The method of definition of tactics of treatment for withdrawal of alcohol

 

(57) Abstract:

The invention relates to medicine, namely to psychiatry-addiction, and may find application in the treatment of the syndrome of alcohol delirium. On admission the patient spend integral rheography of the body when the frequency of the probe current 282 kHz. Rogramme determine the volume of the extracellular fluid, total peripheral vascular resistance and integral impedance of the body. By reducing the volume of the extracellular fluid by more than 950 ml, total peripheral resistance vessels below 1200 dissm-5and increasing the integral of the impedance of the body more than 20 Ohms diagnose shock disorder of systemic hemodynamics. In this case, the treatment begins with an antishock therapy. For all other values of these indicators, the treatment begins with detoxification therapy. The method provides early detection of shock when the syndrome of alcohol with delirium, which allows adequate therapy and improve treatment effectiveness.

The method relates to medicine, more specifically to psychiatry-addiction, and may find application in the treatment of the syndrome of alcohol delirium.

The syndrome is a long time and in high doses, divided into non-psychotic syndrome and the syndrome of alcohol delirium.

According to the international classification of diseases under non-psychotic withdrawal syndrome alcohol is defined as a group of symptoms of variable clustering and severity occurring during the discontinuation of ethanol, limited in time and to a certain extent, appropriate dose, immediately prior to the abstinence. Typically, this syndrome is facilitated by hung over. The diagnosis should be coded as the main, if sufficiently pronounced, and is a direct reason for seeking a doctor.

The initial symptoms of cancellation alcohol is insignificant and presents subjective complaints: discomfort, discomfort in the mouth, feeling of heaviness in the head, cravings for alcohol, lower efficiency. These symptoms are themselves, or through, as mentioned above, Pokolenie, which quickly eliminates unpleasant bodily sensations, but retains and enhances the attraction to alcohol. At this stage, good help and nonspecific toning effect: strong tea, coffee, cold shower. Medication bar is m abolition of alcohol presents subjective and distinct somatovegetative symptoms: tremor, hyperhidrosis, tachycardia, unstable blood pressure, mydriasis, less frequently, vomiting, relaxation of the intestine, high urine output, insomnia, etc.

A pronounced withdrawal syndrome include mental illness, sometimes regarded as a precursor of alcoholic psychosis: tension, anxiety, unconscious fear, guilt, insomnia with nightmarish dreams, delusional disorder, sometimes hallucinations. These disorders, many authors call "transitional" or "intermediate" between non-psychotic withdrawal options and expanded alcoholic psychosis.

The syndrome of alcohol with delirium according to the international classification of diseases (ICD-10) is understood as delerium tremens, characterized by short, but sometimes life-threatening state of confusion with comorbid medical disorders: tremor, fever, tachycardia, profuse sweating, dilated pupils, redness of the skin, nausea, insomnia, and allometrically disorientation in the form of hallucinatory stupor of consciousness, confusion of thought, changeable affect, anxiety, fear, prevalence of true hallucinations, illusi the Oia, leukocytosis, shift leukocyte formula to the left, increased sedimentation rate, and sodium and magnesium, as well as prothrombin reduced. Constantly you can identify urobilinuria, oligouria, hypertensive, some degree of dehydration and tissue acidosis.

Symptoms of autonomic over-activity of the nervous system, psychiatric, and metabolic disorders usually peak at 2-3 days after the onset of symptoms. Recovery usually occurs after critically deep sleep, much less gradually (lytic). Memories of former mental disorders to some extent fragmented. Ill remember (often in great detail) the content of these disorders in the first place hallucinations, while going, as well as their own behavior are partial and even total amnesia. Delirium in all cases ends with fatigue, the symptoms of which is subject to large fluctuations.

The frequency of the syndrome of alcohol delirium significantly superior to all other meta-alcoholic psychosis, taken together, although the syndrome of alcohol delirium passes through 3-5 days, it can often lead to death. Retrospective analysis of cases, si is on the background of intense mental disorders can increase the pathology of the cardiovascular system (shortness of breath, acrocyanosis, tachycardia, arrhythmia, deafness heart sounds, changes in blood pressure). After 10-12 hours after such deterioration due to ongoing mental disorders, in particular intensive motor excitation, such patients often encountered severe collapse and death. Death withdrawal syndrome alcohol with delirium according to the statistical data from different sources are observed from 1 to 16%.

Currently, the identification of the syndrome of alcohol is a clinical-psychological method comprising the following: clinical interview with the patient, history taking, assessment of mental status, physical and neurological examination, complete blood count and urine analysis, biochemical analysis of blood (sugar, protein with protein fractions, bilirubin, enzymes, sublimate and thymol turbidity tests, hematocrit, blood pH, blood gases, residual nitrogen, urea, creatinine, potassium, sodium, calcium, magnesium, chloride in serum, ECG, x-ray examination of the chest, the ratio of the injectate and diuresis, counseling, therapist, neurologist, ophthalmologist.

The results of this survey are directly dependent on sitsa the possibility of unexpected complications, including death.

At diagnosis the syndrome of alcohol treatment according to existing Standards (Protocol models) diagnosis and treatment of drug patients.// Annex to the decree of the Ministry of health of Russia from 27.04.98,, 140". This method is closest to the proposed and taken as a prototype.

When the syndrome of alcohol moderate treatment includes the following:

1. Detoxification within 3-5 days in a row: dextran 40, dextran 70, polyvidone, Trisol, global, saline, 5% glucose solution - in/drip; sodium thiosulfate, unithiol.

2. Vitamins: thiamine, pyridoxine, ciankobalamin, ascorbic acid, nicotinic acid, thioctic acid, folic acid.

3. Tranquilizers and hypnotics: chlordiazepoxide, oxazepam, nitrazepam, medazepama, phenazepam, reladorm sleeping pills, phenobarbital.

4. Anticonvulsants: carbamazepine, volpaia acid.

5. Dehydrating: furosemide, triampur.

6. Neuroleptics: thioridazine, periciazine, chlorpromazine and other

7. Physiotherapy: electrocrystallization.

8. Psychotherapy: the rational, the suggestion on the background of electrocrystallization.

9.retinol.

At diagnosis the syndrome of alcohol delirium" in any scenario and its severity according to existing Standards (Protocol models) diagnosis and treatment of drug patients.// Annex to the decree of the Ministry of health of Russia from 27.04.98,, 140" scope of examination and treatment should be the maximum.

Treatment of the syndrome of alcohol delirium provides the following:

1. Detoxification: polyvidone, dextran 70, dextran 40, Trisol, global, ringer's solution/drip; saline, 5% glucose solution p/drip 500-1000 ml; magnesium sulfate 25% - 5-10 ml/10% glucose drip; sodium thiosulfate, calcium chloride/unithiol 5-10 ml/m

2. Non-drug detoxification: cleansing enema, plasmapheresis, hyperbaric oxygenation, surface craniocerebral hypothermia, chelators.

3. Vitamins: thiamine, pyridoxine, ciankobalamin, ascorbic acid, nicotinic acid/or/m

4. Diuretics: mannitol/furosemide/m, acetazolamide, triampur inside.

5. Means of combating the agitation and insomnia: sodium salt-hydroxybutyric acid, sodium thiopental/diazepam/hydrocortison, prednisolone in/in or/m

8. Anticonvulsants: carbamazepine, volpaia acid inside.

This method usually relieves acute psychotic disorders, restores fully or partially criticism to the transferred state, stabilizes somatic functions when possible preservation of fatigue. However, in spite of the method prototype diagnosis and treatment, it is often possible deterioration of the patient, including death, reaching, as was said above from 1 to 16% of cases.

The technical result of the present method consists in reducing the number of deaths due to the objectification of diagnosis and determine on the basis of adequate treatment.

This result is achieved by the fact that simultaneously with clinical and psychological examination and subsequent detoxification patient previously conducted integral rheography of the body when the frequency of the probe current 282 kHz, obtained reogramme determine the volume of the extracellular fluid, total peripheral vascular resistance and integral impedance of the body and by reducing the volume of the extracellular fluid by more than 950 ml, total periphery the Om diagnose shock disorder of systemic hemodynamics, and the treatment begins with an antishock therapy, for all other values of these indicators conduct detoxication therapy.

Doing professionally for many years in the diagnosis and treatment of patients with chronic alcoholism, coming with the syndrome of alcohol, we have repeatedly noted that the recommended intensive detoxification therapy sometimes led to a sharp deterioration of the patient. Literature data (Azrieli, And. On the "start" delirium tremens/ Ukr. neuropathol. and the psychiatrist.// 1973, 9, S. 1191; Azrieli, I. New aspects of the pathogenesis of alcohol/ L., Med., 1975, 145 S.) also suggests that in the treatment of non-psychotic syndrome alcohol in the same hospital with high doses of hypnotics and neuroleptics development of alcoholic psychosis (the syndrome of alcohol with delirium according to ICD-10) was observed in 3% of cases, and when switching to treatment with intensive detoxification therapy by massive infusions polyionic solutions with minimal use of sleeping pills - in 17% of cases.

We decided to study this problem. Exploring the condition of such patients, we drew attention to the cases smartjustice, and in some cases quickly kupirovtsa. Samootrechenie disease was sometimes difficult to link to any external factors, including therapeutic and diagnostic procedures. In some cases the deterioration is so obviously coincided with the treatment that the patients themselves have pointed to these factors as causes. So, we had a patient who said that after intravenous infusion of isotonic him every time was disoriented, there were hallucinations, increased anxiety, there was excitement. He said that after such hard drinking at home, he did not develop the syndrome of alcohol delirium, although he was suffering from a hangover in a few days.

Sometimes we had to observe the rapid transition of non-psychotic variant of the syndrome alcohol withdrawal syndrome alcohol with delirium after heavy intravenous detoxification solutions. Extensive injuries, fractures of tubular bones with hemorrhage at the site of fracture often resulted in the development of the syndrome of alcohol delirium, if the injury was preceded by a bout. But it is particularly dangerous was samootrechenie state when the syndrome alkogolny delirium tremens, such deterioration could occur abruptly. Unstable blood pressure were followed by hypotension. In these cases, it became extremely difficult to puncturevine vein, since Vienna was spadolini, and the blood was folded in the needle. The skin was cold. Developed acrocyanosis, pallor nasolabial triangle were replaced on a pale grey skin. Facial features were pointed. The pulse was threadlike, very frequent, weak, often appeared arrhythmia. Heart sounds became deaf. Stopped urination. Appeared harsh breathing, and sometimes clinically evident pulmonary edema. Marked psychomotor agitation was exhausted. The patient could not get out of bed, motor excitation was limited to small hand movements, myoclonic twitching. The speech became slurred, muttering. Developed skill. If dipped in blood pressure, collapse when the patient was already very difficult to save. Often such a sharp deterioration occurred after such treatment procedures, medications, causing a decrease in blood pressure. A similar result of a sharp aggravation of the condition when the syndrome of alcohol sometimes caused quite fast, cerebral pathology in the pathogenesis of the syndrome of alcohol greater role apparently, plays a disorder of systemic hemodynamics. For standard clinical psychological observations violations of systemic hemodynamics were available and doubtless only at the stage of extreme aggravation of psychosis. A question was raised about the need for early detection of systemic disorders of hemodynamics in the syndrome of alcohol with delirium and how natural it is to the disorder. We went to rheography, allowing to determine the volume of the extracellular fluid, total peripheral vascular resistance and integrated impedance, that is, to judge the state of systemic hemodynamics in patients with different variants of the syndrome of alcohol. As a result of the research, we found that patients with the syndrome of alcohol delirium is a deep violation of both systemic hemodynamics and regional microcirculation. On the basis of theoretical and practical research, we hypothesized that the syndrome of alcohol delirium runs in the background of the shock response of the body.

The shock from the positions of the pathophysiology, can be defined as a state of deep depression circulation. As a result, the blood flow becomes insufficient to normal is antenna... or not interrupted adequate therapeutic interventions, there comes death" (Ryabov, A. Syndromes critical States.// M.: Medicine, 1994, S. 175).

Shock is the phase current. In erectile phase is observed prevalence of processes of excitation and activation of the endocrine and metabolic functions. Clinically this is manifested standard and even hypertension, tachycardia, increased respiration. Characterized by motor and verbal agitation, fidgeting. The patient is active, but the activity of its ill-conceived and poorly productive. The face and the visible mucous often pale, rarely face hyperemic. The width of the normal pupil, their reaction to light is fast, but can be and dilated pupils. Increased sweating. The normal pulse frequency, sometimes slow, tense. Blood pressure normal or slightly reduced.

Unlike erectile phase torpid phase of shock is characterized by indifference and prostration. Some patients move their erectile phase in the nodules is gradual, but more quickly, within a few minutes. The General condition in this case is heavy, mind retarded. Pupils dilated, react poorly to light. The face is pale or pale grey, cool sticky the thread, sometimes not detectable on the limbs and depends only on large vessels. Saphenous vein spachina, breathing casino and weakened. Blood pressure, especially systolic, reduced (60 - 40 mm RT. Art.), cardiac output is reduced. Determined by metabolic acidosis, the urine output is reduced or absent. Torpid phase gradually and sometimes suddenly enters a terminal state. This stage but essentially represents a comatose state with all its characteristic features (Losev N. And., Khitrov N. K., Grachev S. C. Extreme condition// In the book: Pathophysiology, ed Lytvytsky P. F., M.: Medicine, 1995, 752 S.).

The shock has a different origin, from its etiology depends symptoms, but common in all species it is intracellular violation in various organs and tissues. This fact, characteristic of the syndrome of alcohol with delirium and in some cases flowing through the type of shock reactions, prompted us to hypothesize that the syndrome of alcohol delirium is a form of shock. Numerous studies conducted in patients with the syndrome of alcohol delirium, helped to establish the first signs of shock when syndromerelated developing shock and to take adequate measures to in order to avoid him or immediate pain.

Determination in patients with the syndrome of alcohol with delirium by the integral rheography body total peripheral resistance vessels, volume of extracellular fluid and integrated impedance as an informative indicator of the development shock, allowed us to start treatment with an anti-shock therapy, which are as follows:

1. Intravenous injection of a 0.5% solution of diazepam 4 ml, then 20% solution of sodium oxybutyrate dose of 70-120 mg/kg prior to the onset of pharmacological sleep. If necessary, the introduction of drugs is repeated for prolonging sleep for at least 10-12 hours. This allows you to cut off the excitation of the Central nervous system with predominant disturbance of the braking process, which is of importance in the development of shock.

2. Intravenous injection of a 6% aqueous solution poliglyukina 400 ml, if necessary, repeat for days infusion of 400 ml more poliglyukina. This allows you to restore the volume of the effective circulating blood.

3. Intravenous injection of 2%-aqueous solution trental 5 ml of a 5% solution of ascorbic acid in 3 ml of 0 is as in the tissues.

4. Introduction intravenous prednisolone hemisuccinate dose up to 1 mg/kg for hypotension. It stabilizes blood pressure.

5. Upon the occurrence of respiratory disorders - the transition to a controlled breath.

After 8 hours of pharmacological sleep in patients with significantly reduced symptoms of shock, improved systemic hemodynamics and regional microcirculation, recovered diuresis. To improve metabolic processes were introduced complex vitamins, nootropics, when pain syndrome - analgesics, with a decrease in cardiac output - cardiac glycosides, swelling in the brain - diuretics. The amount of fluid controlled according to the integral rheography of the body, and it did not exceed the deficit of the extracellular fluid.

Executed then control measurements showed that after such therapy shock hemodynamic changes were significantly decreased and we had no deaths.

Repeated targeting of integral rheography of the body when the frequency of the probe current 282 kHz and analysis of results of ongoing resuscitation and detoxification therapy has allowed to establish that the reduction of the volume of extracellular fluid is aqueous impedance of the body more than 20 Ohms indicate the development of shock and require immediate resuscitation therapy. For all other values of these parameters it is necessary to conduct detoxication therapy.

The essence of the method is illustrated by examples.

Example 1.

Patient, 36 years old, male. Growth 170 see the body Weight 65 kg.

The diagnosis of the Syndrome of alcohol delirium. Active alcohol dependence, the middle stage.

Data for family history there. Development without features. He graduated 10 classes. Then he entered the electrical engineering College, from which he graduated. He was drafted into the army. The service was good. After the army I started working in the specialty at the factory. Married, has a daughter 6 years. His wife soon divorced. Relationship with ex-wife does not. Lives with her mother in a separate apartment. The last two years engaged in petty trade. Going to organize a larger commercial enterprise.

In the childhood has transferred the chicken pox, dysentery, epidemic parotitis. Was treated by an ophthalmologist about chorioretinitis. In adolescence was a concussion.

To alkoholitarbimist began after the army, with approximately 21 years. The last seven years has been sober beer. Tolerance up to 1.5 liters of vodka. Recent years have seen the palimpsests. Postolka and started a new pseudogaps. In 1998 addressed to the psychiatrist, was treated as an outpatient. But soon again began to drink. The last bout in 2 weeks. In intoxicated resisted the police. Was sentenced to 15 days. While serving his sentence, the patient developed abstinency syndrome. Two days later he had lost sleep. At night the patient "saw" that allegedly burst pipes, pouring streams of water. Tried to "repair" the pipe was excited, didn't understand where he is, didn't know what number. Was determined by a pronounced tremor, sweating. Correctly called themselves. Was examined by a psychiatrist emergency room and diagnosed with alcoholic delirium delivered in a psychiatric hospital. In a psychiatric hospital delivered within 13 hours of the day.

Upon admission to the hospital. Skin, clean, warm. Tremor, hyperhidrosis. Tongue thickly coated whitish-yellowish tint. Pallor nasolabial triangle. Increased thirst. Oliguria. Heart sounds rhythmic, muted, 148 beats per minute. HELL 130/80 mm RT.article Body temperature 36,9oC. In the lungs vesicular breathing. The liver is smooth, elastic, acts of pogrebennoi arc 3 see the Abdomen is soft, painless. Mydriasis. The reaction of pupils to light LM and the patient is oriented correctly in place, time and self. Anxious, restless. Remember the night experiences, talks about the streams of water, which threatened all flood. Says he tried to fight it. Critics do not. By evening, the patient became disoriented in the surrounding. Don't know the date, believes that he is at home. Excited, talking to imaginary people, turns over the bed, something is trying to catch with his hands, with quarrels. Briefly distracted from their experiences, and then again becomes agitated. Critics do not. Two hours were allocated 66 ml of urine.

The diagnosis of the Syndrome of alcohol delirium. Active alcohol dependence, the middle stage.

Performed integral rheography of the body with the help of the device "KM-AR-01" producer JSC Diamond. The device is equipped with software which calculated the following: should the volume of the extracellular fluid, should the impedance and other necessary parameters. Should the volume of the extracellular fluid was 10880 Jr. Has impedance 226 Ohms.

All parameters were determined by the formulas used in the method of integral rheography body (Comprehensive assessment of the functional state systems krivooserski C. B., Zemtsovsky E. C. , Guseinov B. A. M., 1989, 1992). Should the volume of extracellular fluid (Downing) can be determined by the formula

Downing = DOCK,4 = 4533 ml,4 10880 ml,

where DOCK (blood volume) is determined based on the height and weight of the patient on the table S. Albert, and in this case amounted 4533 ml, and 2.4 is an empirical coefficient.

Should the impedance (DimP) defined by the formula

DimP = 0,085 L2/ Downing = 0,0851702/ 10880 226 Ω,

where L is the growth of the patient, and of 0.085 is an empirical coefficient. It is established that the volume of the extracellular fluid of the patient is 9500 ml at norm equal 10880 ml. Thus, the volume of the extracellular fluid is reduced to 1380 ml Total peripheral vascular resistance was 614,4 dissm-5, at the rate equal to not less than 1200 dissm-5(Fundamentals of human physiology/ Ed. B. I. Tkachenko. In 2 volumes, St. Petersburg, 1994, T. 1, S. 244). Integral impedance of the body amounted to 249 Ohms at the rate equal to 226 Ohms, and thus was increased to 23 Ohms. Based on this established a state of shock. Started antishock therapy. Introduced p-p 0.5% diazepam 4 ml intravenously, then R-R 20% sodium oxybutyrate 25 ml intravenously slowly; R-R 6% poliglyukina 400 ml nutriv Ivanna at 40 drops per minute.

Came pharmacological sleep. During the procedure had gone pale nasolabial triangle. Recovered diuresis. After two hours allocated 454 ml of urine, and within 12 hours allocated 1600 ml of urine. After a 14-hour sleep phenomena of psychosis cropped completely. The patient is oriented correctly in the self, knows that it is in the hospital, but can't remember the circumstances of the hospitalization. In a good mood. Delusions, illusions of perception is not detected. Was antiroll many real events that happened to him during the period of psychosis. Remember that he allegedly was at the station, which for some reason was flooded with water, in the company of friends who drank, but he should drink interfered with the web, which climbed into her mouth. With some surprise declares: "All things, was so blind drunk delirium tremens". Ascension. Tongue thickly coated. Blood pressure is 125/80 mm RT.article Muffled heart sounds. The pulse was good and filling voltage 112 beats per minute. In the lungs vesicular breathing. The abdomen is soft, painless. Hand tremor. Excessive sweating. Tendon reflexes uniform, average vivacity.

One day after receipt held integral rheography of the body. It is established that extracellular volume Total peripheral resistance of vessels amounted 1198 dissm-5, at the rate equal to not less than 1200 dissm-5. Integral impedance of the body 240 Ohms at the rate equal to 226 Ohms, and thus was increased to 16 Ohms. Indicators integral rheography body beyond limits set by us. Shock cropped.

Further received detoxification treatment, including:

1) a Physiological solution of 0.9% - 400 ml

Glucose 40% - 50 ml

The solution of magnesium sulfate 25% - 10 ml

A solution of potassium chloride 4% - 10 ml

The ascorbic acid solution 5% - 3 ml

The solution of pyridoxine hydrochloride 5% - 2 ml

The solution furosemide 1% - 2 ml

intravenous drip 3.

2) the Solution of nicotinic acid 1% - 2 ml intramuscularly 10.

3) Solution of thiamine bromide 6% to 2 ml subcutaneously 10.

4) Solution of vitamin ciankobalamin of 0.05% to 1 ml intramuscularly 10.

5) Phenazepam 0,001 1 tab. three times a day, for three days.

6) Methionine 0.25 in table 2. three times a day.

7) the Solution of chlorpromazine 2,5% - 2 ml intramuscularly at night 3.

During the control study integral rheography body on the fifth day of stay in hospital was established that the volume of extracellular fluid is 9980 ml at norm, Davudov was 1482,8 dissm-5at the rate equal to not less than 1200 dissm-5. Integral impedance of the body was 238 Ohms at the rate equal to 226 Ohms, and thus was increased to 12 Ohms. Thus, the phenomenon of systemic hemodynamics improved significantly, there are no signs of shock.

To the transferred state on the fifth day of hospitalization the patient is completely critical. Remained moderate non-psychotic phenomena variant of the syndrome of alcohol with asthenic component.

In the future, the General condition of the patient was normal. Was discharged in good condition after 11 days home under the supervision of a psychiatrist at the place of residence.

Example 2.

Patient Century, 30 years old, male. Growth 174 see the body Weight of 55 kg

The diagnosis of the Syndrome of alcohol moderate. Active alcohol dependence, the middle stage.

The father suffers from alcoholism. Previously the development of a patient without disease. The secondary education. He graduated from vocational school, majoring in Turner. Served in the army in 1988-90, the Service went smoothly. He was married, but now divorced. He lives with his parents, a daughter 8 years old and wife. Recently working as a janitor at the school. Alcoholized 15 years. Special was put on drug registration. Repeatedly treated but about alcoholism outpatient and inpatient. Remission for 3-4 months. The last four years pseudogaps to 1.5 weeks. The patient is drinking mostly vodka. Tolerance up to 1.5 liters of vodka a day. Several times in my life drank alcohol surrogates (tincture of hawthorn). There were cases when drank away things because of the strong desire to be sober Last bout in 10 days. Before admission to the hospital stopped drinking alcohol.

On examination, the patient on the ward. The patient complains of craving for alcohol, insomnia, headache, characterized as "a feeling of heaviness in the head, weakness. Skin, clean, warm. Determined hyperhidrosis, increased thirst. Tongue thickly coated. Heart sounds rhythmic, muted, 80 beats per minute. HELL 140/80 mm RT.article The body temperature of 36.7oC. In light scattered dry rales (patient many years Smoking). The liver is smooth, elastic, acts of pogrebennoi arc 4.5 see the Abdomen is soft, painless. Two hours were allocated 321 ml of urine. Pupils uniform, their reaction to light alive. Hand tremor. Tendon reflexes uniform, average vivacity.

The consciousness of the patient is clear. Correctly oriented watts. Gets up to drink water. Delusions and illusions of perception is not detected. The main events of his life remembers. APAS knowledge corresponds education. Actively complains of feeling unwell. Looking for help. Formally critical to the disease. He says that if get sober, it will be easier, but then it is impossible to stop the bout will continue. At the same time believes that normal people should drink: "So the doctors say, good for the heart. But I don't know how to drink, so we need to "stop". Personality altered by alcohol type. Expresses lightweight judgments about alcohol consumption: "it's all I drink, what am I weird to walk. Who doesn't drink, doesn't respect".

The diagnosis of the Syndrome of alcohol moderate. Active alcohol dependence, the middle stage.

Performed integral rheography of the body. Should the volume of extracellular fluid 10150 Jr. Has impedance 254 Ohms. Should the volume of circulating blood 4230 Jr. Should the volume of the extracellular fluid, should the volume of circulating blood, should the impedance was determined by the formula shown in example 1.

Downing = DOCK,4 = 4230 ml,4 10150 ml.

DimP = 0,085 L2/ Downing = 0,0851742/10150 254 Ohms.

The mouth of emochnoy liquid is reduced to 720 ml Total peripheral vascular resistance was 1219,1 dissm-5, at the rate equal to not less than 1200 dissm-5(see Example 1). Integral impedance of the body was 265 Ohms at the rate equal to 254 Ohms and thus was increased to 11 Ohms. Based on this established that the state of shock in a patient no. Started detoxification therapy:

1) a Physiological solution of 0.9% - 400 ml

A solution of sodium thiosulfate and 30% - 10 ml

Glucose 40% - 50 ml

The solution of magnesium sulfate 25% to 20 ml

A solution of potassium chloride 4% - 10 ml

The ascorbic acid solution 5% - 3 ml

The solution piracetam 20% - 10 ml

The solution of pyridoxine hydrochloride 5% - 2 ml

intravenous drip 3.

2) Furosemide 0,04 1/2 tablet three days.

3) the Solution of nicotinic acid 1% - 2 ml intramuscularly 10.

4) Solution of thiamine bromide 6% to 2 ml subcutaneously 10.

5) a Solution of vitamin ciankobalamin of 0.05% to 1 ml intramuscularly 10.

6) Phenazepam 0,001 1 tab. three times a day, for three days.

7) Methionine 0.25 in table 2. three times a day.

8) the Solution of chlorpromazine 2,5% - 2 ml intramuscularly at night 4.

The condition of the patient in the treatment process has gradually improved. Recovered from a dream. Popocat. The mood is even and smooth. Delusions, illusions of perception is not detected. Critical to its state. Communicates with patients. Expresses the staff's compassion and gratitude: "For your patience and assistance, such as we are." Trying to help in the Department. Tongue thickly coated. Heart sounds rhythmic, muted, 78 beats./min In the lungs vesicular breathing. The abdomen is soft, painless. The liver acts of pogrebennoi arc 4.5 cm, smooth, supple. Blood pressure 120/80 mm RT.article Diuresis in normal. Tendon reflexes average vivacity, uniform. Hand tremor. When carrying mattresses, cleaning the house quickly gets tired, sweating heavily.

During the control study integral rheography body on the fifth day found that the indicators do not go beyond limits set by us.

In the course of the treatment effects of the syndrome of alcohol cropped. The patient sleeps and eats well. The mood is even and smooth. Delusions, illusions of perception is not detected. Feels fresh. Expresses the installation on a sober life. Intends to continue treatment and follow-up in outpatient drug Cabinet. On day 10 of hospitalization was discharged home in good condition under the supervision of a psychiatrist.

Polucen is passed.

To the present time using the proposed method, a survey and treatment of 63 people, including the 22 identified shock, conducted antishock therapy. They are all alive. 3 people of them identified the syndrome of alcohol with delirium without shock. They have undergone detoxification therapy, which was uneventful.

Compared with known has a number of advantages:

1. Allows for early identification shock when the syndrome of alcohol with delirium and to carry out an anti-shock therapy, which significantly reduces the risk of unexpected complications leading to death.

2. Provides fast and effective diagnosis shock and the treatment of the syndrome of alcohol with delirium due to the fact that for integral rheography body requires 15-30 minutes.

3. Owing to instrumental study to objectify the diagnosis shock when the syndrome of alcohol delirium.

4. Non-invasive and has no negative impact on the processes in the body of the patient, can be reused in the treatment process balinovac with a positive result.

The method of definition of tactics of treatment for the syndrome of alcohol by clinical psychopathological examination, wherein the pre-spend integral rheography of the body when the frequency of the probe current 282 kHz, obtained reogramme determine the volume of the extracellular fluid, total peripheral vascular resistance and integral impedance of the body and by reducing the volume of the extracellular fluid by more than 950 ml, total peripheral resistance vessels below 1200 dissm-5and increasing the integral of the impedance of the body more than 20 Ohms diagnose shock disorder of systemic hemodynamics and treatment begin with an antishock therapy, for all other values of these indicators of detoxification therapy.

 

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SUBSTANCE: method involves recording rheogram from feet and legs lifted and fixed at an angle of 45є. Then, rheogram is recorded on inhaling from legs directed vertically downward. Functional blood circulation reserve index is calculated as product of results of dividing and subtracting rheographic indices recorded under conditions of lifted and lowered extremities that means under conditions of functional venous system relief and venous hypertension, respectively.

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6 dwg

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