Intestinal toxicosis

Intestinal toxicosis

Intestinal toxicosis (CT) is a syndrome observed in severe forms of intestinal infections (CI), occurring with intoxication, dehydration, and hemodynamic disturbances. The term is used mainly for severe conditions in CI in young children. So far CT

• • the main underlying cause of infant mortality in CI. Classification according to the degree of dehydration
  • Hypotonic variant
  • Hypertonic variant
  • isotonic version. Etiology. The disease is registered with CI occurring with a clinic of gastroenteritis, enteritis and enterocolitis (salmonellosis, escherichiosis, CI caused by opportunistic pathogens, less often dysentery).

Clinical picture

• • Symptoms of dehydration
  • Thirst: An early sign of fluid deficiency, associated with an increase in plasma effective osmotic pressure, is most pronounced in the hypertensive variant.
  • Dryness of the skin is associated with a compensatory reaction to a decrease in sweating; as a result of the loss of water by skin cells, it loses elasticity; most noticeable in hyper- and isotonic variants, in hypotonic due to intracellular hyperhydration it is less pronounced.
  • The decrease in turgor (elasticity) of soft tissues is associated with the loss of fluid in the interstitial space.
  • CNS lesions. Characterized by a subsequent change in the period of excitation (the first 1-3 days) by a general inhibition of the activity of the central nervous system (somnolence, stupor). Changes in CSF osmolarity and its volume in different types of toxicosis lead to various changes in the large fontanelle in infants: in hypotonic dehydration, it sinks, and in hypertonic dehydration, it swells. Coma on CT is not a frequent occurrence, prognostically unfavorable.
  • Changes in the temperature reaction of the child’s body. Usually, with hypertensive dehydration, the child’s body temperature is increased due to a reflex decrease in skin moisture – one of the thermoregulation factors. Hypothermia is characteristic of the hypotonic variant of exsicosis and anhydraemic shock.
  • Disorders of the central and peripheral circulation are associated with loss of isotonic fluid and dehydration with a lack of plasma electrolytes.
  • Respiratory disorders are a consequence of impaired blood circulation. Tachypnea in the hypertensive variant can lead to additional fluid loss.
  • Decreased urination is associated with a reflex decrease in diuresis in response to extrarenal fluid loss. Accounting for this feature is necessary when assessing the effectiveness of rehydration therapy and restoring BCC. AKI develops traditionally as a result of hemolytic uremic syndrome in acute intestinal infections, shock kidney syndrome in infectious-toxic shock.
  • Dehydration levels
  • I degree – underweight 3-4% of the initial body weight of the patient
  • II degree – deficiency of mass 5 ~ 8%
  • III degree – a mass deficiency of more than 8%.

CT phase diagnostics

• • The phase of the initial manifestations or precursors of toxicosis (duration from several hours to 5-6 days).
  • Phase of expanded manifestations of CT
  • Clinical and laboratory signs of the hypertensive variant (a relative excess of osmotically active ions in the plasma leads to the release of free water into the plasma from the cells and the development of intracellular dehydration)
  • Expressed thirst
  • Severe dryness of the skin
  • Decreased soft tissue turgor
  • psychomotor agitation
  • Increase in body temperature
  • Preserved indicators of central hemodynamics with an increase in heart rate corresponding to fever
  • Shortness of breath corresponding to fever
  • Decreased urination
  • High levels of potassium, sodium, plasma chlorine with unchanged Ht; indicators of KShchS change a little.
  • Clinical and laboratory signs of a hypotonic variant (extracellular dehydration [decrease in the amount of free water in plasma] is accompanied by intracellular overhydration)
  • Lack of thirst, up to complete refusal to drink water
  • Normal moisture or slight dry skin
  • Decreased soft tissue turgor
  • CNS depression: lethargy, drowsiness, possible severe disorders of consciousness up to coma (prognostically unfavorable sign)
  • Normal or reduced temperature response
  • Severe disorders of microcirculation and central hemodynamics
  • Frequent shallow breathing; with severe hemodynamic and neurological disorders – up to pathological types of breathing
  • Oliguria to anuria
  • Low levels of plasma electrolytes, an increase in Ht, metabolic acidosis in varying degrees of compensation.
  • Clinical and laboratory signs of isotonic variant
  • moderate thirst
  • Moderate dryness of the skin
  • Decreased soft tissue turgor
  • CNS depression: lethargy, drowsiness; gross disorders of consciousness are not typical
  • Moderate increase in body temperature
  • Microcirculatory disorders, pronounced hemodynamic disturbances are observed only with massive fluid losses (II-III degree of dehydration)
  • Frequent shallow breathing
  • Decreased diuresis, up to anuria
  • Normal levels of plasma electrolytes, a moderate increase in Ht, compensated variants of acid-base disorders.
  • The resolution phase of CT is recorded with a favorable course.

Research methods

• • Determination of the concentration of plasma electrolytes (potassium, sodium, chlorine): determine the dehydration option
  • In the hypotonic variant, the content of ions is below normal (salt deficiency)
  • With hypertensive – higher (relative excess of salts in plasma)
  • With isotonic – within normal limits
  • Growth in Ht with iso- or hypotonic variant of CT
  • Changes in acid-base balance, most often in the acidic direction, with significant losses of sodium and bicarbonates, with gross disorders of hemodynamics and kidney function (hypo- and isotonic variants of dehydration).

Treatment:

Rehydration therapy

• • Oral intake of fluids – at I degree, as well as as an adjunct to infusion therapy at II and III degrees

dehydration. Oral rehydration is effective in preventing exsicosis in diarrhea in adults and children

• Citroglucosolan, glucosolan, rehydron. For emergency rehydration, any solutions suitable for drinking
• Fluids will need to be taken despite vomiting and diarrhea in excess of ongoing losses.
• Infusion rehydration is the main type of care for severe degrees of dehydration.
• With signs of shock (drop in blood pressure, weak frequent pulse, decrease in peripheral blood flow, skin moisture), rapid compensation of the BCC without taking into account the concentration of blood electrolytes; apply 0.9% solution of NaCl at the rate of 20 ml / kg for 30 minutes. Further replenishment of the volume of fluid is carried out according to needs.
• Isotonic dehydration. Fluid to correct the deficiency and meet daily requirements is prescribed as a 24-hour infusion. At the same time, half of the total volume is administered in the first 8 hours. Treatment of a child with 10% dehydration with a body weight of 10 kg with a body area of ​​0.6 m² is carried out according to the following scheme:
• The child needs 1 liter of fluid to meet daily physiological needs (1,500 ml/m2) and 1 liter of fluid to compensate for the deficiency (10% of 10 kg), as well as Na + and K + (20-30 mEq each to meet physiological needs and 70 mEq each to replace electrolyte deficiency [Na + deficiency is determined by its concentration in 0.5 l of deficient fluid, assuming that intracellular fluid is lost; K + deficiency is equated to Na deficiency
• ])
• Half of the total amount (1 l of 5% glucose solution in 0.3% NaCl solution) is administered in the first 8 n, the rest – in the next 16 hours
• It is necessary to periodically monitor the condition of the child and monitor fluid losses.
• Hypertensive dehydration. To prevent a too rapid decrease in the concentration of Na
• its missing amount is administered evenly and slowly over 48 hours, along with the volume of physiological fluid requirements.
• Hypotonic dehydration
• The amount of sodium you will need to transfer the state of hyponatremia dehydration to isonatremia is determined by the formula: [Na + = 0.6
• body weight (kg) x (necessary concentration of Na + – registered concentration of Na +)]
• Given the possible risk of neurological complications, including osmotic demyelination syndrome, it is not necessary to completely compensate for the total Na deficiency.
• . Usually, when correcting, it is considered quite reasonable to achieve a serum concentration of Na + 125 mEq / l. At very low initial sodium concentrations (