type and severity of poisoning.

   RESULTS. Patients who received intestinal lavage showed a clear positive dynamics of the process of cleansing the affected areas of the mucous membrane of the esophagus and stomach from necrotic masses and the appearance of granulations already on the 5^th day. In the comparison group, by this time there were no signs of healing of local defects in the mucous membrane of the esophagus and stomach.

   CONCLUSION. The inclusion of intestinal lavage in the treatment complex helps reduce the regeneration time of the mucous membrane of the gastrointestinal tract in case of damage and inflammation caused by poisoning by corrosive substances, a decrease in the incidence of extraintestinal complications, in particular pneumonia (by 17.1 %), which is reflected in a decrease in mortality (by 5.7%) and a decrease in the duration of hospitalization by 2.1 times.

1. Luzhnikov EA (ed.). Neotlozhnaya klinicheskaya toksikologiya. Moscow: Medpraktika Publ.; 2007. (in Russ.)

2. Ostapenko YuN (ed.). Toksicheskoe deystvie raz”edayushchikh veshchestv. Toksicheskoe deystvie myl i detergentov. Federal’nye klinicheskie rekomendatsii. Moscow; 2014. (In Russ.)

3. Govorin AV, Vitkovsky YuA, Rutskina EA, Solpov AV, Sokolova NA, Boiko EV, et al. Platelet Aggregation and Endothelial Dysfunction in Patients With Acute Acetic Acid Poisoning. The Far Eastern Medical Journal. 2007;(3):42–44. (In Russ.)

4. Leyderman IN, Sentsov VG, Vorontsov SV. Fenomen povyshennoy kishechnoy pronitsaemosti kak proyavlenie sindroma kishechnoy nedostatochnosti (SKN) u bol’nykh s otravleniyami prizhigayushchimi zhidkostyami sredney i tyazheloy stepeni. Intensivnaya terapiya. 2012;(2). (In Russ.). Available at: http://icj.ru/journal/number-2-2008/158-fenomen-povyshennoy-kishechnoy-pronicaemosti-kak-proyavlenie-sindroma-kishechnoy-nedostatochnosti-skn-u-bolnyh-s-otravleniyami-prizhigayuschimi-zhidkostyami-sredney-i-tyazheloy-stepeni.html html [Accessed Nov 24, 2023]

5. Rychin EP. Rubtsovye suzheniya pishchevoda posle khimicheskikh ozhogov: diagnostika, taktika, lechenie, profilaktika. Saint Petersburg;1999. (In Russ.)

6. Pinchuk TP, Abakumov MM, Il’yashenko KK, Gulyaev AA, Dement’eva IV, Savintseva EA. Reflyuks-ezofagit pri khimicheskom ozhoge zheludka. The Doctor. 2004;(8):31–33. (In Russ.)

7. Matkevich VA. Kishechnyy lavazh. In: Luzhnikov EA (ed.) Meditsinskaya toksikologiya. Moscow: GEOTAR-Media Publ.; 2012. Ch. 4:162–186.

8. Volkov SV, Ermolov AS, Luzhnikov EA. Khimicheskie ozhogi pishchevoda i zheludka. Moscow: Medpraktika-M Publ.; 2005. (In Russ.)

9. Matkevich VA, Potskhveriya MM, Simonova AYu, Sukhodolova GN, Belova MV, Bitkova EE. Management of Disorders of Homeostasis With Saline Enteral Solution in Acute Poisoning With Psychopharmacological Drugs. Russian Sklifosovsky Journal Emergency Medical Care. 2020;9(4):551–563. doi: 10.23934/2223-9022-2020-9-4-551-563

10. Matkevich VA, Luzhnikov EA, Belova MV, Yevdokimova NV, Syromyatnikova ED, Kurilkin YuA. The Role of Intestinal Translocation in the Origin of Endotoxemia in Acute Poisoning and Detoxification Effect of Intestinal Lavage. Russian Sklifosovsky Journal Emergency Medical Care. 2015;(4):16–21.