Abstract
The aim of the study is to explore the best intensive care strategies for acute 1,4-butanediol poisoning complicated by post-intoxication delirium. Materials and methods . The data of the laboratory testing and treatment of 40 men with acute severe poisoning with 1,4-butanediol, complicated by post-intoxication delirium were analyzed. Twenty patients received succinate-containing drug, others were treated with conventional methods. The control group included 18 healthy male patients aged 25 to 40 years. Clinical course of delirium, parameters of glutathione system and lipid peroxidation in patients' red blood cells, oxygen transport function (by indirect calorimetry), gammahydroxybutyric acid level in the biological fluids by gas chromatography/mass spectrometry were evaluated during the study. Results. An increases in levels of reduced glutathione by 50.3% by day 7 (from 3.68±0.57 to 5.53±0.35 pmol/g), hemoglobin (Hb), antioxidant enzymes and glutathione reduction enzymes were found; glucose-6-phosphate dehydrogenase increased by 17,1% (from 3.68±0.26 to 4.31±0.41 pmol/g Hb) and glutathione reductase increased by 15% (from 174.1±16.3 to 200.2±4.11 pmol/min/g Hb). At the same time, the MDA lipid peroxidation system activation was decreased by 41.9% (from 7.78±1.06 to 4.52±0.28 nmol/g Hb). Conclusion. The obtained data proved high efficacy of a succinate-containing drug in slowing down the progression of post-intoxication delirium through increasing the level of the main cellular antioxidant, the reduced glutathione.
Highlights
Delirium is one of significant challenges of modern medicine [1,2,3]
An increases in levels of reduced glutathione by 50.3% by day 7, hemoglobin (Hb), antioxidant enzymes and glutathione reduction enzymes were found; glucose-6phosphate dehydrogenase increased by 17,1% and glutathione reductase increased by 15%
A statistically significant decreases in enzyme activity in RBCs of patients with post-intoxication delirium (PD) were found: reduced glutathione (RG) — by 54.9%, glutathione peroxidase (GP) — by 13.2%, glucose-6-phosphate dehydrogenase (G6PD) — by 50.2%, sulfhydril protein groups (SG) — by 47.3%, glutathione reductase (GR) — by 20.2% compared to the control group during the first day of observation
Summary
Delirium is one of significant challenges of modern medicine [1,2,3]. Notably, this issue is common world-wide, as evidenced by numerous international publications [4,5,6].Delirium is one of the most common postoperative complications in elderly patients with chronic coronary heart disease and a wide range of associated conditions [7, 8]. Delirium is one of significant challenges of modern medicine [1,2,3]. This issue is common world-wide, as evidenced by numerous international publications [4,5,6]. Alcohol addiction remains one of the frequent causes of delirium syndrome in intoxicated patients admitted to the intensive care unit (ICU) [9]. Ingestion of the alcohol was found to increase the permeability of the bloodbrain barrier, reduce the intensity of tissue respiration, undergo metabolic changes with the formation of its aldehyde and (or) acid metabolites, causing non-uniform dystrophic changes in nervous tissue cells and cerebral edema in animal experimental studies. The development of severe withdrawal or delirium syndrome in patients who regularly use the toxicant has been demonstrated clinically [14,15,16,17]
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