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Vol. 24, Art. 61 (pp. 829-839)    |    2023       

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On the significance of the concentration factor for the assessment of the severity of acute poisoning with psychoparmacological drugs in patients over 60 years of old

Ilyashenko K.K.1,2, Potskhveria M.M.1,3, Belova M.B. 1,3,4 , Simonova A.Yu.1,2,3

1 N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow Department of Health, 129090, Moscow, Russia
2 Scientific and Practical Toxicological Center of the Federal Medical and Biological Agency of Russia,
3 Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation
4 First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of the Russian Federation (Sechenov University), 119991, Moscow, Russia

Brief summary

Since the end of the last century, the number of people of geriatric age has increased significantly, including in our country. In this age category, there has been an increase in acute chemical poisoning, primarily with psychopharmacological drugs. An objective measure of the severity of acute poisoning is the concentration of toxicants in the blood of patients. Taking it into account, threshold, critical and irreversible levels of toxic concentrations of toxicants were determined for patients younger than 60 years, according to which the clinical picture of poisoning changes, reflecting its severity. The purpose of the study: to evaluate the value of the concentration factor for the severity of acute poisoning with psychopharmacological drugs (PPD) in of elderly and senile age patients. Material and methods. 115 patients with PPD poisoning aged 60 to 89 years, 70.4% of women, 29.6% of men. Qualitative and quantitative determination of PPDs and their metabolites in urine and blood serum was carried out by chromatography-mass spectrometry. Results. In 39% of patients, mono-poisoning occurred, in other cases, combined administration of two or more drugs of different names was registered. Both mono- and combined poisoning occur most often as a result of taking benzodiazepines, among them phenazepam. Among the combined poisoning, simultaneous administration of barbiturates and benzodiazepines was most often detected. Combinations of phenazepam with amitriptyline, carbamazepine, clozapine, as well as other combinations of two or more drugs were identified. The range of detected concentrations of the studied PPD ranged between therapeutic and toxic levels. It was found that in elderly and senile people, in some cases, the clinic of poisoning of mild and sometimes moderate severity was noted with therapeutic concentrations of drugs in the blood, more often with their combined use. Conclusion. In elderly and senile patients with PPD poisoning, the concentration thresholds of toxicants are reduced, therefore, for an objective assessment of the severity of poisoning in them and the effectiveness of treatment, thresholds of toxic concentrations for specific drugs should be established.


Key words

acute poisoning; psychopharmacological drugs; concentrations; elderly people

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