Poisoning with antihistamines. Emergency treatment of drug poisoning. What to do in case of poisoning with antihistamines

Severity of poisoning is determined not only by the amount of the substance taken orally, but also by the degree of individual sensitivity to it. Children early age are especially sensitive to this group of drugs. The clinical picture of poisoning is in many ways similar to the picture of poisoning with atropine-containing substances, which may be due to the anticholinergic effect antihistamines. They selectively influence such formations of the central nervous system as reticular formation brain stem, vestibular analyzer, cerebellum.
There is also a pronounced tropism towards the vascular system.

Main in clinical picture poisoning is psychomotor agitation with bright visual hallucinations. The duration of this state is 10-12 hours. It may precede the phase of impaired consciousness or develop after it. The clinic of impaired consciousness often manifests itself as stunned or increased sleepiness, in severe poisoning there may be a coma of varying depth.

In the majority of patients in the excitation phase, of various nature convulsions: myoclonic jerks of individual muscle groups, single or repeated generalized seizures.

During excitement such neurological symptoms, such as mydriasis, increased muscle tone and tendon reflexes, tremor of the limbs, dynamic and static ataxia. Stupor or coma is accompanied by constriction of the pupils, decreased muscle tone, and hyporeflexia. Autonomic disorders include hyperemia and dryness skin and mucous membranes, increased breathing, tachycardia, increased blood pressure.
On EEG Individual high-amplitude sharp and slow waves are recorded, arising in any part of the cerebral cortex.

Emergency treatment for acute drug poisoning includes measures to remove the toxic agent from the body, detoxify the poison with the help of an antidote and measures to maintain basic vital functions. The removal of poison from the body is facilitated by gastric lavage, saline laxative, and cleansing enema. In young children, gastric lavage is best done with isotonic sodium chloride solution in order to prevent disorders water-salt metabolism(2-3 tablespoons of sodium chloride per 5-10 liters of water).

The main method of combating poisoning is forced diuresis, since this accelerates the process of removing poison from the body. Forcing diuresis is achieved in case of mild poisoning due to heavy drinking alkaline waters, in case of poisoning with impaired consciousness - intravenous administration of a 5% glucose solution, isotonic solution glucose, isotonic sodium chloride solution, Ringer's solution. Liquid is administered at the rate of 100-200 ml per 1 kg of body weight under constant control the amount of urine excreted.

The ratio of glucose and salt solutions in children under 3 years of age it should be 3:1. There must be a balance between the amount of fluid administered and diuresis. The maximum fluid retention should not exceed 1.5-2% of body weight. To enhance the excretory function of the kidneys, diuretics (Lasix, furosemide), as well as osmotic diuretics (mannitol), should be used. Normalization measures are being carried out acid-base balance. In comatose patients, detoxification therapy begins after preliminary establishment of adequate ventilation.

For the purpose of liquidation cardiovascular disorders Cardiac glycosides, pressor amines, and hormones are used. Analeptics (caffeine, cordiamine) should be prescribed with caution, as they can deplete reserve capacity respiratory center, and in children under 3 years of age can cause seizures. For poisoning with sleeping pills and tranquilizers, bemegride is used. To combat hyperthermic syndrome should be used as physical methods body cooling, and antipyretics (analgin, amidopyrine). In the presence of convulsive syndrome anticonvulsant therapy is administered. In case of joining septic complications antibiotics are prescribed. In order to eliminate metabolic disorders, one should use ascorbic acid, B vitamins, cocarboxylase.

Timely and comprehensive implementation detoxification And symptomatic therapy acute medicinal poisonings in most cases leads to recovery of children.

Antihistamines medicines - pharmacological group drugs that block receptors of free neurotransmitters. Histamine is released from cells connective tissue responsible for the occurrence of immune reactions.

Its interaction with neurotransmitters provokes the appearance allergic reactions in the form of itching, skin rash, edema, hyperemia. Antihistamines are able to block the activation of receptors, thereby eliminating pathological manifestations.

On pharmaceutical market There are 3 generations of antihistamines:

The first includes fat-soluble agents that establish a connection with H1 receptors in the brain. Are different sedative effect. Poisoning antihistamines 1st generation is accompanied by psychomotor agitation. The group includes: Diphenhydramine, Suprastin, Diazolin, Tavegil, others.
Second generation drugs affect potassium metabolism and produce a cardiotoxic effect, so use should be accompanied by regular monitoring functional state hearts. Possess more long-term action, up to 24 hours after administration. Presented by Claritin, Kestin, Clarotadine and others.
Third-generation drugs have the ability to be converted into active metabolites in the body and are unable to cross the blood-brain barrier, which explains the absence negative impact on cardiac activity, central nervous system. They are also characterized by long-lasting action. Among the antihistamines are 3 generations: Fexadin, Gismanal, Levocetirizine, Erius, others.

There is no separate category dedicated to children. If it is necessary to treat allergies in a child, the most convenient form and dosage of the drug is selected.

Release forms

The following forms of antihistamines are presented on the pharmaceutical market:

pills;
nasal, eye drops;
syrups;
drops for oral use;
ointments, gels for external application;
solutions for intramuscular and intravenous administration.

After starting to take one form or another of drugs, it is important to monitor the patient’s well-being. Often, antihistamines in the form of syrups for children cause an allergic reaction not so much to the main active ingredient, but to the auxiliary components synthetic origin. At the first pathological manifestations you should stop taking it, consult a doctor, or change the medicine you are using.

Indications

Antiallergic drugs are effective in various pathologies allergic origin:

seasonal, vasomotor rhinitis;
skin reactions - rash, itching, hyperemia after an insect bite;
food allergy – a reaction to the consumption of substances of plant or synthetic origin;
drug allergies, etc.

Infusion administration is prescribed as an addition to adrenaline-containing solutions for anaphylactic shock, angioedema.

Contraindications

The main contraindications to the use of antiallergic drugs are:

hypersensitivity to the main active substance;
peptic ulcer duodenum, stomach;
angle-closure glaucoma;
inflammatory processes of the prostate gland;
diseases Bladder(obstruction, cervical contracture);
respiratory diseases (pathologies of the lower respiratory tract).

Particular caution should be exercised when treating with antihistamines during pregnancy and lactation, avoiding taking medications of this group if possible. Also, under medical supervision, the use of drugs in children, especially early childhood, elderly patients, those who have recently suffered serious illnesses.

Side effects

Among pathological reactions For 1st generation antihistamines, the following can be noted:

dermatological manifestations;
photosensitivity;
rarely - anaphylactic shock;
reflex tachycardia;
thrombus formation;
arterial hypertension;
rapid pulse;
lack of coordination;
lethargy;
fainting;
dizziness;
discomfort, stomach pain;
loss of appetite;
bitter taste;
difficult, painful urination;
feeling of constriction in the chest;
drying of the mucous surface of the nasopharynx;
nosebleeds;
accumulation of mucus in the bronchi.

New generation antiallergic drugs can cause the same side effects with a lower degree of severity.

Interaction with other medications

1st generation antihistamines enhance the therapeutic effect:

anticonvulsants of synthetic origin;
anticholinergics;
antidepressants (tricyclics);
Medicines used for Parkinson's disease;
neuroleptics;
MAO blockers.

Potentiation of the inhibitory effect is also noted when combined with:

general anesthetics;
sleeping pills and sedatives;
tranquilizers;
centrally acting analgesics.

Prohibited during drug treatment drink alcoholic beverages.

Dosage

The prescribed dosage is determined by the following factors:

specific diagnosis;
features of the course of the disease;
patient's age;
individual characteristics of the body.

First generation drugs are prescribed to adult patients mainly three times a day, 1 tablet. Only a doctor prescribes dosage for children!

Second generation drugs are prescribed to adults, 1 tablet once a day (standard regimen).

Maximum permissible daily amount:

adults - 100 mg or 4 tablets.

Solution for injection:

adults - 1 – 2 ml.

In the presence of functional disorders from the liver or kidneys, as a rule, the amount of medication used is reduced to avoid the development of complications.

Factors and signs of overdose

Poisoning with antihistamines can happen either intentionally or unintentionally. In the first case, a person, as a rule, pursues the goal of suicide. In the second, there is an erroneous use of an inflated dose due to forgetfulness.

It is important to remember: an overdose of antihistamines can be fatal, which often happens to children.

Characteristic symptoms of poisoning are:

psychomotor agitation, which can last from 10 to 12 hours;
visual hallucinations;
disturbance of consciousness;
drowsiness;
coma.

Phase increased excitability often accompanied by:

convulsions;
mydriasis (dilated pupils);
increased muscle tone;
activation of tendon reflexes;
tremor of the limbs;
ataxia – loss of coordination (static or dynamic).

With the development of coma, the following is observed:

constriction of the pupils, lack of reaction to light;
muscle hypotonicity;
hyporeflexia (weak reflexes).

Also progressing autonomic disorders, manifested:

dry skin, mucous membranes;
tachycardia;
increased heart rate;
sharp jumps in blood pressure readings.

Electroencephalography reveals chaotic bursts bioelectrical activity various areas brain.

First aid

If an overdose of antihistamines is suspected or confirmed, you should urgently call an ambulance team. Without wasting time, carry out a series of procedures to neutralize the toxic effect active substances on the victim's body.

The first mandatory action orally high doses - thorough gastric lavage. To do this, an adult or child is given about 1 liter of a weak saline solution to drink. For this, 1 tbsp. l. salts are diluted with 2 - 3 liters of water.

After complete cleansing it is important to ensure the stomach drinking plenty of fluids. It is also recommended to drink a saline laxative or give a cleansing enema.

Increasing diuresis is the main step towards rapid elimination of toxins.

To neutralize harmful effects absorbents are used (activated carbon, Polysorb, Atoxyl, Polyphepan, etc.).

Treatment of poisoning with antihistamines

Acute forms of poisoning require immediate administration of an antidote. Relief of seizures is carried out with the help of seduxen - 5 - 10 mg is administered intravenously. Psychomotor agitation can be reduced by intramuscular injection tizercin, aminazine - 2 ml 2.5% r – ra.

If necessary, therapy is supplemented with injections of the following agents:

galantamine - 1 – 3 ml 0.25% under the skin;
physostigmine - 1 ml 0.1% subcutaneously;
aminostigmine - 1 – 3 ml 0.1% intravenously, intramuscularly.

For the purpose of detoxification, forced diuresis and oxygen therapy are carried out in a hospital setting.

Conclusion

Poisoning with antihistamines poses a considerable danger to health and life, especially for children. When undergoing a therapeutic course, it is necessary to strictly adhere to the dosage and regimen of taking the drug. If signs of intoxication appear, immediately consult a doctor and take first aid measures.

So, we have already discussed the topic of poisoning in detail, but we have not examined specific types of poisoning - only general principles, began to sort out the poisonings and foodborne diseases. But there are still enough factors that can cause poisoning in children, including small ones. Let's continue discussing the topic of poisoning in detail and we'll talk about medications. Or more precisely about their pathogenic effect in case of poisoning.

Drug poisoning

Usually poisoning medicines arise due to oversight or negligence of adults who may leave drug packaging or capsules or liquids behind. As a result, children's hands and mouths get to the beautiful tablets, which are usually sweet (shell) and bright, the syrups smell pleasant (although children can easily swallow strong-smelling ones, alcohol tinctures). But that’s not all - the most dangerous thing about drug poisoning is that the clinical manifestations of poisoning may not occur immediately, and children hide the fact of eating pills and their quantity, and parents themselves do not remember exactly how many pills they had in the package. When taking sugary pills, children do not initially experience discomfort, They dont have pain as in case of poisoning with other substances.

It can take from half an hour to several hours until signs of poisoning appear, and most active substance and accompanying substances in the drug will have time to be absorbed into the blood and have its effect negative effect. The signs of drug poisoning are as varied as the drugs themselves can be different in action - therefore, often clinical symptoms overdose (and this is what happens in case of drug poisoning) depends largely on the drug group and dose taken pills and the active substance in them. But drug poisoning also has several common symptoms.

Signs of drug poisoning in children

Any, even seemingly harmless, drugs are dangerous for children - including nasal drops, antipyretics, vitamins, minerals. Everything will depend on the dose of tablets or syrups taken. At the same time, the lives of children who have been poisoned by drugs will depend on active and right actions parents and doctors to provide first aid and medical care. At the slightest suspicion that the child may have taken the pills, immediate gastric lavage is necessary if the child is conscious. In an unconscious state, rinsing is strictly prohibited - there may be aspiration of the contents into the Airways. Rinse the stomach several times until clean waters, then the child is given a laxative - all this is done before the ambulance arrives, without delaying assistance for a minute.

You need to call an ambulance right away: one flushes the stomach, and the second calls 03. If the child's breathing becomes weaker or the heart stops, immediately begin artificial respiration and to indirect massage hearts. If the child is conscious and can answer questions, try to find out what drugs, when and in what quantity the child could have taken, but do not scare him - out of fear of punishment he may hide the truth from you. If poisoning occurs in a very small child, carefully examine the place where the child played, and find the packaging of pills, try to count the number taken drug. This is necessary to select an adequate antidote and start as soon as possible early treatment poisoning The child will be hospitalized in the intensive care unit for toxicology and will receive emergency treatment.

Paracetamol poisoning

Paracetamol is widely used for fever, colds and for the purpose of pain relief various states in children. It is usually produced for babies in sweet syrups, which caring mothers can leave unattended. And children, once they taste the sweet syrup, may want to drink it all. Paracetamol or its analogues - Panadol, Cefekon, Efferalgan, Kalpol, Milistan - are dangerous for children if the dose is exceeded. In order to utilize paracetamol in the liver, a lot of a special substance is required - glutathione; with an overdose of paracetamol, there is not enough glutathione and as a result, a toxic intermediate product begins to form. This product binds to liver cells and causes their necrosis, leading to acute liver failure. An overdose of the drug by 30-50 times will require an immediate liver transplant - paracetamol will kill the child’s liver. The kidneys are no less affected - they are killed by the paracetamol metabolite paraaminophnol, and they can also fail. Toxic effects occur with an overdose 10 times higher than the therapeutic dose, with excessively frequent re-administration of the medication, or one-time dose a large dose at once.

Paracetamol poisoning occurs in several stages. The first lasts from the first thirty minutes until the end of the first day. There may be no symptoms, but there is usually nausea and vomiting, pallor and very heavy sweating. In the second stage, from the first to the second day, nausea and vomiting, pain in the right hypochondrium, and increased levels of liver enzymes occur. Two to three days after taking a toxic dose of paracetamol, jaundice occurs, liver failure and encephalopathy. The kidneys and heart may be affected, but the mortality rate is low - no more than 0.5%, and less than smaller child, the more his liver resists poisoning. In the hospital, in case of paracetamol poisoning, glutathione preparations are used (they are most effective in the first eight hours), which help in removing paracetamol, rehabilitation treatment, monitor blood and urine tests.

Salicylate poisoning

Salicylates include the well-known aspirin in all its forms, Citramon, acetylsalicylic acid and "Acelysin". This group drugs are actively used for fever, colds and inflammation in adults. These drugs are prohibited for children under 12 years of age in principle, but in case of poisoning their effect is especially dangerous. When there is an excess of salicylates, highest temperature and acidification of the blood, fluid loss, severe blood clotting and bleeding, liver and kidney damage. A toxic dose for children can be 3 or more tablets. The drugs also cause ulcers of the digestive tract and severe gastritis.

The initial manifestation of poisoning is agitation, vomiting and severe rapid breathing; this stage lasts up to twelve hours. Then metabolic disorders occur with coma, hallucinations, convulsions, persistent fever, bleeding from the digestive tract, and kidney damage. May be fatal outcome from cerebral edema, pulmonary edema or vascular collapse. It is not easy to cure such poisonings - the stomach is washed out, laxatives are prescribed, alkaline solutions to relieve plasma acidification. And then hemodialysis methods are used to eliminate the manifestations renal failure. Vitamin K is also used internally to prevent bleeding.

Poisoning with antihistamines (allergy medications)

Antihistamines include Pipolfen, Diphenhydramine, Suprastin, Tavegil and analogues. These drugs, especially the first generation, penetrate the brain and spinal cord, which leads to toxic manifestations. Exceeding the dose by five or more times becomes toxic for children. This manifests itself in excitement, and then the appearance of lethargy, drowsiness and decreased tone and tendon reflexes. Convulsions, mental disorders with delusions and hallucinations may occur. In moderate poisoning, special symptoms: “Crazy as a hatter, hot as a hare, dry as a leaf, red as a beet.” This stands for agitation and hallucinations, seizures, encephalopathy, dry skin, mucous membranes dry out, body temperature rises sharply to 40 degrees and above, pupils dilate, tachycardia, increased blood pressure and arrhythmia occur. As the poisoning deepens, a coma occurs, a decrease in pressure, dilated pupils, and severe muscle hypotension. May occur death due to acute vascular insufficiency.

How to treat such poisonings? Gastric lavage and laxatives are necessary, and then resuscitation methods - normalization of breathing and pressure, relief of convulsions, normalization of blood circulation. In case of organ damage, antidotes of antihistamines and infusion agents are administered to maintain blood pressure; in case of severe poisoning, children are transferred to hemodialysis. Antibiotics are also used, since dry mucous membranes lead to disruption of the bronchi. It is also important to monitor your heart, breathing and digestive tract. Mortality is low, mainly from neurological complications. Complications may then persist for up to several months.
Continue tomorrow.

Antihistamine drugs have the properties to prevent the development and alleviate the course of allergic reactions. This group of substances includes pipolfen, diphenhydramine, suprastin, etc. Antihistamines that penetrate the blood-brain barrier have a pronounced effect on nervous system They exhibit a fairly strong calming effect, enhance the effect of painkillers, lower body temperature, and have an antiemetic effect. Poisoning with these drugs in adults is possible due to substance abuse or attempted suicide. Electoral toxic effect drugs of this group – neurotoxic (anticholinergic), psychotropic (narcotic). What to do in case of poisoning with antihistamines?

Symptoms of antihistamine poisoning

The severity of antihistamine poisoning is determined not only by the amount of the drug taken, but also by the degree of individual sensitivity to it. Thus, severe poisoning can develop when taking both 500 mg and 100–125 mg of pipolfen. The first symptoms of poisoning appear 10 to 90 minutes after taking the drug. Patients become lethargic, drowsy, stagger when walking, speech becomes incoherent and slurred. Dry mouth is noted, and in case of diphenhydramine poisoning - numbness of the oral cavity.

In case of poisoning moderate severity a short period of stunning is replaced by a state of mental and motor excitement. Patients become restless, begin to rush about, scream, catch something in the air, try to run, and experience an influx of hallucinations. After 5 - 7 hours from the moment of poisoning, the state of excitement is replaced by sleep, which is interrupted by periods of mental and motor excitement. Sleep lasts 10–12 hours, after which consciousness clears up, but patients remain lethargic and drowsy. Throughout intoxication, dry skin and visible mucous membranes, tachycardia and increased breathing are noted.

Antihistamine poisoning. In severe poisoning with antihistamines, two variants of the sequence of disturbances of consciousness can be noted. In some patients, after the initial stunning, as in cases of moderate poisoning, a state of excitation develops, after which sleep or coma occurs, a drop in blood pressure and respiratory depression. In others, sleep or a state of stupor after a few hours is replaced by mental and motor agitation, hallucinations, followed by sleep or coma.

Almost all patients with severe poisoning experience convulsive twitching of the muscles of the face and limbs at the beginning of intoxication. Single or repeated attacks of general clonic-tonic convulsions are possible. In severe poisoning, breathing increases to 30–40 beats per minute, the pulse rate reaches 130–150, and in children, up to 170–190 beats per minute.

In patients with acute poisoning antihistamines usually dilate the pupils, their sluggish reaction to light, nystagmus, slurred speech. Muscle tone increases during periods of excitement and decreases during sleep. Tendon reflexes are animated. Trembling of the limbs and loss of coordination are noted.

What to do in case of poisoning with antihistamines

First aid for patients with poisoning with antihistamines consists of gastric lavage, administration of a saline laxative, and a cleansing enema. All these measures can be carried out only after the seizures have stopped. For this purpose, use Seduxen, 5 – 10 mg intravenously. When excited, use aminazine or tizercin, 2 ml of a 2.5% solution intramuscularly. The administration of physostigmine (1 ml of 0.1% solution subcutaneously), or galantamine (1 - 3 ml of 0.25% solution subcutaneously), or aminostigmine (1 - 3 ml of 0.1% solution intramuscularly or intravenously) is indicated. To cleanse the body of absorbed poison, forced diuresis is used in the hospital. Oxygen therapy is carried out.

Antihistamines (chloropyramine, promethazine, clemastine and others) are used mainly for treatment allergic diseases. Many of them have an effect on the central nervous system, both stimulating and depressing.

Symptoms of poisoning with antihistamines.

Disturbances in the activity of the central nervous system - mental and motor agitation or, conversely, lethargy, drowsiness, muscle hypotonia, inhibition of tendon reflexes. In both the first and second cases, convulsions, loss of orientation, delirium, and hallucinations may occur. Redness and dryness of the skin and mucous membranes and increased body temperature develop. During examination, the victim is found to have dilated pupils, rapid heart rate, increased blood pressure, and there may be disorders heart rate. In severe poisoning with antihistamines, coma develops.

A typical description of a victim of antihistamine poisoning: “Crazy as a hatter, hot as a hare, dry as a leaf, red as a beet.” The comparison "mad as a hatter" is associated with similar disorders brain activity from hat manufacturers, resulting from chronic poisoning mercury used in work.

First urgent Care in case of poisoning with antihistamines.

Rinse the victim’s stomach using a probe or artificially inducing a gag reflex, and use a suspension to complete the rinsing activated carbon. After gastric lavage, administer a saline laxative (15–30 g of sodium sulfate) through a tube. As a drug with the opposite effect, aminostigmine is used (0.01–0.02 mg/kg body weight, used in a 5% glucose solution), which is administered twice with an interval of 15–20 minutes.

Galantamine and proserine are also used. For convulsions, diazepam (0.2–0.5 mg/kg body weight) or sodium hydroxybutyrate (100–150 mg/kg body weight) is administered intramuscularly. Mandatory infusion therapy in forced diuresis mode ( intravenous administration glucose-salt solutions in combination with a diuretic - furosemide). In case of severe poisoning with antihistamines, hemodialysis (hardware blood purification) is indicated.

Poisoning with antipsychotics and antidepressants.

Neuroleptic drugs (aminazine, levomepromazine and others) and antidepressants (amitriptyline and others) affect the central nervous system, many of them have side effects on the heart. vascular system, which is even more significant in case of poisoning.

Symptoms of poisoning with antipsychotics and antidepressants.

Feeling of heaviness in the epigastric region, nausea, vomiting initial stages poisoning Then the gag reflex is suppressed. The victim develops indifference to the environment, lethargy, decreased muscle tone, and gait disturbances occur. This state may give way to excitement, hypersensitivity to various external stimuli. Gradually developing deep dream. There is dryness of the skin and mucous membranes.

Moderate poisoning is also characterized by dilated pupils, rapid heartbeat, decreased amount of urine output and urine retention. Rhythm disturbances may be detected. Intestinal motility absent. At severe poisoning Coma develops, breathing becomes impaired, and a significant decrease in blood pressure is noted. There is marked pallor of the skin, cold sticky sweat. Possible tonic or clonic seizures, cardiac and respiratory arrest.

First emergency aid for poisoning with antipsychotics and antidepressants.

Rinse the victim's stomach using a probe or artificially inducing a gag reflex; to complete the rinsing, use a suspension of activated carbon. Then introduce a saline laxative (15–30 g of sodium sulfate) - give it to drink or through a tube. As a drug with the opposite effect, aminostigmine is used (0.01–0.02 mg/kg body weight, used in a 5% glucose solution), which is administered twice with an interval of 15–20 minutes. Riboxin is administered intravenously at a dose of 20 mg/kg body weight twice with an interval of 1 hour.

For seizures, use diazepam (0.2–0.5 mg/kg body weight) or sodium hydroxybutyrate (100–150 mg/kg body weight). With a significant decrease in blood pressure, dopamine is administered (10–15 mcg/kg body weight per minute). To speed up the transformation of the antipsychotic into an inactive form, injections of a solution of vitamin B12 are practiced, which are done 2-3 times a day. Glucose infusion therapy is mandatory. saline solutions. IN severe cases hemosorption (hardware blood purification) is indicated.

Based on materials from the book " Quick help in emergency situations."
Kashin S.P.