Severe acute poisoning with methadone and α-pyrrolidinovalerophenone complicated by circulatory arrest

-pyrrolidinovalerophenone. The case manifested as a critical circulatory arrest with a significant depression of consciousness, reaching a coma II level, alongside cytotoxic edema affecting the white matter of the brain and corpus callosum. Notably, the serum S-100 protein concentration was increased to 152.1 ng/L. The patient also exhibited acute respiratory failure, mixed acid-base disorders, lactic acidosis, cardiotoxic effects, acute renal impairment, acute hepatic impairment, toxic encephalopathy, post-cardiac arrest syndrome, and subsequent severe neurocognitive deficits, as well as cystic gliosis and atrophy in the anterior and anterior-basic parts of the frontal lobes, along with cyst formation in the basal nuclei. The patient received intensive care, including mechanical ventilation with the Hamilton C2 device in Continuous Mandatory Ventilation (CMV) mode, inotropic support, correction of acid-base and hypoxic disturbances, and nutritional support via percutaneous endoscopic gastrostomy to address protein-energy deficiency. Additionally, antibacterial therapy was employed, along with measures to resolve intestinal obstruction. Following stabilization of the blood's oxygen transport function, a multicomponent drug containing inosine, nicotinamide, riboflavin, and succinic acid was used, which facilitated correction of hypoxic complications and the acute psycho-organic syndrome, leading to improvements in cognitive function.