The Role of Premorbid Background in Tanatogenesis of Acute Poisonings with Psychoactive Drugs in Gerontological Patients

Background Human aging is a universal and regular process characterized by uneven and steady progression, inevitably affecting to some extent all levels of biological organization. In the structure of acute exotoxicosis, patients of gerontological age range from 10.3 to 12.9%. After 60, with an increase of years, there is a growth of mortality rate from 9.8% in elderly patients to 25.5% in long-livers. A certain role in its genesis is played by the premorbid background, i.e. somatic diseases preceding and accompanying acute exotoxicosis.

Aim of study To identify the role of concomitant diseases in the course and outcome of acute poisoning by psychoactive drugs in patients over 60. MATErIALS AnD METhODS We retrospectively analyzed hospital records of 99 patients aged 60 to 90 years who died from poisoning with psychoactive drugs at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2013–2016, as well as their autopsy, forensic and histological research data.

Results In gerontological patients with acute poisoning with psychoactive drugs, the main premorbid background (100%) is atherosclerotic lesion of the heart and vessels of different degree and extent. In case of lethal outcomes, in toxicogenic stage of poisoning on primary electrocardiograms, myocardial ischemia was revealed in 76.9% of cases, heart rhythm disturbances were detected in all patients, most often in the form of supraventricular extrasystoles (38.4%) and atrial fibrillation (23.1%). In the deceased patients during the somatogenic stage of poisoning, cardiac conduction disorders (31.3%) prevailed. Concomitant chronic lesions of the bronchopulmonary system, including terminal bronchi, contributed to the development of hypostatic pneumonia and its long, migratory course. In 50% of cases, large and small droplet fatty liver disease was detected, which could have a negative effect on the course of poisoning, altering biotransformation of toxicants.

Conclusion Atherosclerotic lesion of the heart and vessels, as well as chronic bronchopulmonary disease and fatty liver disease are the main premorbid background factors, which have a negative effect on the course and outcome of acute poisoning with psychoactive drugs.

1. Shishkin A.N., Petrova N.N., Slepykh L.A. Geriatrics. Moscow: Akademiya Publ., 2008. 192 p. (In Russian).

2. Kishkun A.A. Biological age and aging: possibilities of definition and ways of correction. Moscow: GEOTAR-Media Publ., 2008. 976 p. (In Russian).

3. Gladchenko YU.L, Bukhartseva N.V., Arustamyan A.V., Parfenov L.L. Acute chemical poisoning is an urgent medical and social problem in the Astrakhan region. In: Effectiveness of the state and organization of the Toxicological service of the Ural Federal district in improving care for patients with acute poisoning: abstracts of the 2nd scientific conference of the Ural Federal district on clinical toxicology with international participation (Ekaterinburg, 19–20 September 2013). Ekaterinburg, 2013. 30–32. (In Russian).

4. Vishnevetskiy M.K., Terekhin G.A. Structural analysis of acute poisoning in the Perm region 2002–2011. In: Effectiveness of the state and organization of the Toxicological service of the Ural Federal district in improving care for patients with acute poisoning: abstracts of the 2nd scientific conference of the Ural Federal district on clinical toxicology with international participation (Ekaterinburg, 19–20 September 2013). Ekaterinburg, 2013. 22–24. (In Russian).

5. Saldan I.P., Karpova E.N., Ushakov A.A. Acute poisoning of chemical etiology in the context of social and age groups of the population (based on socio-hygienic passport of the Altai territory). In: Effectiveness of the state and organization of the Toxicological service of the Ural Federal district in improving care for patients with acute poisoning: abstracts of the 2nd scientific conference of the Ural Federal district on clinical toxicology with international participation (Ekaterinburg, 19–20 September 2013). Ekaterinburg, 2013. 68–73. (In Russian).

6. Il’yashenko K.K., Simonova A.YU., Belova M.V. A structural analysis of acute exotoxicoses in people of elderly and senile age. Toksikologicheskiy vestnik. 2017; (1): 10–14. (In Russian).

7. Belova M.V., Lisovik ZH.A., Klyuyev A.E., et al. Chemical-Toxicological diagnosis of acute chemical poisoning. Moscow: Grafikon Print Publ., 2007. 120 p. (In Russian).

8. Luzhnikov E.A., ed. Medical toxicology. Moscow: GEOTAR-Media Publ., 2012. 928 p. (In Russian).

9. Rebrova O.YU. Statistical analysis of medical data. Application software package STATISTICA. Moscow: MediaSfera Publ., 2006. 312 p. (In Russian).

10. Yarygin V.N., Melent’yev A.S., eds. Manual on gerontology and geriatrics: in 4 vol. Vol. III: Clinical geriatrics. Moscow: GEOTAR-Media Publ., 2007. 896 p. (In Russian).

11. Il’yashenko K.K., Belova M.V., Simonova A.YU., et al. Features of pneumonia in patients with acute poisoning with psychopharmacological drugs of older age groups. Moskovskaya meditsina. 2016; (1, Special issue: abstracts of the Assembly “Health of Moscow”). 118–119. (In Russian).

12. Kolobov S.V., YArema I.V., Zayrat’yants O.V. Basics of regional immunotherapy. Moscow: GOU VUNMTS MZ RF Publ., 2001. 184. p. (In Russian).

13. Beresneva E.A., Smirnov S.V., SHevyakova S.V., et al. The Value of Xray and Laboratory Investigations in the Casualties Suffered from the Exposure to the Flame and Combustion Products during the Fire (in the “Lame Horse 11 Nightclub, PERM, 2009). Problemy bezopasnosti i chrezvychaynykh situatsiy. 2012; (1): 17–33. (In Russian).

14. Melent’yev A.S., Gasilin V.S., Gusev E.I., et al. Geriatric aspects of internal medicine. Moscow, 1995. 50–59. (In Russian).

15. Korkushko O.V. Cardiovascular system and age: clinical and physiological aspects. Moscow: Meditsina Publ., 1983. 176 p. (In Russian).

16. Martynov A.I., Ostroumova O.D., CHechetkina O.L., Mamayev V.I. Rhythm and conduction disorders in elderly and senile persons. Klinicheskaya meditsina. 2000; (2): 4–10. (In Russian).

17. Mazur N.A. Senile age and features of pharmacotherapy of cardiovascular diseases. Russkiy meditsinskiy zhurnal. 1996; 4(8): 480–486. (In Russian).