Intestinal lavage for intravenous methadone poisoning

Abstract

Introduction. Among opioid poisonings, acute intravenous methadone poisoning is distinguished by the most severe course with a pronounced manifestation of toxic-hypoxic encephalopathy, a large number of complications, deposition in tissues, which complicates its removal from the body and requires the greatest resource costs during the treatment process.
 The aim of the study. To increase the effectiveness of treatment of patients with intravenous methadone poisoning by including intestinal lavage in the complex of standard therapy.
 Material and methods. Of the 52 patients with intravenous methadone poisoning, 33 (observation group) underwent intestinal lavage (IL) for the purpose of detoxification, and 19 received standard therapy (comparison group). The age of the patients was 32.0 (29.0; 36.0), and in the comparison group – 
 31.0 (25.0; 37.0) years. Poisoning occurred as a result of the use of methadone when administered intravenously for the purpose of drug intoxication, which resulted in depression of consciousness (coma) and rare inadequate breathing with periods of apnea. IL was started urgently after restoration of adequate breathing. To carry out IL, enteral solution (ER) was administered through a nasogastric tube at a rate of 1950–2600 ml/hour. Perfusion of the gastrointestinal tract (GIT) was stopped when clear lavage water appeared from the rectum. The total volume of the solution was 7.0 (4.5; 7.5) l, the volume of intestinal secretions was 5.3 (4.0; 6.3) l, the duration of the procedure was 4 (3; 6) hours. The quantitative content of methadone in blood and urine, as well as in washing waters, was determined by gas chromatography with mass-selective detection.
 The duration of coma, length of hospitalization, incidence of pneumonia as a complication of poisoning, and mortality in the observed and comparison groups were compared.
 Results. With the help of IL, cleansing of the gastrointestinal tract of patients occurred within 3–6 hours. Methadone was detected in the washing waters, and its concentration in the blood after IL decreased by an average of 2.5 times. 19 (16.0; 27.0) hours after IL, the patients were in clear consciousness, which was 
 13 hours (40.6%) earlier than in the comparison group, in which it took an average of 32.0 hours to restore clear consciousness (24.5; 35.0) h (p < 0.05). Pneumonia in the group of patients who underwent IL occurred 
 2.6 times less frequently than in the comparison group. The duration of stay of patients in the intensive care unit of the observed group was 2.6 times shorter than in the comparison group, and the total length of hospitalization was 1.5 times less, respectively. There were no deaths in the observed group, and in the comparison group the mortality rate was 5.3%.
 Limitations. The study concerns the effectiveness of intestinal lavage as a detoxification method for acute intravenous methadone poisoning in male and female victims, the limitations of which were: nosological form, period of poisoning, age of patients (from 18 to 65 years) and the absence of positional compression syndrome.
 Conclusion. The use of IL in intravenous methadone poisoning promotes the elimination of the latter from the gastrointestinal tract, which is accompanied by a decrease in its concentration in the blood, a reduction in the duration of coma, a decrease in the incidence of pneumonia and mortality.