Alcohol poisoning mkb 10. The toxic effect of alcohol

Treatment

Therapy is prescribed by a narcologist after a complete examination. The main goal of taking medications is to detoxify the body, reduce clinical manifestations and reduce the risk of complications.

In most cases, the following groups of drugs are prescribed:

• saline solutions;
• diuretics;
• nootropics;
• neuroleptics;
• vitamins;
• sorbents;
• antacids;
• analgesics;
• antispasmodics.

Treatment is sometimes supplemented with glucocorticoids, beta-blockers, atropine. Mechanical purification of blood is possible with the help of hemodialysis, plasmapheresis. Rehabilitation of the patient takes place at home within one month.

The effectiveness of treatment and the overall prognosis for the victim will depend entirely on the accepted dose of the surrogate and on the timeliness of medical care. In addition, an important factor is the initial physical condition of the patient.

So, chronic alcoholics are more difficult to tolerate the toxic effects of surrogates. However, the consequences for both can be the same - from loss of vision and paralysis to death with kidney or liver failure.

In general, a number of specific measures are used in relation to the victim in the hospital. Emergency care for poisoning looks like this:

• Probe gastric lavage. Shown if the victim is conscious.
• Taking sorbents to bind and remove toxins.
• Administration of intravenous antidotes. In most cases, ethanol is used. In the case of ethylene glycol poisoning, calcium gluconate is used as an antidote.
• Increased diuresis for the rapid elimination of toxins through the kidneys (shown only with the normal functioning of the kidneys).
• The introduction of vitamins of group B, C into the body. Having poisoned, a person loses all electrolytes, minerals and vitamins, which requires restoring their balance.

At the stage of primary health care, it is recommended to normalize impaired breathing and restore or maintain adequate hemodynamics (see 3.1 "Treatment of hemodynamic disorders".

Level of persuasiveness - D (level of evidence - 4)

1. in cases of aspiration-obstructive respiratory disorders, it is recommended to perform an oral toilet; to reduce hypersalivation and bronchorrhea, atropine ** (1-2 ml of a 0.1% solution) is injected subcutaneously;
2. with a superficial coma - aspiration of the contents of the upper respiratory tract is carried out using an air duct;
3. with a deep coma - tracheal intubation is performed.
4. in case of respiratory failure of the central type, it is necessary to carry out artificial ventilation of the lungs after preliminary intubation of the trachea.
5. with a mixed form of disorders, aspiration-obstructive respiratory disorders are first eliminated, and then artificial lung ventilation is connected.
6. inhalation of oxygen is shown.
7. for the resolution of atelectasis - a sanitation FBS.

In severe hemodynamic disorders, anti-shock therapy is recommended: intravenous plasma-substituting solutions, saline solutions and glucose solutions.

After relief of respiratory failure and associated hypoxia, the use of succinic acid preparations (solution of meglumine sodium succinate ** - 1.5% - 400.0) and cardiovascular agents in therapeutic doses (cordiamin, caffeine) is recommended.

Correction of water and electrolyte balance is recommended to be carried out with crystalloid, colloid solutions and glucose under the control of pulse, blood pressure (BP) and central venous pressure (CVP), cardiac index, total peripheral resistance, hematocrit, hemoglobin and electrolyte concentrations, as well as diuresis.

The general hypothermia of the body is below the critical level in persons with an alcoholic coma who were outside closed heated rooms during the cold season;

Chronic alcohol intoxication in the terminal stage with signs of multiple organ failure (hepatic, cardiovascular, metabolic disorders) alcoholic cardiomyopathy;

Acute alcoholic delirium against the background of chronic alcohol intoxication, which develops almost immediately after the patient exits from an alcoholic coma, is dangerous with complications (pnemonia, cerebral edema, acute cardiovascular insufficiency.

Order No. 520n of the Ministry of Health of the Russian Federation dated June 15, 2016 “On approval of the criteria for assessing the quality of medical care, clause 3.13.6;

Toxic effect of substances, predominantly non-medical (T51-T65) / World Health Organization // International Statistical Classification of Diseases and Related Health Problems. Tenth revision. Volume 1 (part 2) .- M .: Medicine, 1995 .- S. 337-344 .;

Order of the Ministry of Health of the Russian Federation No. 925n dated November 30, 2012 “On approval of the procedure for providing medical care in case of acute chemical poisoning”;

Order of the Ministry of Health of the Russian Federation dated 05.10.1998 No. 298 “On the analytical diagnosis of narcotic drugs, psychotropic and other toxic substances in the human body”;

Order of the Ministry of Health and Social Development of the Russian Federation of January 27, 2006 No. 40 "On the organization of chemical and toxicological studies in the analytical diagnosis of the presence of alcohol, narcotic drugs, psychotropic and other toxic substances in the human body."

Chronic alcohol intoxication - poisoning of human organs by the decay products of alcohol when consumed in excessive doses. There may be no alcohol addiction. In contrast to the long-term negative effects of alcohol on the body in alcoholism, chronic intoxication is caused even by irregular drinking, if the doses of alcohol are large enough.

TREATMENT Tactics of management (see Non-Specific Drug Therapy (see also Poisoning, general provisions) For acidosis - 4% r - r sodium bicarbonate IV up to 1,000-1,500 ml / day For agitation and convulsions - 10 ml 25% r - ra magnesium sulfate IM Prednisolone, thiamine, triphosadenine, ascorbic acid, glucose-procaine mixture (200 ml 40% r-ra glucose and 20 ml 2% r-ra procaine) intravenously.

A mild degree of intoxication does not require medical attention. The patient should be allowed to sleep, after which his condition is normalized.

In case of moderate and severe poisoning, assistance is provided according to the following algorithm:

• state stabilization;
• gastric lavage;
• body detoxification;
• management of complications and symptomatic treatment.

Treatment of alcohol intoxication at home is possible only if the victim is conscious, does not turn blue, breathes well and does not show signs of severe toxic effects of ethanol (shortness of breath, decreased blood pressure, severe abdominal pain, low body temperature, etc.).

State stabilization

Measures to stabilize the patient's condition are aimed primarily at restoring adequate spontaneous breathing. To do this, with the help of an electric suction, the remnants of vomit, saliva and sputum are removed from the upper respiratory tract.

In the absence of the necessary equipment, the procedure is carried out by wrapping a bandage or a napkin around two fingers and thus cleaning the oral cavity. In case of severe respiratory disorders according to the central type, the patient is intubated and transferred to mechanical ventilation. As a rule, this happens only with a deep alcoholic coma.

The level of hypersalivation can be reduced by subcutaneous administration of atropine sulfate (0.5-1 ml). It should be remembered that the drug can significantly increase the heart rate and provoke mental arousal. The latter is stopped with the use of chlorpromazine, haloperidol, relanium.

Low blood pressure is corrected by prescribing vasopressors to the victim. With a slight decrease in blood pressure, caffeine is injected under the skin, mezaton at a dose of 0.5 ml. Coma in combination with significant hypotension is an indication for intravenous drip of dopamine, norepinephrine, mezaton.

Gastric lavage

Gastric lavage can be performed at home or in a hospital setting. At home, the victim is given to drink 0.5-1 liter of water, after which they induce vomiting. The procedure is repeated several times.

For washing, clean water, water with the addition of activated carbon powder or sodium bicarbonate (baking soda) can be used. Gastric lavage in this way is possible only with the patient's consciousness and the ability to swallow.

In the hospital and at the SMP stage, lavage is carried out through a thick gastric tube. The latter is brought into the stomach through the mouth, and after the procedure is removed.

Alcohol surrogates are alcohol-based liquids that are not meant to be taken orally. When using alcohol surrogates, poisoning develops, which often leads to death.

Alcohol surrogates are liquids containing alcohol that are not drinks. Once in the human body, they cause intoxication with severe health consequences.

Ethyl alcohol in the composition of surrogates may or may not be present. The ethanol group includes:

• Butyl alcohol.
• wood spirits.
• Denatured alcohol.
• Colognes.
• Varnish.
• Stain.

Surrogates are much more toxic than alcohol. So, wood spirits contain methanol, denatured alcohol contains aldehyde, polish contains a whole combination of various toxic alcohols. The stain contains chemical dyes, which, when ingested, cause blue skin and mucous membranes.

The second group includes "false surrogates":

• methanol.
• Ethylene glycol.
• Isopropanol.
• Clay BF.
• Dichloroethane.

Toxic doses

Alcohol surrogates are dangerous because even a small amount of these liquids, when ingested, provokes a fatal outcome.

Their toxic doses for the development of acute poisoning differ depending on the composition:

• methanol - 7-8 ml;
• ethylene glycol - 50 ml;
• polish - 50 ml;
• acetone - 30 ml;
• isopropanol - 0.5 - 2 ml / kg;
• glue BF - 20-50 ml.;
• dichloroethane - 5 ml.

Methanol is broken down in the human body to formic acid and formaldehyde. These substances are highly toxic and cause severe CNS damage. 7 ml. enough for acute poisoning with fainting and loss of vision. 50 cause lightning death.

Poisoning by alcohol substitutes is very dangerous, as it is often accompanied by severe pathological lesions of the liver, kidneys, and central nervous system. Such lesions often end in the death of the poisoned.

Some poisonings are associated with the use of low-quality alcohol, but in most cases poisoning with alcohol substitutes occurs in chronic alcoholics who use household chemicals, medicinal liquids and technical alcohols.

Classification of alcohol surrogates

What are alcohol substitutes? These are liquids containing alcohol, used in everyday life and for technical needs. They are used for the purpose of intoxication, when ordinary alcoholic beverages are not available. The group of alcohol surrogates can also include low-quality / counterfeit wine, cognac, vodka and other types of alcoholic beverages.

Treatment begins with urgent gastric lavage and the introduction of sodium sulfate through a tube. In case of methanol poisoning, the patient is given ethanol (antidote) orally or a 2-5% alcohol solution is injected intravenously.

In case of poisoning with substances containing ethylene glycol, sodium bicarbonate solution administered orally or intravenously is used to eliminate acidosis. The tactics of further treatment in case of poisoning with true surrogates is determined by the identified violations on the part of various organs and systems.

All patients undergo detoxification therapy, prescribe vitamins, nootropics, etc.

In case of poisoning with alcohol surrogates containing methanol, prednisolone, atropine, ATP and lumbar punctures are used to correct visual impairment. With ethylene glycol poisoning, the first priority is to combat kidney damage.

Patients are prescribed diuretics, drinking plenty of fluids and magnesium sulfate. Carry out correction of water-salt balance.

In severe cases, hemodialysis or peritoneal dialysis is performed. The prognosis for poisoning with alcohol substitutes is determined by the type and amount of fluid taken.

After the use of true surrogates, death rarely occurs, and long-term consequences are possible as a result of damage to internal organs. As a result of taking substances containing methanol and ethylene glycol, a fatal outcome is often observed, many surviving patients become disabled.

Titles

Alcohol poisoning.

Titles

Russian name: Piracetam.
English name: Piracetam.

Latin name

Piracetamum (Piracetami).

chemical name

2-Oxo-1-pyrrolidineacetamide.

Pharm Group

Nootropics.

Nosology

A89 Viral infection of the central nervous system, unspecified.
D57 Sickle cell disorders.
F00 Dementia in Alzheimer's disease (G30).
F01 Vascular dementia.
F03 Dementia, unspecified.
F04 Organic amnestic syndrome not caused by alcohol or other psychoactive substances.
F05 Delirium not caused by alcohol or other psychoactive substances.
F06.7 Mild cognitive impairment.
F07.1 Postencephalitic syndrome.
F07.2 Post-concussion syndrome.
F07.9 Organic disorder of personality and behavior due to disease, damage or dysfunction of the brain, unspecified.
F09 Organic or symptomatic mental disorder, unspecified.
F10.2 Alcohol dependence syndrome.
F10.3 Withdrawal state.
F10.4 Withdrawal state with delirium.
F10.5 Alcoholic psychosis.
F11 Mental and behavioral disorders caused by the use of opioids.
F13 Mental and behavioral disorders due to the use of sedatives or hypnotics.
F29 Nonorganic psychosis, unspecified
F32 Depressive episode.
F34.1 Dysthymia.
F41.2 Mixed anxiety and depressive disorder.
F48.0 Neurasthenia.
F60.3 Emotionally unstable personality disorder.
F63 Disorders of habits and drives.
F79 Mental retardation, unspecified
F80 Specific developmental disorders of speech and language.
F90.0 Violation of activity and attention.
F91 Conduct disorders.
G21.8 Other forms of secondary parkinsonism.
G25.3 Myoclonus.
G30 Alzheimer's disease.
G40.9 Epilepsy, unspecified.
G46 Vascular cerebral syndromes in cerebrovascular diseases.
G80 Infantile cerebral palsy.
G93.4 Encephalopathy, unspecified.
H55 Nystagmus and other involuntary eye movements.
I61 Intracerebral hemorrhage.
I63 Cerebral infarction.
I67.2 Cerebral atherosclerosis.
I69 Consequences of cerebrovascular diseases.
P15 Other birth injuries.
P91 Other disorders of cerebral status of the newborn.
R26.8 Other and unspecified disorders of gait and mobility
R40.2 Coma, unspecified.
R41.0 Disorientation, unspecified.
R41.3. 0* Reduced memory.
R41.8. 0* Intellectual-mnestic disorders.
R42 Dizziness and impaired stability.
R45.1 Restlessness and agitation.
R46.4 Lethargy and delayed reaction.
R47.0 Dysphasia and aphasia.
R51 Headache.
R53 Malaise and fatigue.
R54 Old age.
S06 Intracranial injury.
T40 Drug and psychodysleptic [hallucinogen] poisoning.
T42.3 Barbiturate poisoning.
T51 Toxic effect of alcohol.
Z55 Problems related to learning and literacy.

CAS code

Substance characteristic

Cyclic derivative of GABA.

Pharmacodynamics

Pharmacological action - nootropic.
Pharmacodynamics.

Improves connections between the hemispheres of the brain and synaptic conduction in neocortical structures, improves cerebral blood flow.
It has an effect on the central nervous system in various ways: it modifies neurotransmission in the brain, improves metabolic conditions that promote neuronal plasticity, improves microcirculation by affecting the rheological characteristics of the blood and does not cause vasodilation.
With cerebral dysfunction, it increases concentration and improves cognitive functions, including the ability to learn, memory, attention and consciousness, mental performance, without having a sedative or psychostimulating effect. The use of piracetam is accompanied by significant changes in the EEG (increase in α- and β-activity, decrease in δ-activity).
Helps restore cognitive abilities after various cerebral injuries due to hypoxia, intoxication or electroconvulsive therapy.
It is indicated for the treatment of cortical myoclonus both as monotherapy and as part of complex therapy.
Reduces the duration of vestibular neuronitis and nystagmus.
The hemorheological effects of piracetam are associated with its effect on erythrocytes, platelets and the vascular wall.
In patients with sickle cell anemia with pathological rigidity of erythrocytes, piracetam restores the elasticity of the erythrocyte membrane, increases their ability to deform and filter, reduces blood viscosity and prevents the formation of coin columns. In addition, it inhibits the increased aggregation of activated platelets without significantly affecting their number. At a dose of 9.6 g, it reduces the level of fibrinogen and von Willebrand factor by 30–40% and prolongs bleeding time.
Animal studies have shown that piracetam inhibits vasospasm and counteracts various vasospastic substances.
In studies on healthy volunteers, piracetam reduced the adhesion of erythrocytes to the vascular endothelium and stimulated the production of prostacyclins in the endothelium.

Definition and background[edit]

Acute intoxication with alcohol (without consequences and the formation of the disease).

Etiology and pathogenesis[edit]

Types of alcohol intoxication

1. Simple alcohol intoxication.

Alcohol intoxication with hebephrenic features;

Alcoholic intoxication with hysterical features.

2. Pathological intoxication.

Clinical manifestations[edit]

Acute alcohol intoxication: Diagnosis[edit]

- violation of concentration;

Narrowing of mental possibilities;

Decreased mental and industrial productivity.

Negative Romberg test;

A thorough somatoneurological examination of the patient is necessary, taking into account the possibility of injuries and infections. The patient should always be examined for possible multi-substance intoxication.

Differential diagnosis[edit]

Acute alcohol intoxication: Treatment[edit]

Indications for hospitalization

1. The presence of convulsive phenomena.

2. Concomitant acute consequences of TBI.

4. High temperature.

5. Physical exhaustion or dehydration.

7. Severe depression or obvious risk of suicidal behavior.

Therapeutic measures include monitoring the patient, symptomatic therapy, and, if necessary, parenteral nutrition.

Bibliography

BP - blood pressure

ADH - alcohol dehydrogenase

ALAT - alanine transferase

ASAT - aspartate transferase

GGTP - gamma-glutamyl transpeptidase

GGTP - gamma-glutamyl transferase

HD - hemodialysis

HDF - hemodiafiltration

GLC - gas liquid chromatography

GIT - gastrointestinal tract

IVL - artificial lung ventilation

KOS - acid-base state

CT - computed tomography

CPK - creatine phosphokinase

LDH - lactate dehydrogenase

ICD10 - International Statistical Classification Classification of Diseases and Related Health Problems, Tenth Revision

MRI - magnetic resonance imaging

ARDS - acute respiratory distress syndrome

ICU - intensive care unit

PZh - gastric lavage

Ultrasound - ultrasonography

FBS - fibrobronchoscopy

FD - forced diuresis

CVP - central venous pressure

AP - alkaline phosphatase

EC - ethyl alcohol

EGDS - esophagogastroduodenoscopy

ECG - electrocardiography (cardiogram)

EEG - electroencephalography

EAPCCT – European Association of Poison Centers and Clinical Toxicologists

LD - lethal (lethal) dose

Rg - radiograph

Terms and Definitions

In response to the question “what is surrogate alcohol”, it is worth conveying to the reader the information that surrogate alcoholic beverages are considered to be those that were produced in an artisanal way in violation of the recipe or those that have expired.

Such alcohol is so toxic to the human body that in ICD 10 (International Classification of Diseases) such conditions have their own code. In particular, it is poisonings of this type that are indicated by coding in the T51 range.

Moreover, according to ICD-10, each component, which is the main active ingredient in a surrogate drink, is classified with certain codes.

All low-quality (surrogate) alcoholic beverages can be divided into two main groups:

• Alcohol containing ethyl alcohol and its derivatives. These include drinks based on butyl alcohol (lethality within an hour when taking 30 ml), sulfite and hydrolytic alcohol, industrial alcohol or denatured alcohol. Also included in this category are all lotions / colognes / polishes and stains. In the latter case (when using stain), the skin and mucous membranes of the patient become blue.
• False surrogate. This is the most dangerous category of low-quality alcoholic beverages for human life. To reduce the cost of alcohol production, methyl alcohol or ethylene glycol is used here instead of ethanol. Both lead to paralysis or death of the person.

0 Thus, the term alcohol is essentially used as a synonym for alcoholic beverages.

Alcohol intoxication is a phrase that characterizes a health disorder caused by excessive consumption of alcoholic beverages. Historically, the term "alcohol intoxication" is used by medical specialists of various profiles, including toxicologists, psychiatrists-narcologists (mainly), forensic doctors.

Currently, the concept of "alcohol intoxication" is present in the ICD10 under the code F10 - Mental and behavioral disorders caused by alcohol, including: F.10. 0 "Acute intoxication" - as acute intoxication with alcoholism and alcohol intoxication.

At the same time, it is customary to distinguish the following clinical forms: acute alcohol intoxication: simple alcohol intoxication; altered forms of alcohol intoxication; pathological intoxication; chronic alcoholism 1, 2, 3 stages; alcoholic psychoses (alcoholic delirium, acute alcoholic hallucinosis, acute alcoholic paranoid, etc.).

"Chronic alcohol intoxication" characterizes a disease that has developed as a result of prolonged abuse of ES and is not accompanied by coma (with the exception of the terminal stage of multiple organ failure).

For this disease, various behavioral and mental disorders are more characteristic. The substitution of the concepts of "alcohol intoxication", "acute alcohol intoxication" and "alcohol poisoning" often leads to incorrect diagnosis, hospitalization and therapy of the victim.

Alcoholic coma is a coma that has developed as a result of the use of ES mainly in the form of alcoholic beverages in a toxic / lethal dose with the appearance of a toxic / lethal concentration of ethanol in the blood.

Alcohols are an extensive and very diverse class of organic compounds: they are widely distributed in nature, are of great industrial importance and have exceptional chemical properties.

Aliphatic saturated alcohols with a long chain of up to 5 carbon atoms (methyl, ethyl, propyl, butyl and amyl) have the greatest toxicological significance.

The toxic effect of alcohol (according to the ICD10 wording) implies a health disorder caused by the ingestion of one or more representatives of this group and is interpreted as acute poisoning.

At the same time, from the standpoint of clinical characteristics, the leading value, both in terms of the frequency of occurrence of this pathology and medical consequences, is poisoning with ES (ethanol) or a commonly used concept - alcohol poisoning, which, from the standpoint of toxicologists, is a disorder of consciousness (coma) caused by excessive simultaneous intake of ethanol.

Poisoning with other alcohols of this group can manifest itself with various symptoms with preserved consciousness.

Given the higher toxicity and the specificity of clinical manifestations and complications, these recommendations do not consider the toxic effect (poisoning) of methanol (methyl alcohol), which is separated into separate clinical recommendations.

Surrogate alcoholic products are considered to be those drinks that were not originally intended for drinking. Conventionally, they can be divided into 2 groups.

First group

Short description

Acute alcohol poisoning (ethanol) is usually associated with the ingestion of ethyl alcohol or drinks containing more than 12% ethyl alcohol. The lethal concentration of ethanol in the blood is 5–8 g.l, the lethal single dose is 4–12 g.kg (300–500 ml of 96% ethanol); however, this rate varies from patient to patient and often depends on acquired tolerance to alcohol.

Acute alcohol poisoning is most widespread in countries of northern and middle latitudes.

Frequency. 25% of all acute poisonings. More than 60% of all fatal poisonings are due to alcohol. The predominant gender is male. Risk factors Alcoholism (about 90% of those hospitalized with acute alcohol poisoning are alcoholics) Drinking alcohol on an empty stomach (food masses in the stomach slow down the absorption of alcohol) Alcoholic beverages with a strength of up to 30% are absorbed faster.

Acute poisoning with alcohol substitutes is associated with the intake of ethyl alcohol containing impurities of various substances prepared on the basis of ethanol or other monohydric or polyhydric alcohols.

Alcohol surrogates prepared on the basis of ethyl alcohol containing various impurities. The clinical picture, course and treatment are similar to those for alcohol intoxication (see.

When ingested - alcohol intoxication; intense staining of the skin and mucous membranes in blue, which persists for 3-4 months. Differential diagnosis - methemoglobinemia.

Alcohol surrogates that do not contain ethyl alcohol and are other monohydric or polyhydric alcohols (false surrogates) Methyl alcohol (methanol, wood alcohol). The lethal dose when taken orally is about 100 ml (without prior intake of ethanol).

The toxic concentration in the blood is 300 mg/l, the lethal concentration is more than 800 mg/l. Ethylene glycol is classified as a dihydroxy higher alcohol; is part of antifreeze and brake fluid. The lethal dose when taken orally is 100 ml.

Symptoms

Poisoning by alcohol surrogates can manifest itself in different ways, it directly depends on what was drunk and in what quantity. If it was a substance from group I, then most likely the threat to life will not be very big and poisoned in 9 cases out of 10 it will be possible to “pump out” safely.

But if we are talking about the internal use of group II surrogates, then the poisoning will be extremely difficult, and the consequences can be the most unpredictable.

Intoxication with alcoholic surrogates includes such initial symptoms as:

• emotional arousal;
• increased physical activity;
• strong euphoria;
• dizziness, loss in space;
• redness of the skin of the face;
• profuse salivation;
• physical and emotional relaxation.

After some time, intoxication begins to manifest itself in the following symptoms:

• pale skin;
• severe dry mouth;
• frequent urination;
• dilated pupils that do not respond to light;
• impaired motor coordination;
• the affected nervous system;
• labored breathing;
• loss of the ability to speak and reason.

The first sign of alcohol poisoning is loss of consciousness, deep sleep, coma. There are three stages of coma in alcohol poisoning according to severity.

superficial coma. The pupils are constricted, but react to light.

From the mouth - a sharp smell of the alcoholic beverage that the patient had previously consumed. When trying to revive the vapors of ammonia, the patient reacts with an appropriate grimace and protective movements of the hands, but does not come to his senses.

The prognosis is usually favorable. If at this stage the patient is given a gastric lavage with the help of a gastric tube, then he quickly regains consciousness.

Coma of moderate severity. It differs from the previous one by a pronounced relaxation of muscle tone.

It reacts weakly to the inhalation of ammonia vapors. Gastric lavage does not bring recovery of consciousness.

Such patients require hospitalization in the toxicology department. deep coma.

Complete absence of tendon reflexes. The pupils are constricted or (in violation of breathing) wide and do not react to light.

Pain sensitivity and reaction to ammonia is absent. Requires emergency hospitalization in the toxicology department.

You should know that all types of alcohol intoxication can be accompanied by a retraction of the tongue, which blocks the access of air to the larynx and lungs, the ingress of mucus and vomit into the respiratory tract.

Blood pressure in a state of mild coma is usually increased, but in a state of deep coma it drops to critical numbers. Characterized by increased heart rate.

Alcoholic coma should be distinguished from a traumatic brain injury (often drunk people have a combination of both), from a stroke, and also from drug poisoning.

If the poisoned person drank surrogates with ethanol in the composition, this is not so bad, although sometimes in these cases the poisoning is too difficult. Of particular danger are alcohols from the group that does not contain ethanol. When poisoned by them, a person first looks like with ordinary alcohol intoxication:

• the drinker's face turns red;
• the person becomes excited emotionally and physically;
• a state of euphoria appears;
• increased sweating;
• saliva is produced more abundantly;
• excitement is replaced by relaxation.

• the skin turns pale;
• pupils become wider;
• dry mouth;
• increased diuresis;
• movements become uncoordinated, their amplitude expands;
• physical and mental activity increases again;
• attention weakens;
• speech becomes slurred and unintelligible.

These symptoms of poisoning are still more like a high degree of intoxication. However, when using different surrogates, the signs will differ.

methanol

Quickly absorbed into the blood, methanol deals a crushing blow to the kidneys and nervous system. As a result of the poisoning effect, a number of characteristic symptoms will appear in a person:

• the optic nerve is affected;
• a person is sick and vomits;
• vision worsens (black dots appear, double vision, vision of objects becomes blurry, blindness may gradually develop);
• the pupils are dilated, the response to the light stimulus is insufficient.

After 1-2 days, other signs of poisoning with burned vodka or other counterfeit alcoholic beverages are added:

• the whole body hurts (aches in the muscles, lower back and joints, pains and pains in the abdomen are felt);
• the temperature rises to 38 ° C;
• pressure drops;
• drying of the mucous membranes and skin is observed;
• the heart works intermittently;
• consciousness becomes clouded;
• agitation and convulsions occur.

As symptoms increase without assistance, a coma occurs in a person, followed by paralysis and death.

ethylene glycol

This surrogate is also rapidly absorbed, and the liver and kidneys suffer from its toxic effects. In severe intoxication, damage to the nervous system is observed. The clinical picture develops progressively, according to the three stages of poisoning:

1. Early. The first 12 hours after drinking surrogate alcohol, symptoms of intoxication do not appear. The man looks just drunk, but he still does not complain about his health.
2. Toxic damage to the nervous system. At this stage, a person vomits, there are complaints of headache, thirst. Diarrhea appears, the skin and mucous membranes become bluish, the temperature rises and the pupils dilate. It is difficult for the poisoned person to breathe, the heart beats rapidly, and the excitation phase begins. If you do not help, the victim will lose consciousness, and he will begin to have convulsions.
3. Hepato- and nephrotoxic stages. This stage begins on 2-3 days. A person's kidneys and liver fail. The skin turns yellow, itching begins. Urine darkens, its production decreases and disappears altogether. Liver and kidney failure develops, resulting in organ failure.

The symptoms of poisoning with alcoholic surrogates differ depending on which group they belong to. They will be more favorable if they are alcoholic surrogates of the first group containing ethyl alcohol, and more severe and dangerous in case of methanol or ethylene glycol poisoning, so they should be considered in more detail.

Symptoms of poisoning with surrogates containing ethyl alcohol

Clinically observed first signs of alcohol intoxication:

• emotional and motor excitement;
• redness of the face;
• state of euphoria;
• sweating;
• increased salivation;
• feeling of mental and physical relaxation.

Poisoning by alcohol surrogates microbial 10 (International Classification of Diseases) is represented by codes T51.1 - T52.9.

Symptoms will depend, first of all, on the type of surrogate accepted. So, in people poisoned by alcohol with ethanol, the symptoms are not so dangerous. Substitutes that do not contain ethyl alcohol are of great danger.

In both cases, common symptoms will be nausea, vomiting, abdominal pain, and dizziness. They are similar to those that occur with ordinary poisoning. It is possible to determine the type of accepted surrogate by the symptoms characteristic of each of them.

This poisoning is not so scary compared to the poisoning by surrogates of the second group, since ethanol is used to make alcoholic beverages. First, a person gets drunk, feels relaxed, peaceful, is in a euphoric state.

With further use of the surrogate, symptoms of ordinary poisoning appear, as well as:

• Pale face, skin;
• A person increasingly wants to go to the toilet;
• pupils dilate;
• Dryness appears in the mouth, a person is thirsty;
• The person cannot control his movements;
• It is difficult for a poisoned person to speak, speech is confused;
• There may be confusion or loss of consciousness.

Methanol or wood alcohol acts on the body as psychotropic drugs. You can die by taking only 50 milliliters of the substance. Symptoms of methanol poisoning include:

• Symptoms of ordinary poisoning: nausea, dizziness, etc.;
• Virtually no sense of intoxication;
• Dilated pupils that do not respond to light
• Vision problems: inability to focus, black dots before the eyes, etc.;
• A few days after the poisoning of the patient, pain in the joints and muscles begins to bother;
• The temperature rises;
• The skin becomes dry, as do the mucous membranes;
• The pressure drops;
• The patient is worried about the heartbeat;
• Consciousness is confused;
• The person becomes agitated, which may be accompanied by convulsions.

Ethylene glycol quickly spreads throughout the body, and the main blow is taken by the liver and kidneys, since it is through them that the substance is excreted. Symptoms of ethylene glycol poisoning include:

• Feeling of intoxication in the first 12 hours, no signs of poisoning;
• Then nausea, vomiting, diarrhea begin;
• There is a feeling of thirst;
• The skin acquires a blue tint, as do the mucous membranes;
• Pupils dilate;
• The temperature rises;
• It becomes difficult to breathe;
• The heartbeat quickens.

If the patient does not seek help or treatment does not help, his skin begins to turn yellow, the kidneys and liver fail, the skin itches and the urine darkens. In this case, death is possible.

Russia is among the top ten countries in the world in terms of the number of people who abuse alcohol.

A huge number of deaths occur from poisoning with alcohol substitutes, the use of which leads to serious intoxication of the body, in most cases ending in the death of a person.

It is rarely possible to save people, because not everyone pays attention to the terrible symptoms of poisoning with burned vodka, the development of which quickly leads to death. Knowing how to help the victim will save him from death.

What is surrogate alcohol

Alcohol is drunk in order to change the emotional state to a more comfortable one. However, there are products approved by the state for ingestion that have been certified, and there are products that are not intended for drinking at all.

Why do we need surrogate vodka and analogues? Such a “singed” product is cheaper than a certified one, it is easier to get it, and the effect of intoxication is almost the same. Poisoning by surrogates, according to the classification codes according to ICD 10, belongs to the groups of diseases T5.1.1 - T5.2.

9. Surrogate alcohol includes:

• Chemical liquids containing ethyl alcohol as the main component - lotions, cosmetic and medicinal tinctures, methylated spirits, technical alcohols, insect stains.
• Deceptive or false substitutes for alcohol-containing drinks, in which there is no ethanol, but there is methanol, dichloroethane, ethylene glycol.

Poisoning from surrogate alcohol containing ethyl alcohol is very common, as alcoholics consider such liquids to be the safest to drink.

However, all these substances are by no means intended for the human body; they contain a high concentration of potent chemicals, the impact of which destroys internal organs.

These include: BF-based glue, glass cleaners, colognes, deodorants, mouth fresheners, and other household chemicals that contain ethyl alcohol.

False surrogates

Poisoning by alcohol surrogates, which do not contain ethyl alcohol, is considered the most severe and leads to almost instant death, since methyl alcohol, ethylene glycol are quickly absorbed by the body and decompose into separate, extremely toxic substances.

At best, when using methyl alcohol, the alcoholic will get off with blindness. Ethylene glycol is part of the brake and defrosting fluid for cars, dichloroethane is a solvent for adhesive bases.

The WHO organization presents impressive and terrible figures - approximately 60% of men in Russia aged 15 to 60 die from intoxication with surrogates, which dramatically reduces the age of survival for men to retirement in the country to 59 years instead of 75, as, for example, in the UK.

Ethanol is a toxic substance, and poisoning with alcohol and its surrogates depends on the individual reaction of the body. A lethal dose for any person is considered to be three bottles of cognac, drunk with an interval of less than 5 hours.

At the same time, doctors stipulate that for fakes, the lethal dose may not exceed one sip, depending on the concentration of toxins in the substance that the person drinks.

Paradoxically, an immoderate snack can lead to death, because the body does not have time to cope with the incoming food that accumulates in the digestive tract, and alcohol is simply not absorbed at first, but then it enters the blood in huge quantities, which can lead to death.

The mechanism of action of poison on the body

Each toxic substance acts on the internal organs in its own way, however, since the poison passes through the digestive tract, all organs of the gastrointestinal tract are at risk, from the stomach to the kidneys.

Unable to cope with incoming poisons, the gastric mucosa reacts with ulcerative formations.

Approximately one third of methanol and ethylene glycol are excreted by the kidneys, which leads to acute organ failure, up to the absence of urination, the rest enters the blood, causing a serious blow to the cells of the central nervous system, up to cardiac arrest.

Signs of alcohol poisoning

It is not uncommon for people to buy a bottle of alcohol in a store, labeled and certified, which turns out to be “burnt”.

It is difficult to notice poisoning by surrogates if alcohol is drunk in a cheerful company, especially when you consider that the first signs of the effect of alcohol are euphoria, emancipation, high spirits.

And only a few hours after drinking alcohol with toxic impurities, frightening symptoms of a hangover may appear, indicating that poisoning by alcohol surrogates has occurred.

ethyl alcohol

Poisoning by alcohol substitutes in most cases is fatal if the victim is not provided with emergency medical care in time. The poison quickly not only affects the organs of the gastrointestinal tract, but also spreads through the blood throughout the body. A person experiences severe intoxication, the symptoms of which can be very painful.

Alcohol surrogates are conditionally divided into several types. The first is those that contain ethyl alcohol. It can be cosmetics, liquids for cleaning household items, etc.

The second type is surrogates that do not contain ethyl alcohol. These include means for processing materials against the negative effects of insects, mold, as well as dyes, adhesives, etc. There is also a third type. It's called false surrogates.

Poisoning by alcohol surrogates occupies a leading position in the statistics of all intoxications. Moreover, 98% of patients die before hospitalization. A brief description of the alcohol surrogate will help to understand the reason for such a high mortality rate.

What are alcohol substitutes? What are the signs of poisoning with such an alcoholic fake? How to help the victim? What are the consequences of such intoxication? We will analyze the answers to these questions in this article.

Alcohol carries a considerable danger to the body. Using a poor quality product can not only poison you, but also die.

According to statistics, poisoning by alcohol substitutes occurs quite often and often leads to irreparable consequences. For example, in Russia in 2011, according to statistics, about 11,700 people died from poisoning, but the true result exceeds this figure.

And every year the number of victims of the surrogate is growing.

Symptoms of poisoning with surrogates are different, since everything depends on the type of substance and its amount. A more favorable prognosis with the use of low-dangerous surrogates. And in case of poisoning with methanol and ethylene glycol, the consequences are severe and most often fatal.

Since there are 2 groups of surrogates, it is important to understand that the symptoms will also differ greatly depending on the cause of the poisoning. Even if it is known which group the surrogate that provoked the poisoning belonged to (for example, it was a true surrogate), it is necessary to know what kind of impurity was contained in the drink in order to competently help the victim.

Symptoms of poisoning with true surrogates

Signs of poisoning with surrogates are similar to those that indicate that the patient has consumed ethyl alcohol, but in the first case, the malaise is more pronounced and is observed after a shorter period of time. The consequences of poisoning with a base alcoholic drink depend on the amount of alcohol ingested.

When poisoned by true surrogates, intoxication occurs due to toxic impurities. For example, after drinking hydrolytic alcohol, all the same symptoms appear as after drinking high-quality alcohol:

• nausea;
• vomit;
• weakness;
• drowsiness;
• sudden changes in blood pressure.

However, the speed of manifestation of the first signs is much higher. Intoxication is often recorded with the use of drugs for the heart on an alcohol basis. In this case, the symptoms of poisoning will be added:

• bradycardia;
• decompensated dysfunction of the myocardium.

Surrogate alcohol poisoning is often provoked by the use of alcohol-containing products for external use. In this case, the patient will experience a sharp blue of the lips and mucous membranes, and the blood will become more brown. This is due to the presence of anestezin in the composition, which tends to prevent oxygen from entering the tissues and internal organs.

The use of alcohol in the form of cosmetics leads to disruption of the functioning of the digestive tract along with signs of simple alcohol poisoning. This is due to the presence of butyl and methyl alcohols in most cosmetic products, which can lead to acute gastritis and even provoke the development of hepatitis.

When using the stain, a change in the color of the mucous membranes is observed, but this is due to the presence of dyes in the composition.

The main harm of moonshine lies in the danger of fusel oils, which have an extremely destructive effect on the liver and lead to acute liver failure, and in the most advanced cases, even to cirrhosis. To provoke severe poisoning by surrogates of this group, you need to drink a relatively small portion of an alcoholic liquid.

Symptoms of poisoning with false surrogates

The most common "substitute" for ethyl alcohol is methyl alcohol, which in itself does not cause much harm to the human body. The main danger is represented by its decomposition products - formic acid and formaldehyde.

It is possible to avoid acute poisoning with surrogate alcohol if ethyl alcohol is present along with methyl alcohol in the composition of the drink. The thing is that ethanol is an “antidote” that prevents the transformation of methanol into substances harmful to the body.

Therefore, people suffering from chronic alcoholism mix two types of alcohol, but such experiments are extremely dangerous to health.

A small dose of a surrogate causes a mild stage of intoxication, during which a person feels satisfactory, only the main signs of alcohol intoxication appear. Poisoning with low-quality alcohol occurs at the end of this "hidden" period.

If the amount of alcohol taken is a little more, signs of intoxication appear instantly: in just a few hours, a fatal outcome can occur if the person is not given proper assistance.

With a mild and moderate degree of poisoning, the following are observed:

• a sharp deterioration in vision with its subsequent restoration;
• dizziness;
• nausea.

In the severe stage, there are very pronounced symptoms of acute alcohol poisoning. A person can fall into an alcoholic coma within 2 hours after the onset of the first symptoms:

• drowsiness;
• violation of self-control;
• sudden changes in blood pressure;
• strong thirst;
• pain in the joints.

Another common substitute for ethyl alcohol is ethylene glycol, which is present in brake fluid. The danger is the decomposition products of this substance, the most toxic of which is oxalic acid, which causes kidney damage. Main symptoms:

• redness of the skin;
• change in the color of the mucous membranes;
• increase in heart rate;
• hyperthermia;
• violation of the perception of the surrounding world;
• psychomotor disorders;
• convulsions.

Oxalic acid leads to acute heart failure, disrupts the liver and provokes acute kidney failure, which is the most common cause of death in human poisoning with ethylene glycol.

At the first signs of poisoning by surrogates, it is necessary to seek qualified help, as the ailment progresses at a very high rate. The first aid should always be gastric lavage with warm water.

Further treatment measures directly depend on the cause of the poisoning:

1. methanol. For treatment, ethanol is used in small doses, which prevents the breakdown of methanol. Atropine and prednisolone are used to restore vision.
2. Ethylene glycol. Sodium bicarbonate solution is used. It is necessary to correct the water and electrolyte balance and drink diuretics to restore kidney function.
3. True surrogates. Here, treatment is prescribed depending on which organs and systems of the body are affected. It all depends on the amount of alcohol taken and its type.

Alcohol poisoning and any of its surrogates can be extremely dangerous. Surrogate alcohol very often leads to death, and many people who have been treated after poisoning by surrogates become disabled. It is important to protect a person from drinking such alcohol.

Surrogate alcohol has become a real national problem due to the increasing cases of poisoning with toxic compounds instead of alcoholic beverages.

The later stages of alcoholism are characterized by the degradation of personality and thinking, which leads to ill-considered actions, including drinking cheap products that are unsuitable for food consumption and life-threatening.

The impact of surrogate alcohol on mortality

Toxic doses

Surrogate alcohol has become a real national problem due to the increasing cases of poisoning with toxic compounds instead of alcoholic beverages. The later stages of alcoholism are characterized by the degradation of personality and thinking, which leads to ill-considered actions, including drinking cheap products that are unsuitable for food consumption and life-threatening.

However, not only chronic alcoholism can cause poisoning - illegally manufactured low-quality products can be found on store shelves under a harmless label.

Poisoning by alcohol and its surrogates is accompanied by a rapid loss of consciousness, the development of a soporous and coma. First of all, the brain and the circulatory system suffer from toxic drinks, therefore, in addition to impaired consciousness, the symptoms are accompanied by problems with breathing and blood vessels.

The clinical picture of poisoning may vary slightly - it all depends on the type of product that caused it. So, moonshine poisoning is accompanied by persistent irreversible changes, since this highly toxic alcoholic surrogate contains a number of heavy and dangerous compounds.

The main danger of low-quality alcohol is due to fusel oils, from which it is either not cleaned at all, as is the case with moonshine, or is partially cleaned. Moreover, it is very difficult to clean burnt vodka or moonshine at home from fusel oils.

The taste and smell of methyl alcohol are the same as those of ethyl alcohol. A lethal outcome can occur after consuming only 100 ml.

Individual sensitivity varies, so after consuming the same dose, one patient may experience more severe alcohol surrogate poisoning than another. The severity of poisoning also depends on whether the patient simultaneously took ethanol, which is an antidote to methanol - some alcoholics dilute methyl alcohol with ethyl alcohol to avoid poisoning.

However, such attempts to save are associated with an immediate risk to life. Methanol itself is not poisonous, but when it is broken down in the body, strong poisons formaldehyde and formic acid are formed.

When using a large dose, signs of poisoning by alcohol surrogates appear almost immediately, death occurs after a few hours. When taking a small dose, there is a latent period during which the patient feels satisfactory.

A mild form of poisoning with alcohol surrogates is manifested by nausea, repeated vomiting, headache, dizziness, epigastric pain, mild visual disturbances - flickering flies, impaired clarity of perception (“seen through a fog”).

Symptoms persist for several days and then gradually disappear. In case of poisoning with alcohol surrogates of moderate severity, the manifestations are similar, but all the symptoms are more pronounced.

After 1-2 days the patient loses sight. Subsequently, vision is partially restored, but then deteriorates again.

Such poisonings usually do not pose a threat to life, but can lead to visual impairment with access to disability.

Causes

The cause of severe poisoning and death of a person can be a single use of surrogates in a large dosage or their regular use over many years. Predisposing factors are:

• antisocial lifestyle;
• bad Company;
• alcohol addiction;
• burdened heredity;
• addiction;
• lack of permanent residence;
• severe family events.

Ethanol

1.2 Etiology and pathogenesis

Alcohols included in the T51 group are characterized by limited volatility and, with relatively low toxicity, acute inhalation alcohol poisoning in clinical practice practically does not occur, with the exception of cases of inhalation use of some alcohols (isopropyl) and some technical formulations containing alcohols for the purpose of drug intoxication.

The most common in clinical practice are acute oral poisoning with alcohols used for the purpose of intoxication.

Acute alcohol poisoning usually occurs when taking ethyl alcohol or various alcoholic beverages with an ethyl alcohol content of more than 12%. The lethal dose of 96% ethanol ranges from 4 to 12 g per 1 kg of body weight (approximately 700-1000 ml of vodka in the absence of tolerance).

Alcoholic coma occurs when the concentration of ethanol in the blood is 3 g.l and above, death occurs at a concentration of 5-6 g.l and above. Poisoning, as a rule, is of the nature of household - accidental, with the aim of intoxication.

Poisoning with pure higher alcohols - propyl, butyl, amyl alcohols are much less common in toxicological practice than with ethyl alcohol, poisoning with their mixture with ethyl alcohol is more common.

Lethal doses and concentrations: cases of fatal poisoning by ingestion are described - 0.1-0.4 liters of propyl alcohol or more. Death occurred in the period from 4-6 hours to 15 days, coma - when the content of propanol in the blood was about 150 mg%.

However, fatal poisoning is also described when 40 ml of alcohol is ingested. The lethal dose (LD100) of isopropyl alcohol by mouth for adults is considered to be 240 ml, lethal concentration levels vary from 0.04 mg/l in children and 4.4 mg/l in adults.

Routes of entry into the body are inhalation, oral, percutaneous, however, in clinical practice, poisoning as a result of oral intake of these alcohols predominates.

1.3 Epidemiology

Acute ES poisoning is one of the leading causes of emergency hospitalization for poisoning. According to the reports of the toxicological centers of Russia (Form No. 64), patients with this pathology amounted to 37.

9%, 30.7%. of all hospitalized in these units in 2008 - 2011, respectively.

In 2015, this figure averaged 32.7%. In federal districts, the proportion of patients hospitalized with ethanol poisoning in 2015 ranged from 7.1% in the Northwestern Federal District to 69% in the Urals and Siberian Federal Districts.

The average hospital mortality rate for ethanol poisoning was 3.0% in 2005-2012, and 4.7% in 2015. Mortality due to ethanol poisoning in relation to other causes of deaths due to poisoning in the Russian Federation is the leading factor for the same period, ranging from 55.8% in 2005 to 42.1% in 2012, 2015 - 43, 7%, other alcohols - 3.3% - 4.0%.

Criteria for assessing the quality of medical care

	Quality Criteria	Level of Evidence
	An examination by a toxicologist and / or an anesthesiologist-resuscitator was performed no later than 15 minutes from the moment of admission to the hospital
	Probe gastric lavage was performed no later than 30 minutes from the moment of admission to the hospital (if this was not carried out at the stage of primary health care)
	Forced diuresis with alkalinization of urine was performed no later than 30 minutes from the moment of admission to the hospital (in the absence of medical contraindications)
	The study of the acid-base state of the blood (pH, PaCO2, PaO2, BE, SB, BB, SO2, HbO) was performed no later than 1 hour from the moment of admission to the hospital
	A blood glucose test was performed no later than 1 hour from the moment of admission to the hospital
	A study of the level of ethanol, methanol in the blood (gas-liquid chromatography) was performed no later than 2 hours from the moment of admission to the hospital
	The study of the level of ethanol, methanol in the urine (gas-liquid chromatography) was performed no later than 2 hours from the moment of admission to the hospital
	A study of the level of 2-propanol, fusel oils in the blood (gas-liquid chromatography) was performed - if poisoning with higher alcohols is suspected
	An electrocardiographic study was performed no later than 2 hours from the moment of admission to the hospital
	An X-ray of the chest organs was performed no later than 2 hours from the moment of admission to the hospital (in a state of coma)
	An X-ray of the entire skull was performed, in one or more projections no later than 2 hours from the moment of admission to the hospital
	Performed hematocrit assessment
	Completed general (clinical) blood test
	Performed general urinalysis
	A general therapeutic biochemical blood test was performed (total bilirubin, creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total protein, urea, creatinine, potassium, sodium, calcium) at least 2 times during the period of hospitalization
	Performed ultrasound examination of the abdominal organs (complex)
	Performed intravenous drip administration of detoxification drugs (in the absence of medical contraindications)
	Therapy with hepatoprotectors was carried out (with an increase in aspartate aminotransferase and alanine aminotransferase and alkaline phosphatase more than 2 times and in the absence of medical contraindications)
	Conducted therapy with drugs to correct water and electrolyte disorders (in the absence of medical contraindications)
	A study of the level of myoglobin in the urine was performed (with an increase in the level of creatine phosphokinase and creatinine and urea more than 2 times)
	Achieved normalization of homeostasis at the time of discharge from the hospital
	Achieved recovery of consciousness at the time of discharge from the hospital
	Normalization of spontaneous breathing and hemodynamic parameters was achieved at the time of discharge from the hospital

Classification

Classification of coma due to the toxic effect (acute poisoning) of ethanol, which is subdivided by depth, respectively

coma superficial uncomplicated,

coma superficial complicated,

deep coma uncomplicated

coma deep complicated.

Toxic effect of alcohols:

2-propanol (propyl alcohol),

fusel oils (alcohol: amyl;

butyl; propyl

classified according to severity:

mild - not accompanied by loss of consciousness,

moderate severity - with a disorder of consciousness according to the type of stupor condition, toxic encephalopathy, but without complications,

severe - characterized by complete loss of consciousness (coma), which may be accompanied by various complications.

First group

Low-dangerous

Low-dangerous

The toxicology of poisoning with alcohol and its surrogates distinguishes two types of substances: those produced on the basis of ethanol and those made with the use of impurities. The first group includes the following:

1. ethanol made using hydrolysis from wood;
2. denatured alcohol;
3. cosmetic lotions, cologne;
4. glue BF - the composition includes polyvinyl acetal, phenol-formaldehyde resin, dissolved in acetone, alcohol;
5. varnish - a mixture of ethanol with butyl, amyl, acetone;
6. nigrosine - stain containing ethanol, dyes. It is used for processing wood, coloring leather products in blue.

The second variety includes chemicals that do not contain ethanol. They are made using ethylene glycol, methyl alcohol with the addition of various impurities.

Diagnostics

Should be organized immediately. The doctor initially collects an anamnesis of the disease, life, conducts a general examination, pays special attention to the smell from the mouth, the consciousness of the victim, and the skin. After that, laboratory and instrumental examination methods are prescribed. The most informative are:

• general urine analysis;
• general and biochemical blood test;
• electrocardiogram;
• Ultrasound of the abdominal cavity, heart;
• CT and MRI;
• electroencephalogram.

An ECG is usually performed by SMP doctors, which makes it possible to identify disorders that threaten the patient's life and stop them in time.

2.3.1 Chemical-toxicological laboratory diagnostics

The basis is chemical-toxicological laboratory diagnostics. It is not recommended to use for the purpose of diagnostics the determination of the presence and level of ES in the blood using the analysis of exhaled air (alcometer), since this method does not allow to determine the presence of other alcohols, is inferior in accuracy to GLC, and also does not allow obtaining the required amount of exhaled air (the most complete active expiration) in a patient in a coma).

The determination of ethyl alcohol in blood and urine is recommended to be carried out 2 times with an interval of 1 hour in order to confirm the result of the first study and determine the phase of poisoning by the ratio of ethanol concentration in these biological media (resorption or elimination).

Instrumental diagnostics has no specifics and is carried out for the purpose of differential diagnosis and monitoring of the patient's condition.

electrocardiography (ECG) - the probability of the presence of cardiomyopathy, chronic cardiac pathology (especially since the history of the life of such patients upon admission to the hospital is practically unknown),

chest radiography,

x-ray of the skull in two projections - for patients brought from the street, public places, with traces of injuries.

esophagogastroduodenoscopy (EGDS) - higher alcohols have a local irritating effect on the mucous membrane of the digestive tract (up to 2 times).

Additional instrumental diagnostic methods are recommended to be performed once in order to detect trauma, comorbidity or possible complications (ultrasound examination (ultrasound) (ECHO-scopy) of the brain, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, ultrasound of the abdominal organs, kidneys, pancreas, fibrobronchoscopy FBS.

At the stage of primary health care, it is recommended to exclude the disease or condition that caused the coma on the background of alcohol intoxication, in particular:

traumatic brain injury, acute cerebrovascular accident;

hypoglycemic coma;

infectious disease (meningitis, encephalitis, etc.)

hepatic and uremic coma, coma with endocrinological diseases, severe encephalopathy with water-electrolyte and metabolic disorders.

In the hospital, upon admission of the patient, it is also recommended to exclude the diseases or conditions listed above, and in the absence of positive dynamics after 2.0-4.0 hours after the start of infusion therapy, a more in-depth study is recommended, including chemical-toxicological, in order to exclude the presence of a combined intake of any - or psychotropic drugs or other somatic or infectious disease.

Arriving doctors will first interview witnesses of the poisoning, examine the victim himself. If necessary, medical assistance will be provided on the spot, after which the patient will be transferred to a hospital for further examination:

• a blood test from a vein to detect alcohol, which contained drunk singed vodka;
• blood for the detection of methanol;
• ECG to study the activity of the heart (is the rhythm disturbed, is there any damage to the myocardium, etc.).

After the diagnosis, when a specific surrogate is known and the true picture of the patient's condition is revealed, doctors will prescribe targeted treatment.

Methods for studying the EEG ECG (decrease in the S-T segment, negative T wave, extrasystole; with alcoholic cardiomyopathy, persistent rhythm and conduction disturbances are possible) Microdiffusion test and gas-liquid chromatography - tests for the presence of ethanol in the blood.

Differential diagnosis of TBI Acute cerebrovascular accident Poisoning by false alcohol surrogates (chlorinated hydrocarbons, methanol, ethylene glycol) Poisoning by sleeping pills, drugs and tranquilizers Hypoglycemic coma.

EEG research methods Gas-liquid chromatography. Differential diagnosis is carried out with acute alcohol poisoning.

TREATMENT Tactics of management (see Lack of positive dynamics of the patient's condition within 3 hours against the background of ongoing therapy indicates unrecognized complications (TBI, pulmonary atelectasis, etc.) or an erroneous diagnosis.

Toxic doses

2.1 Complaints and medical history

With ethanol poisoning, there are practically no complaints, since the patient is unconscious. In case of poisoning with higher alcohols with preserved consciousness, complaints are characteristic of exposure to narcotic and irritating substances: weakness, dizziness, headache, pain in the epigastric region, nausea, vomiting.

In case of poisoning with butanol, amyl alcohols, there may be complaints of diarrhea.

The anamnesis should be aimed at clarifying the following data: type of toxic substance (vodka, wine, beer, technical alcohol, solvent - its name, trade mark, etc.), dose, time of taking the toxicant.

In addition, it is advisable to find out some data from the anamnesis of life: previous diseases, injuries, bad habits.

2.2 Physical examination

In case of poisoning with ethanol, higher alcohols, it is recommended to evaluate the following:

The appearance of the skin - there is no specific color, in case of respiratory failure, shock, cyanosis of the lips, face, acrocyanosis, cold snap is noted, with a deep coma there may be moisture. It is necessary to identify the presence / absence of a rash, local changes, the so-called. "Decubitus ulcers" due to positional injury due to pressure from one's own body weight, the so-called positional pressure on certain areas of soft tissues, leading to the appearance of areas of skin hyperemia, which are often regarded as bruises, hematomas, burns, phlebitis, allergic edema, etc. and are usually detected in the early stages (1-3 days).

Assess the psychoneurological status: state of consciousness (clear, lethargy, stupor, coma, psychomotor agitation, hallucinations). In the presence of coma - assess its depth, the presence or absence of reflexes, the width of the pupils, their reaction to light, the presence (absence) of anisocoria, the state of muscle tone. When detecting anisocoria, pathological reflexes, pay attention to their constancy (“pupil play”), since with a superficial alcoholic coma, anisocoria and pathological reflexes can appear and quickly disappear.

Assess the state of breathing: adequacy, frequency, depth, uniformity of participation in the act of breathing of all parts of the chest, auscultatory picture.

Examine visible mucous membranes - some higher alcohols are irritating and can cause a burning sensation, pain when swallowing.

Pay attention to the presence / absence of injuries, especially in the face, head, abdomen, lower back.

Pay attention to the presence / absence from the exhaled air of a smell characteristic of ES, higher alcohols, but it is not an absolute fact confirming ES poisoning, since the state of alcoholic intoxication can accompany various somatic, infectious diseases, injuries.

Pharmacodynamics

Nootropics.

Pharmacological action - nootropic. Pharmacodynamics.

Piracetam binds to the polar heads of phospholipids and forms mobile piracetam-phospholipid complexes. As a result, the two-layer structure of the cell membrane and its stability are restored, which in turn leads to the restoration of the three-dimensional structure of membrane and transmembrane proteins and the restoration of their function.

At the neuronal level, piracetam facilitates various types of synaptic transmission by predominantly influencing the density and activity of postsynaptic receptors (data from animal studies).

Improves connections between the hemispheres of the brain and synaptic conduction in neocortical structures, improves cerebral blood flow. It has an effect on the central nervous system in various ways: it modifies neurotransmission in the brain, improves metabolic conditions that promote neuronal plasticity, improves microcirculation by affecting the rheological characteristics of the blood and does not cause vasodilation.

With cerebral dysfunction, it increases concentration and improves cognitive functions, including the ability to learn, memory, attention and consciousness, mental performance, without having a sedative or psychostimulating effect.

The use of piracetam is accompanied by significant changes in the EEG (increase in α- and β-activity, decrease in δ-activity). Helps restore cognitive abilities after various cerebral injuries due to hypoxia, intoxication or electroconvulsive therapy.

It is indicated for the treatment of cortical myoclonus both as monotherapy and as part of complex therapy. Reduces the duration of vestibular neuronitis and nystagmus.

The hemorheological effects of piracetam are associated with its effect on erythrocytes, platelets and the vascular wall. In patients with sickle cell anemia with pathological rigidity of erythrocytes, piracetam restores the elasticity of the erythrocyte membrane, increases their ability to deform and filter, reduces blood viscosity and prevents the formation of coin columns.

In addition, it inhibits the increased aggregation of activated platelets without significantly affecting their number. At a dose of 9.6 g, it reduces the level of fibrinogen and von Willebrand factor by 30–40% and prolongs bleeding time.

Animal studies have shown that piracetam inhibits vasospasm and counteracts various vasospastic substances. In studies on healthy volunteers, piracetam reduced the adhesion of erythrocytes to the vascular endothelium and stimulated the production of prostacyclins in the endothelium.

Nosology

A89 Viral infection of the central nervous system, unspecified. D57 Sickle cell disorders.

F00 Dementia in Alzheimer's disease (G30). F01 Vascular dementia.

F03 Dementia, unspecified. F04 Organic amnestic syndrome not caused by alcohol or other psychoactive substances.

F05 Delirium not caused by alcohol or other psychoactive substances. F06.7 Mild cognitive impairment.

F07.1 Postencephalitic syndrome. F07.2 Post-concussion syndrome.

F07.9 Organic disorder of personality and behavior due to disease, damage or dysfunction of the brain, unspecified. F09 Organic or symptomatic mental disorder, unspecified.

F10.2 Alcohol dependence syndrome. F10.3 Withdrawal state.

F10.4 Withdrawal state with delirium. F10.5 Alcoholic psychosis.

F11 Mental and behavioral disorders caused by the use of opioids. F13 Mental and behavioral disorders due to the use of sedatives or hypnotics.

F29 Nonorganic psychosis, unspecified F32 Depressive episode.

F34.1 Dysthymia. F41.2 Mixed anxiety and depressive disorder.

F48.0 Neurasthenia. F60.3 Emotionally unstable personality disorder.

F63 Disorders of habits and drives. F79 Mental retardation, unspecified

F80 Specific developmental disorders of speech and language. F90.0 Violation of activity and attention.

F91 Conduct disorders. G21.8 Other forms of secondary parkinsonism.

G25.3 Myoclonus. G30 Alzheimer's disease.

G40.9 Epilepsy, unspecified. G46 Vascular cerebral syndromes in cerebrovascular diseases.

G80 Infantile cerebral palsy. G93.4 Encephalopathy, unspecified.

H55 Nystagmus and other involuntary eye movements. I61 Intracerebral hemorrhage.

I63 Cerebral infarction. I67.2 Cerebral atherosclerosis.

I69 Consequences of cerebrovascular diseases. P15 Other birth injuries.

P91 Other disorders of cerebral status of the newborn. R26.8 Other and unspecified disorders of gait and mobility

R40.2 Coma, unspecified. R41.0 Disorientation, unspecified.

R41.3. 0* Reduced memory.

R41.8. 0* Intellectual-mnestic disorders.

R42 Dizziness and impaired stability. R45.1 Restlessness and agitation.

R46.4 Lethargy and delayed reaction. R47.0 Dysphasia and aphasia.

R51 Headache. R53 Malaise and fatigue.

R54 Old age. S06 Intracranial injury.

T40 Drug and psychodysleptic [hallucinogen] poisoning. T42.3 Barbiturate poisoning.

T51 Toxic effect of alcohol. Z55 Problems related to learning and literacy.

Poisoning by alcohol surrogates occupies a leading position in the statistics of all intoxications. Moreover, 98% of patients die before hospitalization. A brief description of the alcohol surrogate will help to understand the reason for such a high mortality rate.

What are alcohol substitutes? What are the signs of poisoning with such an alcoholic fake? How to help the victim? What are the consequences of such intoxication? We will analyze the answers to these questions in this article.

What applies to alcohol surrogates

Poisoning by alcohol surrogates in the international classification of diseases ICD-10 corresponds to codes T51.1 - T52.9.

They are divided into two groups: those surrogates of alcohol that may contain ethyl alcohol in their composition and those that may be without it. The first group includes:

The second group or they are also called "false surrogates" is represented by:

• methyl alcohol;
• ethylene glycol.

Clinical symptoms of alcohol poisoning

The symptoms of poisoning with alcoholic surrogates differ depending on which group they belong to. They will be more favorable if they are alcoholic surrogates of the first group containing ethyl alcohol, and more severe and dangerous in case of methanol or ethylene glycol poisoning, so they should be considered in more detail.

Symptoms of poisoning with surrogates containing ethyl alcohol

Clinically observed first signs of alcohol intoxication:

• emotional and motor excitement;
• redness of the face;
• state of euphoria;
• sweating;
• increased salivation;
• feeling of mental and physical relaxation.

Then intoxication is replaced by symptoms of alcohol intoxication. The skin becomes pale. Frequent urge to urinate. The pupils dilate, the mouth feels dry. Increased mental and physical activity is accompanied by impaired coordination, movements become sweeping. The concentration of attention becomes reduced, speech is slurred. Criticism of one's words and actions is sharply reduced or completely absent.

Symptoms of methanol (wood alcohol) poisoning

Methyl alcohol is rapidly absorbed in the digestive system. About 75% of the absorbed poison is excreted in the breath, the rest - in the urine. The lethal dose is 50 to 150 milliliters. The main blow in case of poisoning falls on the nervous system and kidneys. There is a psychotropic effect (pathological changes in the psyche) and a neurotoxic effect, accompanied, among other things, by damage to the optic nerves and retina.

So, when poisoning with alcohol substitutes containing methanol, the following symptoms occur:

• nausea, vomiting;
• intoxication and euphoria are weakly expressed;
• visual impairment: flashing black dots before the eyes, blurred vision, diplopia (double vision) and even blindness;
• outwardly, in such patients, the pupils are dilated, sluggishly react to light;
• 1-2 days after poisoning, pain in the abdomen, lower back, aching muscles and joints appear;
• the temperature rises to 38⁰;
• dry skin and mucous membranes;
• low blood pressure;
• interruptions in the work of the heart;
• confusion;
• bouts of excitement, accompanied by convulsions;
• as the symptoms increase, the victim falls into a coma, paralysis of the limbs develops.

Symptoms of ethylene glycol poisoning

Ethylene glycol is also rapidly absorbed in the digestive tract. About 60% of the poison is broken down in the liver, about 20–30% is excreted by the kidneys. Therefore, it is these organs that will suffer most of all, up to the development of their acute insufficiency. In severe poisoning, signs of damage to the nervous system appear.

With intoxication with this alcohol surrogate, symptoms develop over periods.

1. Early period. It lasts about 12 hours and is characterized by signs of intoxication with good health.
2. Toxic damage to the nervous system. There are: nausea, vomiting, headache, thirst, diarrhea, skin and mucous membranes become cyanotic. The pupils are dilated, body temperature rises, difficulty breathing, tachycardia, psychomotor agitation appear. Possible loss of consciousness with the development of convulsions.
3. The nephro- and hepatotoxic period develops on the 2-5th day from the onset of the disease. The clinic of hepatic and renal insufficiency is noted. Yellowness of the skin appears, which appears first on the sclera and lastly the palms turn yellow. Skin itching is characteristic, darkening of the urine may occur. Renal failure is manifested by a decrease in diuresis up to its absence.

Emergency care for poisoning with alcohol surrogates

If poisoning with alcohol surrogates is suspected, emergency care will depend on the initial state of the patient. If the patient is unconscious, then he should be laid on a flat hard surface, turn his head to one side so that there is no aspiration of vomit and call an ambulance. In case of violation of respiratory and cardiac activity, an ambulance is first called, and then an indirect heart massage and artificial respiration are already performed.

When the victim is conscious, first aid consists of the following:

• take a sorbent;
• saline laxative;
• drink an enveloping broth, for example, jelly;
• emergency hospital admission.

Treatment of poisoning with alcohol substitutes in a hospital:

1. Gastric lavage through a tube. In case of intoxication with methanol, it is repeated for 3 days. Give sorbents.
2. Antidote treatment in both cases is the same: 5% ethanol is administered intravenously. In case of mild poisoning, 30% ethyl alcohol is allowed to be taken orally.
3. In case of poisoning with ethylene glycol, calcium gluconate is administered to neutralize the breakdown products of the toxic substance.
4. Forced diuresis is performed, which is based on the drip administration of a large amount of solutions and diuretics in the absence of impaired renal function.
5. Removal of toxins from the blood is also carried out by hemodialysis.
6. Glucose with novocaine, prednisolone, vitamins of group B and C are administered.
7. In methanol poisoning, lumbar punctures are performed.
8. In severe cases of ethylene glycol intoxication, a kidney transplant may be necessary.

Consequences of alcohol poisoning

Despite the fact that the course of poisoning with alcohol substitutes containing ethyl alcohol is more favorable, the consequences can be very serious. The prognosis is determined by the number of drunk fakes, and to a greater extent by the timeliness of the medical care provided. If the patient suffered from chronic alcoholism, poisoning is more severe and there are more deaths than those who did not have alcohol dependence.

With methanol intoxication, a complete loss of vision is possible, which is not restored after the poison is removed from the body. Ethylene glycol-based surrogates lead to kidney failure. These patients usually die.

The problem of poisoning with alcoholic surrogates, unfortunately, remains relevant today. Many are faced with this disease, so knowing the signs of such intoxication will help not only provide emergency assistance to the victim in a timely manner, but also save his life!

What are alcohol substitutes? What are the signs of poisoning with such an alcoholic fake? How to help the victim? What are the consequences of such intoxication? We will analyze the answers to these questions in this article.

What applies to alcohol surrogates

Poisoning by alcohol surrogates in the international classification of diseases ICD-10 corresponds to codes T51.1 - T52.9.

They are divided into two groups: those surrogates of alcohol that may contain ethyl alcohol in their composition and those that may be without it. The first group includes:

1. Butyl alcohol. Death occurs after taking only 30 milliliters.
2. Hydrolysis and sulfite alcohols, which are obtained from wood. They are more toxic than ethanol due to the presence of a small amount of methyl alcohol in the composition.
3. Denatured alcohol or industrial alcohol. Contains some wood alcohol and aldehyde.
4. Polish contains several types of toxic alcohols.
5. The stain, together with ethanol, has dyes, from which the skin and mucous membranes of the patient become blue in color.

The second group or they are also called "false surrogates" is represented by:

• methyl alcohol;
• ethylene glycol.

Clinical symptoms of alcohol poisoning

The symptoms of poisoning with alcoholic surrogates differ depending on which group they belong to. They will be more favorable if they are alcoholic surrogates of the first group containing ethyl alcohol, and more severe and dangerous in case of methanol or ethylene glycol poisoning, so they should be considered in more detail.

Symptoms of poisoning with surrogates containing ethyl alcohol

• emotional and motor excitement;
• redness of the face;
• state of euphoria;
• sweating;
• increased salivation;
• feeling of mental and physical relaxation.

Then intoxication is replaced by symptoms of alcohol intoxication. The skin becomes pale. Frequent urge to urinate. The pupils dilate, the mouth feels dry. Increased mental and physical activity is accompanied by impaired coordination, movements become sweeping. The concentration of attention becomes reduced, speech is slurred. Criticism of one's words and actions is sharply reduced or completely absent.

Symptoms of methanol (wood alcohol) poisoning

Methyl alcohol is rapidly absorbed in the digestive system. About 75% of the absorbed poison is excreted in the breath, the rest - in the urine. The lethal dose is 50 to 150 milliliters. The main blow in case of poisoning falls on the nervous system and kidneys. There is a psychotropic effect (pathological changes in the psyche) and a neurotoxic effect, accompanied, among other things, by damage to the optic nerves and retina.

• nausea, vomiting;
• intoxication and euphoria are weakly expressed;
• visual impairment: flashing black dots before the eyes, blurred vision, diplopia (double vision) and even blindness;
• outwardly, in such patients, the pupils are dilated, sluggishly react to light;
• 1-2 days after poisoning, pain in the abdomen, lower back, aching muscles and joints appear;
• the temperature rises to 38⁰;
• dry skin and mucous membranes;
• low blood pressure;
• interruptions in the work of the heart;
• confusion;
• bouts of excitement, accompanied by convulsions;
• as the symptoms increase, the victim falls into a coma, paralysis of the limbs develops.

Ethylene glycol is also rapidly absorbed into

digestive tract. About 60% of the poison is broken down in the liver, about 20–30% is excreted by the kidneys. Therefore, it is these organs that will suffer most of all, up to the development of their acute insufficiency. In severe poisoning, signs of damage to the nervous system appear.

1. Early period. It lasts about 12 hours and is characterized by signs of intoxication with good health.
2. Toxic damage to the nervous system. There are: nausea, vomiting, headache, thirst, diarrhea, skin and mucous membranes become cyanotic. The pupils are dilated, body temperature rises, difficulty breathing, tachycardia, psychomotor agitation appear. Possible loss of consciousness with the development of convulsions.
3. The nephro- and hepatotoxic period develops on the 2-5th day from the onset of the disease. The clinic of hepatic and renal insufficiency is noted. Yellowness of the skin appears, which appears first on the sclera and lastly the palms turn yellow. Skin itching is characteristic, darkening of the urine may occur. Renal failure is manifested by a decrease in diuresis up to its absence.

Emergency care for poisoning with alcohol surrogates

If poisoning with alcohol surrogates is suspected, emergency care will depend on the initial state of the patient. If the patient is unconscious, then he should be laid on a flat hard surface, turn his head to one side so that there is no aspiration of vomit and call an ambulance. In case of violation of respiratory and cardiac activity, an ambulance is first called, and then an indirect heart massage and artificial respiration are already performed.

• take a sorbent;
• saline laxative;
• drink an enveloping broth, for example, jelly;
• emergency hospital admission.

Treatment of poisoning with alcohol substitutes in a hospital:

1. Gastric lavage through a tube. In case of intoxication with methanol, it is repeated for 3 days. Give sorbents.
2. Antidote treatment in both cases is the same: 5% ethanol is administered intravenously. In case of mild poisoning, 30% ethyl alcohol is allowed to be taken orally.
3. In case of poisoning with ethylene glycol, calcium gluconate is administered to neutralize the breakdown products of the toxic substance.
4. Forced diuresis is performed, which is based on the drip administration of a large amount of solutions and diuretics in the absence of impaired renal function.
5. Removal of toxins from the blood is also carried out by hemodialysis.
6. Glucose with novocaine, prednisolone, vitamins of group B and C are administered.
7. In methanol poisoning, lumbar punctures are performed.
8. In severe cases of ethylene glycol intoxication, a kidney transplant may be necessary.

Consequences of alcohol poisoning

With methanol intoxication, a complete loss of vision is possible, which is not restored after the poison is removed from the body. Ethylene glycol-based surrogates lead to kidney failure. These patients usually die.

The problem of poisoning with alcoholic surrogates, unfortunately, remains relevant today. Many are faced with this disease, so knowing the signs of such intoxication will help not only provide emergency assistance to the victim in a timely manner, but also save his life!

Poisoning by alcohol and its surrogates? Symptoms and signs. First aid for alcohol poisoning, what to do?

Poisoning by alcohol surrogates code for ICb 10

Poisoning by alcohol substitutes

Acute poisoning with alcohol substitutes: signs and symptoms, diagnosis, treatment

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Poisoning by ethanol and alcohol surrogates

Ethanol (ethyl alcohol), a well-known component of alcoholic beverages, is a transparent, volatile, water-soluble liquid with a characteristic odor for alcohols.

It is used extremely widely both in purified form and as part of many technical fluids, cosmetics, etc. Poisoning causes massive intake into the body.

ICD-10 T51 Toxic effect of alcohol T51.0 Toxic effect of ethanol T51.1 Toxic effect of methanol T51.2 Toxic effect of 2-propanol T51.3 Toxic effect of fusel oils T51.8 Toxic effect of other alcohols T51.9 Toxic effect of alcohol, unspecified T52 Toxic effect of organic solvents T52.3 Toxic effect of glycols T52.4 Toxic effect of ketones T52.8 Toxic effect of other organic solvents T52.9 Toxic effect of organic solvents, unspecified.

EPIDEMIOLOGY

EPIDEMIOLOGY A quarter of all acute poisonings are alcohol poisonings. More than 60% of all fatal poisonings also belong to this group.

CAUSES Risk factors: ■ Chronic alcoholism (about 90% of those hospitalized with acute alcohol poisoning suffer from chronic alcoholism). ■ Drinking alcohol on an empty stomach (food in the stomach slows down the absorption of alcohol). ■ Peculiar lifestyle: frequent events accompanied by a feast; the availability of alcohol, especially cheap ones. ■ Alcoholism in the family. The lethal concentration of ethanol (ethyl alcohol) in the blood is 5–8 g / l, the lethal single dose is 4–12 g / kg (300–500 ml of 96% ethanol), however, these figures are not the same for different people and largely depend on the acquired alcohol tolerance. Ethanol easily penetrates tissue membranes and is rapidly absorbed in the stomach (20%) and small intestine (80%). On average, after 1.5 hours, its concentration in the blood reaches its maximum level. The substance acts as a selective CNS depressant at low doses and as a general depressant at high doses, it has a psychotropic (narcotic) effect, which is accompanied by suppression of excitation processes in the CNS due to changes in neuronal metabolism, dysfunction of mediator systems, and slowing down the processes of oxygen utilization. Metabolic toxicosis and acidosis (accumulation of ethanol biotransformation products) play a significant role in pathogenesis. The main endogenous product is the poisonous acetaldehyde, which is formed during all variants of the oxidative degradation of ethyl alcohol. If aldehyde dehydrogenase (an enzyme involved in the metabolism of alcohol) does not have time to transform it into acetate, a picture of severe intoxication develops. Acetaldehyde disrupts the circulation of adrenaline and other catecholamines in the brain and in the periphery, affects the cardiovascular system, liver, and kidneys. Persons of Asian origin are especially susceptible to the toxic effects of alcohol, since in most of them aldehyde dehydrogenase is in an inactive form in the body. In such a situation, even small doses of alcohol can cause serious poisoning.

DIAGNOSTICS

DIAGNOSIS HISTORY AND PHYSICAL EXAMINATION Alcohol poisoning develops in stages. The clinic depends on the dose (Table 9-7). They say about acute ethanol poisoning when the condition of a person who has taken a large dose of alcoholic beverages deteriorates sharply, disturbances of consciousness appear, the ability to walk, perceive the environment is lost, stupor and coma occur.

Table 9-7. Stages of acute action of alcohol (alcohol intoxication) in intolerant persons (with changes according to K.M. Dubovski)

The concentration of alcohol in the blood,% mass / volume	Stage of alcohol exposure	Clinical manifestations
	Sobriety	There is no obvious influence. For an ordinary observer, the behavior is normal. Weak changes are detected by special tests
		Slight euphoria, sociability, talkativeness Increased self-confidence; weakening of inhibitory reactions
		Weakening of attention, prudence, self-control In tests - loss of ability for subtle operations
	Excitation	Emotional instability; weakening of inhibitory reactions Loss of judgment Weakening of memory and comprehension Decreased sensory response; increased reaction time Slight incoordination
	Confusion	disorientation, confusion; dizziness Increased emotionality (fear, anger, sadness, etc.) Disorder of sensory functions (diplopia, etc.), perception of colors, shapes, movements, sizes Increased pain threshold imbalance; quite pronounced disorder of coordination of movements; staggering gait; slurred speech
		Apathy; general inertia, approaching paralysis Noticeable weakening of response to any stimulus Loss of coordination of movements; inability to walk and stand Vomit; urinary and fecal incontinence Clouding of consciousness; deep sleep or stupor
		Complete loss of consciousness; anesthesiaSuppression or absence of reflexes Decrease in body temperature Urinary and fecal incontinence Circulatory and respiratory disorders
0.45 and above		Possible deathDeath from paralysis of the respiratory muscles

The symptomatology of an alcoholic coma is nonspecific and is a variant of a drug coma (see the article "Coma"). Characterized by obturation-aspiration disorders (retraction of the tongue, hypersalivation and bronchorrhea, aspiration of vomit), stridor, tachypnea, acrocyanosis, swelling of the cervical veins, coarse bubbling rales in the lungs, dilated pupils are possible. Hypothermia is noted. In the absence of medical care, the main cause of death in the prehospital stage is respiratory disorders. There may be various severe complications caused by myocardial damage up to necrosis, acute cardiac death. In case of ethanol poisoning in children, in addition to loss of consciousness, acidosis, hypoglycemia (especially in children under 5 years of age) and hypokalemia come to the fore. In young children, percutaneous intoxication has been described with the use of alcohol compresses.

ADDITIONAL EXAMINATION

ADDITIONAL EXAMINATION ■ ECG: decreased ST segment, negative T wave, extrasystole; with alcoholic cardiomyopathy, persistent rhythm and conduction disturbances, signs of myocardial damage are possible. ■ During the first examination of the patient, it is advisable to take venous blood for subsequent chemical analysis for alcohol content, which may be required later (there should be no free space in the vial or test tube between the blood and the stopper; otherwise, the result of the study will be underestimated due to with the evaporation of alcohol).

DIFFERENTIAL DIAGNOSIS

DIFFERENTIAL DIAGNOSIS ■ TBI. The difficulty lies in the fact that the likelihood of TBI in a person in a state of deep alcohol intoxication is extremely high. Even when falling out of the blue, due to lack of coordination, such persons receive severe head injuries. Diagnosis is helped by information received from others (it is important to compare the possible amount of alcohol consumed with the severity of the coma: a discrepancy may indicate head injury), detection of damage to the soft tissues of the head, anisocoria. ■ Stroke (acute cerebrovascular accident) may develop on its own or be provoked by alcohol (especially hemorrhagic stroke). The diagnosis is based on the identification of focal neurological symptoms (see the article "Stroke"). ■ Poisoning by alcohol surrogates, drugs, sleeping pills, tranquilizers or other substances, like ethanol, can cause coma (see below and the articles “Coma”, “Drug poisonings”). ■ Variants of coma in diabetes mellitus, diabetic (ketonemic), hyperosmolar and hypoglycemic coma (see articles "Coma diabetic (diabetic ketoacidosis)", "Coma hyperosmolar"). ■ Alcoholic ketoacidosis, which in turn has to be differentiated from diabetic coma. It develops 24–72 hours after alcohol withdrawal at the end of heavy drinking. The patient complains of nausea, vomiting, abdominal pain, refuses to eat. Rapidly increasing hypovolemia. Confusion appears, coma develops. Tachypnea and even Kussmaul respiration are noted as a response to ketoacidosis. Characteristic laboratory signs: normal or reduced blood glucose, ketonemia and ketonuria (due to the peculiar set of ketones before the start of treatment - the predominance of β-hydroxybutyrate - the reaction to ketones when using test strips may be weakly positive, despite the abundance of ketones in the urine). Treat such patients with complete restoration of BCC by infusion of dextrose without insulin and saline solutions. Electrolyte control is mandatory, as hypokalemia is possible. Additionally, thiamine is prescribed. It must be borne in mind that in the process of improving the patient's condition, the reaction to ketones in the urine will become more and more pronounced (as a result of the oxidation of β-hydroxybutyrate to acetoacetate) - this should not be regarded as a sign of aggravation of the pathology.

INDICATIONS FOR HOSPITALIZATION

TREATMENT INDICATIONS FOR HOSPITALIZATION Hospitalize persons with severe alcohol intoxication, accompanied by a coma, respiratory and circulatory disorders. Victims are taken to the intensive care unit or poison control center.

THERAPEUTIC MEASURES

THERAPEUTIC MEASURES ■ Since the use of analeptics in case of ethanol poisoning is contraindicated (due to the risk of developing a convulsive syndrome; there are only insufficiently confirmed clinical data on the possible use of flumazenil - 3 mg intravenously), in all cases, accompanied by severe respiratory and circulatory disorders, it is necessary to resort to resuscitation. A situation with respiratory arrest with continued cardiac activity is very likely. The onset of clinical death requires the entire complex of cardiopulmonary resuscitation. ■ The implementation of basic resuscitation will greatly facilitate the presence of electromechanical or mechanical suction, since the victim usually has profuse salivation and bronchorrhea, if dehydration has not yet developed.

■ Gastric lavage through a tube is necessary, but is possible only after ensuring complete protection of the respiratory tract by intubation, which is carried out by the resuscitator on the spot or already in the hospital. In this regard, all activities of the first stage of assistance should be carried out very quickly.

DRUG THERAPY

DRUG THERAPY ■ At the stage of providing first qualified medical aid, you can begin to implement forced diuresis. To do this, infusion therapy is started through venous access and furosemide is administered (see the article "Poisoning, General Aspects"). ■ Maintenance therapy for ethanol poisoning includes the use of dextrose solutions without soluble insulin (if the victim is not diabetic) to prevent hypoglycemia and ketoacidosis. ■ Parenteral preparations of potassium, magnesium, thiamine, pyridoxine, ascorbic acid, etc. are also shown. ■ As an auxiliary measure, it may be necessary to use atropine (1 ml of a 0.1% solution subcutaneously) to reduce hypersalivation and bronchorrhea. ■ Severe hemodynamic disorders accompanied by arterial hypotension require, in addition to the introduction of an additional amount of fluid, the use of catecholamines (see articles on shock) and possibly prednisolone at a dose of 90-120 mg intravenously.

POSSIBLE COMPLICATIONS

POSSIBLE COMPLICATIONS ■ Periods of psychomotor agitation with short episodes of auditory and visual hallucinations (during recovery from an alcoholic coma). ■ Aspiration of the contents of the stomach with the development of atelectasis and a detailed picture of Mendelssohn's syndrome (asthma-like condition and pulmonary edema occurring 2-5 hours after aspiration).

FORECAST The prognosis depends not so much on the dose of alcohol, but on the timeliness of the assistance provided (98–99% of deaths occur at the prehospital stage). In chronic alcoholics, whose poisoning occurs against the background of encephalopathy, hormonal changes, cardiomyopathy, damage to the kidneys, liver, lungs, hypomagnesemia, hypovitaminosis, it is logical to expect a more severe clinical picture and a worse prognosis.

Poisoning by alcohol substitutes is a type of intoxication caused by the intake of low-quality alcoholic beverages containing technical compounds or toxic impurities. Often occurs in people suffering from addiction or adolescents who want to get drunk and at the same time purchase a product at a low price. Accompanied by disorders of the digestive, nervous, cardiovascular systems. There is a high probability of death, therefore, it requires emergency care and urgent hospitalization in the toxicology department. It has its own ICD 10 code - T51.

What applies to alcohol surrogates?

According to the classification, they are divided into two groups: true and false. The former include alcoholic beverages that contain ethanol, but also toxic impurities: esters, heavy metals, harmful dyes. The second type includes those products based on any other alcohol: methyl, isopropyl and others. Poisoning in this case is much more difficult, since not only metabolites are considered poisonous, but also the main compound.

Surrogate substitutes are usually drunk by people suffering from alcoholism and teenagers who do not have the means to purchase high-quality but expensive products. The following compounds are considered the causes of intoxication:

TOXINS lead to cancer, diseases of the blood and blood vessels, heart disease and many others, up to the usual chronic and colds.

• methylated spirits;
• varnishes;
• wood stain;
• medicinal medicines (tinctures);
• cosmetical tools;
• household accessories in the form of solutions, aerosols;
• moonshine.

There are also poisonings due to drinking brake fluid, de-icers and other similar substances.

Clinical picture with intoxication

Symptoms of the disease are different, vary depending on what the patient has taken. The manifestations of pathology when drinking a certain chemical component are described in detail below.

Surrogates containing ethyl alcohol

The first thing that the victim feels is euphoria and emotional excitement, which they achieve during the gatherings. Further, the clinic is supplemented by the following symptoms:

• excessive sweating;
• increased production of saliva in the oral cavity;
• pallor of the skin;
• increase in pupil diameter;
• dizziness;
• impaired coordination of movements;
• nausea;
• vomit;
• diarrhea;
• pain in the abdomen.

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Perhaps a change in consciousness, the appearance of delusional disorders, hallucinations.

Methanol (wood alcohol)

They are more toxic, death is possible with the use of fifty milliliters of a surrogate, however, it all depends on the sensitivity of the victim's body. Signs of poisoning are:

• depressive syndrome;
• nausea;
• vomit;
• decreased visual acuity up to its complete loss;
• increase in body temperature;
• convulsions;
• weakness;
• disturbance of consciousness, its absence.

Often disturbed by disorders of the cardiovascular system, namely tachycardia, arterial hypotension, pain behind the sternum.

Symptoms of ethylene glycol poisoning

The clinic is divided into three periods. At first, the patient does not make any complaints, feels only a slight euphoria. Further, after 10–12 hours, signs such as:

• unbearable thirst;
• nausea;
• dry mucous membranes;
• headache;
• cyanosis;
• vomiting that does not bring relief;
• convulsive syndrome.

If proper measures are not taken, kidney, liver or heart failure is formed on the second or third day. The skin acquires a yellow tint, the volume of urine excreted decreases. The man dies in agony.

Diagnosis of intoxication

Should be organized immediately.

The doctor initially collects an anamnesis of the disease, life, conducts a general examination, pays special attention to the smell from the mouth, the consciousness of the victim, and the skin. After that, laboratory and instrumental examination methods are prescribed. The most informative are:

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• general urine analysis;
• general and biochemical blood test;
• electrocardiogram;
• Ultrasound of the abdominal cavity, heart;
• CT and MRI;
• electroencephalogram.

An ECG is usually performed by SMP doctors, which makes it possible to identify disorders that threaten the patient's life and stop them in time.

First aid

Carrying out manipulations at the early stages of poisoning with alcohol surrogates will avoid the formation of complications and death. The algorithm of actions includes the following items:

• washing the stomach with soda solution and pressing on the root of the tongue;
• sorbent intake;
• use of a saline laxative;
• calling a doctor for emergency hospitalization.

During the procedures, it is forbidden to give additional medicines, worsening of the course of poisoning is possible.

Antidote

It all depends on which surrogate the person has accepted. If intoxication is caused by the true type, then the condition is stopped with the help of pyrazole derivatives. In cases where the disease has formed due to methyl alcohol, ethanol is injected intravenously.

Treatment Methods

Therapy is prescribed by a narcologist after a complete examination. The main goal of taking medications is to detoxify the body, reduce clinical manifestations and reduce the risk of complications.

In most cases, the following groups of drugs are prescribed:

• saline solutions;
• diuretics;
• nootropics;
• neuroleptics;
• vitamins;
• sorbents;
• antacids;
• analgesics;
• antispasmodics.

Treatment is sometimes supplemented with glucocorticoids, beta-blockers, atropine. Mechanical purification of blood is possible with the help of hemodialysis, plasmapheresis. Rehabilitation of the patient takes place at home within one month.

Possible consequences

According to statistics, with timely diagnosis and adequate therapy, the prognosis is favorable. Otherwise, complications such as:

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• blindness;
• cerebral edema;
• renal, hepatic insufficiency;
• mental disorders;
• acute alcoholic hepatitis;
• pancreatitis;
• hypovolemic shock;
• acidosis.

The most terrible consequence of poisoning with a surrogate is considered to be a fatal outcome.

Prevention

• purchase products in specialized trusted stores;
• observe the conditions of storage and transportation;
• reduce the amount of alcohol consumed.

If you buy alcohol - do not skimp. Champagne for 150 rubles or cognac for 300, most likely, is not made from the best raw materials and not in the best conditions.

Summary

Such pathologies, unfortunately, are constantly encountered in medical practice, their frequency is growing every year. If earlier everything was attributed to the illiteracy of the population, low financial income, now poisoning even with “elite” alcoholic beverages is not ruled out. That is why doctors recommend not to drink at all, and if you drink alcohol, then only high-quality and purchased at proven points.

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Intoxication with alcohol substitutes

Poisoning by alcohol surrogates ranks first among all intoxications with which victims go to medical institutions. This is a very dangerous phenomenon, which can not only provoke severe complications, but also lead to death. Alcohol surrogate poisoning - ICD code 10:

• T51.0 - ethyl alcohol;
• T51.1 - methyl alcohol;
• T51.2 - isopropyl alcohol;
• T51.3 - fusel oils;
• T51.8 - other alcohols;
• T51.9 - alcohol, unspecified.

Classification of surrogates

The toxicology of poisoning with alcohol and its surrogates distinguishes two types of substances: those produced on the basis of ethanol and those made with the use of impurities. The first group includes the following:

1. ethanol made using hydrolysis from wood;
2. denatured alcohol;
3. cosmetic lotions, cologne;
4. glue BF - the composition includes polyvinyl acetal, phenol-formaldehyde resin, dissolved in acetone, alcohol;
5. varnish - a mixture of ethanol with butyl, amyl, acetone;
6. nigrosine - stain containing ethanol, dyes. It is used for processing wood, coloring leather products in blue.

The second variety includes chemicals that do not contain ethanol. They are made using ethylene glycol, methyl alcohol with the addition of various impurities.

Symptoms

Symptoms of poisoning by various alcohol surrogates differ from each other. If you experience any signs of intoxication with a dangerous substitute for alcoholic beverages, you should immediately contact a medical institution for professional help. Otherwise, everything can end badly.

Surrogate with ethanol

Ethyl alcohol is a substance found in any alcoholic beverage. Ethanol poisoning is accompanied by the following symptoms:

• Gastrointestinal tract: pain in the abdomen, feeling of nausea, vomiting, stool disorder;
• CNS: strong excitability, feeling of euphoria, dilated pupils, auditory and visual hallucinations, incoherent speech (resembling the speech of a mute), loss of coordination of movements, increased sweating;
• cardiovascular system: weakness, redness or pallor of the skin on the face, rapid pulsation, reduced intravenous pressure;
• respiratory system: acute respiratory failure, shortness of breath;
• kidneys: frequent urination, or its stop;
• liver: pain on the right side in the ribs, yellowness of the skin.

Severe poisoning with surrogates can cause a coma.

Ethyl alcohol, after penetration into the body, is absorbed into the walls of the gastrointestinal tract. With the flow of blood fluid, it quickly spreads throughout the body. At low doses of ethanol, the liver is able to cope with its processing. If ethyl alcohol was consumed in large quantities, the body ceases to perform its functions and poisoning occurs with dangerous alcohol surrogates.

methanol

The kidneys and central nervous system suffer the most from methyl alcohol. It has a psychotropic, neurotoxic effect. The following signs of intoxication with surrogate alcohol occur:

• feeling of nausea, vomiting;
• "dots" before the eyes;
• double vision;
• in acute situations - complete blindness;
• pupil dilation;
• no response to light.

After a couple of days, the clinical picture worsens. There is pain throughout the body. There is dryness of the mucous membranes, skin. Functionality of the cardio organ is impaired, intravenous pressure is lowered. The temperature is very high. Seizures and coma may occur.

ethylene glycol

This substance is included in the components of brake fluids, antifreeze. With intoxication, acute liver failure, cerebral edema occurs. The following toxicological symptoms are observed:

• in the first 12 hours, only slight intoxication is observed;
• after that, nausea, vomiting, migraine, stool disorders begin;
• cyanosis of the skin, mucous membranes;
• high body temperature;
• violation of the heart rhythm;
• strong excitability;
• difficulty breathing;
• loss of feelings;
• convulsions;
• dark color of urine.

If the urgent necessary assistance is not provided in case of poisoning by alcohol substitutes, death will occur.

Moonshine

With moonshine intoxication, the following symptoms occur:

• feeling of nausea, vomiting, stool disorders;
• dizziness, up to loss of consciousness;
• increased body temperature;
• intense thirst, dry mouth;
• labored breathing;
• jumps in intravenous pressure;
• chills, increased sweating.

In severe cases, seizures may occur. The victim loses his sight. First, there are visual and auditory hallucinations. After that, the person may fall into a coma.

Diagnostic studies

Before prescribing adequate treatment, the specialist performs a complete examination of the victim. First of all, he conducts a visual inspection. After that, he collects an anamnesis of the pathology: the stage of alcoholism, the substances used, the presence of concomitant diseases, and so on.

Additional diagnostic methods are also assigned. This is necessary to study the heart rhythm, the amount of a toxic element in the blood. Research is complicated by the fact that the poisoned most often end up in the clinic already in a coma. But modern medicine does not stand still, with the right first aid and modern hospitalization, the patient can be saved.

emergency measures

Timely first aid can save a person's life. Therefore, it is necessary not to get confused in an emergency and do everything right. First of all, call a team of medical workers, and then proceed to action:

1. Provide air supply to the victim. To do this, open all windows and vents. Remove the patient to fresh air if possible. Unbutton the collar, remove the tie, belt, corset.
2. Lay the victim on a horizontal surface on their side. Extend your lower arm forward. Control that the poisoned person does not choke on the outgoing liquid, does not choke on his own tongue.
3. If the patient is conscious, he needs to flush the gastrointestinal tract. To do this, let the poisoned person drink plenty of fluids. After that, provoke a gag reflex by pressing on the beginning of the tongue with your fingers or a spoon. Repeat the action until the escaping liquid becomes clear. The stomach is well washed with water-salt, slightly pink potassium permanganate solutions.
4. If the victim is unconscious, bring a cotton pad soaked in ammonia to his nose. Rubbing the earlobes, tickling the tip of the nose will also help to come to your senses.
5. After the release of vomit, the water-salt balance is disturbed. To bring it back to normal, it is necessary to give the patient sorbents. For example, activated charcoal.
6. If the patient has been poisoned by ethylene glycol or methyl alcohol, give the victim some vodka or other quality alcoholic beverage to drink.
7. If the victim is cold, wrap him in a blanket.

When the heartbeat and breathing stop, it is necessary to perform an indirect massage of the cardiac organ and perform artificial ventilation of the lungs.

What Not to Do

In a pathological condition, it is forbidden to do the following:

• turn a person upside down;
• place the victim under a cold shower or bath;
• force the patient to be physically active;
• provoke vomiting if the poisoned person is in an insensible state;
• give any medicines, with the exception of sorbents;
• leave a person alone, unattended;
• refuse hospitalization in a hospital, even if the victim is better.

If this is not taken into account, the patient can be harmed.

Therapy

Therapeutic measures are carried out in stationary conditions, in the intensive care unit in the toxicology department. Treatment of acute poisoning with alcohol substitutes should be carried out under the round-the-clock supervision of medical workers.

1. The hospital detoxifies the body with a special probe. Alcohol 5% is introduced. Diuretics are prescribed, the blood fluid is cleared.
2. In case of intoxication with ethylene glycol, calcium gluconate is prescribed. They use a solution of glucose with novocaine, vitamin complexes B and C. In case of poisoning with methyl alcohol, spinal punctures are performed.
3. After cleansing the body, a special diet must be observed. Nutrition should be light and balanced. There is a complete rejection of alcoholic beverages, even of good quality.

Consequences

Alcohol dependence is a serious disease that must be treated without fail. Otherwise, regular intoxication with alcohol and its surrogates can lead to serious consequences, up to death:

• acute hepatitis;
• pancreatitis;
• cirrhosis of the liver;
• liver failure;
• the occurrence of thoughts of suicide;
• vascular-vegetative disorders;
• vision loss;
• hand tremor and other severe pathologies.

If you cannot get rid of alcoholism on your own, contact a drug treatment clinic for help. They will not only cleanse the body, but also help to cope with addiction on a psychological level.

The use of alcohol-containing liquids is a common cause of acute alcohol surrogate poisoning in adults. A similar problem is faced mainly by people suffering. By itself, it has a moderate, easily penetrates into tissues and, in a large dosage, leads to damage to many organs (liver, brain, stomach, heart, blood vessels). Poisoning with alcohol substitutes is more dangerous, as they contain various harmful impurities. Severe poisoning can cause death. ICD-10 code T51.

Drinking liquids containing alcohol is a common cause of acute poisoning in adults.

What about surrogates

Surrogates are liquids containing alcohol, but not intended for ingestion in order to obtain euphoria. They can be used for technical and medical purposes. Surrogates are true (contain ethanol) and false (contain other alcohols). These include:

• varnish;
• medicines used for heart disease (hawthorn tincture);
• technical alcohol;
• moonshine;
• antifreeze;
• brake fluid;
• glass cleaners;
• lotions and colognes;
• stain;
• "singed" vodka;
• White Spirit;
• methyl and butyl alcohols;
• ethylene glycol.

Homemade drinks

Many women and men use homemade alcohol solutions. These include moonshine liquid. It is obtained using a special apparatus by distillation of mash. During this process, many volatile compounds are formed, including methyl alcohol. With improper distillation (cleaning the solution of impurities), toxic substances may be preserved. Home-made alcoholic drinks are in high demand in rural areas. Such people often experience poisoning by alcohol surrogates.

alcohol poisoning

alcohol poisoning

Medicines containing alcohol

In order to achieve a state of intoxication, alcoholics can use drugs based on alcohol. Most in demand:

• hawthorn tincture;
• tincture of valerian;
• motherwort tincture.

Hawthorn tincture can be purchased at any pharmacy at an affordable price. This medicine contains alcohol and fruits, and is used in diseases of the heart and nervous system. Hawthorn improves blood flow and has a calming effect. When used in high doses, the work of the heart is disrupted and blood pressure drops. People who use this medicine often develop heart failure.

How to determine

Surrogates can be distinguished from alcoholic products intended for mass consumption by smell, color and method of application. All household products (solvents, industrial alcohol) should not be taken orally.

There are 3 degrees of intoxication:

- light- concentration of alcohol in the blood up to 2%o , which corresponds to 0.5-1.5 ml of pure ethanol per 1 kg of human body weight;

- average- 2-3% of alcohol is detected in the blood, i.e. 1.5-2.5 ml of ethanol was taken per 1 kg of body mass;

- heavy- occurs when the concentration of ethanol in the blood is 3-5%o or more, which corresponds to 2.5-4.5 ml of alcohol per 1 kg of weight. With a severe degree of intoxication, a coma develops, which can be the direct cause of death along with asphyxia due to deep aspiration of vomit, acute heart failure.

Upon admission to a hospital in a patient with suspected alcohol poisoning, it is necessary to take blood (urine) to detect ethanol, filling out the "Referral for chemical and toxicological research" in the form 452 / y-06 (in accordance with the order of the Ministry of Health and Social Development of Russia dated 01.01.2001 g. No. 40) . When determining the content of ethanol in the blood and urine of a corpse, to assess the severity of alcohol intoxication (poisoning), special tables should be used (see forensic medicine manuals), which take into account the time elapsed since the moment of the alleged use of alcohol and after the onset of death.

In the case of death from acute alcohol intoxication - poisoning with ethanol (ethyl alcohol) and its surrogates, the latter is always diagnosed as the underlying disease (independent nosological unit) - the initial cause of death. Alcohol poisoning in some cases develops in patients with background diseases - CAI or chronic alcoholism. The final clinical diagnosis of poisoning with ethanol and / or its surrogates requires the direction of the body of the deceased for a forensic autopsy, therefore, the principles for formulating a forensic medical diagnosis in such situations are not considered in these recommendations and are set out in the relevant forensic medical regulatory and administrative documents.

The harmful use of alcohol, alcohol abuse (F10.1), indicates its regular, systematic use (drinking habitual, domestic) in doses when the body is not able to completely process alcohol and its metabolites, leading to a condition with the development of multiple organ morphological manifestations (alcoholic visceropathies), therefore, can be designated as a disease and corresponds in its essence to the term "chronic alcohol intoxication" (CHAI).

CHAI is a group concept in which in the diagnosis, depending on the severity of the lesion and clinical and morphological manifestations, the characteristic alcoholic lesion of one of the organs comes to the fore, which corresponds to the nosological forms according to ICD-10 and in cases of death appears to be the initial cause of death.

In the diagnosis, it is not allowed to substitute the terms "toxic" or "alimentary" for the term "alcoholic" with the corresponding nosological units from the group of alcoholic visceropathies (alcoholic cirrhosis of the liver, alcoholic cardiomyopathy, alcoholic encephalopathy, etc.).

A variety of somatic, neurological and mental disorders (nosological forms and syndromes) in alcoholic disease in the ICD-10 are reflected in different classes, headings and codes, which are grouped in table 1.

Table 1

Nosological unit, syndrome	ICD-10 code	Note
Class IV. Diseases of the endocrine system, eating disorders and metabolic disorders
Cushingoid syndrome caused by alcohol
Class V. Mental and behavioral disorders
Mental and behavioral disorders caused by alcohol use		Generic concept The fourth character of the code determines the clinical characteristics of the condition
Acute intoxication. Acute intoxication with alcoholism Alcohol intoxication NOS Pathological intoxication		These disorders are associated with the acute pharmacological action of ethanol and disappear completely after a while. Not applicable in case of death (use code T51.0 with additional class XX codes)
Harmful use		Alcohol abuse without addiction. Synonym - chronic alcohol intoxication without dependence syndrome
addiction syndrome Chronic alcoholism
withdrawal state		A group of symptoms of varying nature and severity resulting from the complete or partial removal of a psychoactive substance from the body after chronic use.
Withdrawal state with delirium. Delirium tremens (alcoholic)
Psychotic disorder. Alcoholic: hallucinosis, delusions of jealousy, paranoia, psychosis NOS		A complex of psychotic symptoms that occur during or after alcohol consumption. The disorder is characterized by hallucinations, perceptual disturbances, delusions, psychomotor disturbances (arousal or stupor).
amnestic syndrome. Amnestic disorder due to alcohol or drugs. Korsakov's psychosis or syndrome caused by alcohol		A syndrome characterized by a pronounced chronic decrease in memory for recent and distant events. Memory for recent events is usually more impaired than for distant ones. Other cognitive functions are usually well preserved.
Residual and delayed psychotic disorders. Alcoholic dementia NOS. Chronic Alcoholic Cerebral Syndrome
Other mental and behavioral disorders
Mental and conduct disorder, unspecified
Class VI. Diseases of the nervous system
Degeneration of the nervous system caused by alcohol. Alcoholism: cerebellar (ataxia, degeneration), cerebral degeneration, encephalopathy, alcohol-induced autonomic (autonomic) nervous system disorder
Special epileptic syndromes. Epileptic seizures associated with alcohol consumption
Alcoholic polyneuropathy
Alcoholic myopathy
Class IX. Diseases of the circulatory system
Alcoholic cardiomyopathy
Class XI Diseases of the digestive system
Esophagitis: chemical		If necessary, identify the toxic substance and the cause, use an additional external cause code (class XX)
Esophageal ulcer. Erosion of the esophagus caused by: chemicals
Alcoholic gastritis
Toxic gastroenteritis and colitis
alcoholic liver disease		Generic concept
Alcoholic fatty liver
Alcoholic hepatitis (chronic)
Alcoholic fibrosis and liver sclerosis
Alcoholic cirrhosis of the liver
Alcoholic liver failure: acute, chronic, subacute, with or without hepatic coma		Syndrome, cannot be used as a nosological entity
Alcoholic liver disease, unspecified
Chronic pancreatitis of alcoholic etiology
Acute alcohol-induced pancreatitis
Class XVI. Certain conditions arising in the perinatal period
The defeat of the fetus and newborn, due to alcohol consumption by the mother.		Excludes: fetal alcohol syndrome (Q86.0)
Class XVII. Congenital anomalies (malformations), deformities and chromosomal abnormalities
Syndrome of congenital anomalies (malformations) due to known factors, not elsewhere classified.		Generic concept
Fetal alcohol syndrome (dysmorphia)
Class XIX. Injury, poisoning and some consequences of external causes
Toxic effect of substances, mainly non-medical purposes		Generic concept
The toxic effect of alcohol		Generic concept
Ethanol, ethyl alcohol
methanol, methyl alcohol
2-propanol, isopropyl alcohol
Fusel oils
other alcohols
Alcohol, unspecified
Class XX. External causes of morbidity and mortality (class XX should be used as an addition to a code from another class indicating the nature of the pathological condition)
Accidental poisoning and exposure to toxic substances		Generic concept
Accidental poisoning and exposure to alcohol. Includes: alcohol NOS. Ethanol
Intentional self-poisoning and exposure to alcohol
Poisoning and exposure to alcohol with undetermined intentions

For other alcoholic organ pathologies, such as veno-occlusive lesions of the liver with portal hypertension syndrome, IgA nephritis, often caused by alcohol, the appropriate ICD-10 codes should be used, presented without indicating the alcoholic nature of the pathological process.