Incidence of Delirium Tremens in Acute Poisoning by Psychopharmacological Drugs or Corrosive Substances and Its Prevention Using Intestinal Lavage: on the Pathogenesis of Delirium Tremens

RELEVANCE . In patients suffering from alcohol dependence admitted to hospital with an intercurrent disease, the probability of delirium tremens (DT) is high, so the search for means of its prevention is relevant. THE AIM OF STUDY . To study the incidence of DT in patients with poisoning by psychopharmacological drugs and corrosive substances, and to evaluate the effectiveness of intestinal lavage as its prevention. MATERIAL AND METHODS . We conducted a prospective study that followed 287 patients (observation group). Of these, 162 patients had psychopharmacological drug poisoning (PPDP) and 125 patients had corrosive substance poisoning (CSP), who underwent intestinal lavage (IL) for the purpose of detoxification and correction of metabolic disorders. A retrospective analysis of the examination results of 211 patients with PPDP and 102 with CSP (a total of 313 patients — comparison group) who did not receive IL was conducted. The patients in the groups were comparable in terms of gender, age, and severity of the same poisonings. The severity of PPDP corresponded to stage 2b, and the severity of CSP corresponded to 2nd-3rd degree chemical burn of the upper gastrointestinal tract, including the stomach. All the patients had metabolic disorders that required correction. The study endpoints were the incidence of DT, and the duration of treatment in the intensive care unit (ICU). RESULTS . In the comparison group, DT in PPDP and CSP developed in 57.8% and 56.9%, respectively. In the observation group, with the same nosological forms of poisoning, DT developed in 6.8% and 12% of cases, respectively. The intergroup differences in the incidence of DT in the same types of poisoning were statistically significant (p<0.05; U curve). The ICU stay of patients with DT in CSP who had previously underwent IL was 10 days shorter than in the comparison group, and in PPDP — 11 days shorter than in the comparison group. This difference was statistically significant (p<0.05; U curve). CONCLUSION . The obtained results showed the effectiveness of intestinal lavage as a method for preventing delirium tremens in individuals with alcohol dependence. The observed phenomenon of decreased risk of delirium tremens development in patients who underwent intestinal lavage suggests that the pathogenesis of delirium tremens is associated with morphological and functional disorders of the gastrointestinal tract, the key link of which is the excess proliferation of microflora, for the vital activity of which ethanol is necessary. The decreased risk of delirium tremens in the group of patients who underwent intestinal lavage in the complex treatment is obviously associated with the therapeutic mechanisms of the latter — detoxification of the body and correction of homeostasis disorders, including intestinal microbiota, by eliminating ethanol-dependent microflora and its toxins. FINDINGS . 1. In individuals suffering from alcoholism with poisoning by psychopharmacological drugs and corrosive substances, delirium tremens occurs in 57.8% and 56.9% of cases, respectively. 2. When using intestinal lavage in complex treatment for the same poisonings, the incidence of delirium tremens is 6.8% and 12.0%, respectively, which is 8.5 and 4.7 times less than in case of standard treatment. This difference is statistically significant (p<0.05). 3. The use of intestinal lavage in acute poisoning by psychopharmacological drugs and corrosive substances reduces the stay of patients with delirium tremens in the intensive care unit by 2.6 and 2.7 times, respectively. This difference is statistically significant (p<0.05). LIMITATIONS OF THE STUDY : age from 28 to 55 years, clinical diagnosis of “Alcohol related disorders” (ICD-10 code F10) in patients with poisoning by psychopharmacological drugs or corrosive substances, intestinal lavage in a volume of at least 12 (9; 15) l.