Mark a diuretic for forced diuresis. Treatment with forced diuresis. There are such rules

In order to eliminate the intoxicating consequences of using medications, specialists can use various procedures, among which it is worth highlighting forced diuresis. Its effectiveness makes this method one of the main ones in a doctor’s arsenal. To understand the feasibility of this procedure, it is worth studying the essence of its action, the main indications and contraindications, as well as the stages of implementation.

The forced diuresis procedure is used by specialists to eliminate intoxication complications. This effect is achieved by accelerating the processes of urine excretion. This must be done with the help of special medications, as well as with a large amount of fluid consumed. The normal urine output is 0.8-1.2 ml per minute. When performing this procedure, indicators can increase to 8-12 ml/min.

Forced diuresis allows you to remove various final metabolites, as well as the result of the breakdown of medications. The means used in this method can improve the filtration performance of the excretory system.

The results of the procedure are strongly influenced by the levels of toxic substances attached to the cells. This can be explained by the presence of the transition of certain pathogenic factors from the extracellular structure to the cell membrane.

Localized on the outer side of the membrane, toxins easily dissolve in water molecules and undergo diuresis. With reduced efficiency of the urinary system and a high degree of intoxication of the lesions, some remedies may not give the desired result. This is why treatment is ineffective in most cases.

The effects of drugs to reduce toxin levels directly depend on urine acidity levels:

1. At a pH below 7, metabolites with basic properties are perfectly eliminated.
2. At pH above 7 – with acidic properties.

Before using forced diuresis, the doctor must understand the main indications for its use. They are also one of the main factors in the effectiveness of the method.

For forced diuresis, specialists can use various medications. These include Phenamine, Furosemide, Nitroprusside, Diprazine. Before using them, the doctor must decide on the indications.

Among them it is worth highlighting:

• the influence of strong intoxicating substances on the patient’s body;
• overdose medicines;
• development of allergic reactions in response to the use of any medications;
• long-term exposure to strong chemical substances on the patient.

The presence of contraindications in a particular case is a signal that the method of forced diuresis should be replaced with something else.

The main limitations of using this procedure include:

• the patient's state of shock;
• swelling of the lungs, as well as brain structures;
• acute renal or cardiac failure vascular system;
• diseases of endocrine organs;
• the presence of acute intestinal obstruction;
• perforation processes in the gastrointestinal tract;
• internal bleeding and hematomas;
• blood clots in the heart vessels.

The presence of these contraindications gives the doctor a signal that it is worth using another method of cleansing the circulatory system. In this case, the choice is made towards a more conservative technique.

The use of this technique in case of intoxication of the human body occurs only in a hospital setting. Specialists assess the performance of the excretory and vascular systems, and also determine the rate of urine excretion. To do this, find a vessel into which the catheter is installed. With its help, a special diuretic is introduced into the patient’s body. A catheter is also inserted into the bladder cavity. This is done to assess the fullness of the organ.

How much water is introduced:

1. To begin with, two liters of water are injected into the patient's body at a rate of one liter per hour.
2. After this, it must be reduced to 500 ml per hour.
3. For intoxication of moderate severity, men are given 8 liters of water, and women – 6.
4. In more dangerous situations the amount of liquid can be increased.

When performing forced diuresis, every few hours specialists add special medications that can stimulate blood movement. The duration of this method directly depends on the amount of accumulated toxins, as well as the severity of complications. When increasing the amount of fluid consumed, the doctor must ensure that the volumes are equal. If the rate of urine excretion exceeds 100 ml per hour, then diuresis can be considered forced.

It is worth remembering that this procedure should not be carried out at home. This is fraught with serious consequences that can cause significant harm to the patient’s health.

Each stage of this procedure involves the use of special medications and large amounts of liquid. This is necessary in order to speed up the process of urine excretion.

The steps for forced diuresis include:

1. Introduction of 500 ml of three percent sodium bicarbonate and 1500 ml of Acesol. In this case, 2 liters of a mixture of these two components are administered at a rate of 100 drops per minute. It is also worth using at least one diuretic. The most commonly used are Furosemide or Nitroprusside.
2. A 10% solution of Mannitol is used at the rate of 1 gram per kilogram of the patient’s weight, and 250 ml of Eufillin is also added. It must be injected in a stream.
3. Using a five percent glucose solution with the addition of 50 ml of a 7% emulsion of potassium solution and 100 ml of 5% calcium chloride.
4. The doctor may also administer a liter or more of some protein-based product. This remedy is very effective for long-term therapy.

The catheter must be brought to the subclavian or ulnar vein. The second device is inserted into the cavity of the bladder. This is necessary in order to control the speed of its filling.

The procedure must be performed under the strict guidance of a specialized specialist who constantly monitors the patient’s water-electrolyte balance and hemodynamic data. Diuretics are used taking into account various factors, among which the most important are the degree of intoxication, the presence of concomitant diseases, as well as the general condition of the patient’s body.

Despite its prevalence and many benefits, forced diuresis can lead to many different complications. They are usually observed when the rules of the procedure are not followed, as well as when the method is used while there are active contraindications on the part of the patient. In this situation, there is a high probability of developing hypoglycemic and hyperhydration processes.

Long-term use of diuretics can lead to osmotic nephrosis. To avoid this, experts use saluretics. In any case, it is advisable to use a diuretic only under the supervision of a physician. If you adhere to this rule, treatment with medications will be as effective as possible.

With an overdose of drugs to increase urination, the acid-base balance changes. This significantly affects the functioning of various organs and systems.

To prevent the development of any complications, it is necessary to follow all the instructions of a specialized specialist and the procedure will be as safe as possible for the patient’s health!

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Forced diuresis as a method of detoxification is based on the use of drugs that promote a sharp increase in diuresis, and is the most common method of conservative treatment of poisoning, when hydrophilic toxicants are eliminated primarily by the kidneys.

These goals are best met by osmotic diuretics (urea, mannitol), the clinical use of which was started by the Danish physician Lassen in 1960. The osmotic diuretic is distributed only in the extracellular sector, does not undergo metabolic transformations, is completely filtered through the basement membrane of the glomerulus, and is not reabsorbed in the tubular apparatus kidneys

Mannitol is the best, widely used osmotic diuretic. Distributes only in the extracellular environment, is not metabolized, and is not reabsorbed by renal tubules. The volume of distribution of mannitol in the body is about 14-16 liters. Mannitol solutions do not irritate the intima of veins and do not cause necrosis if they get under the skin. They are administered intravenously in the form of a 15-20% solution of 1.0-1.5 g per 1 kg of body weight. The daily dose is no more than 180 g.

Urea is a conditional osmotic diuretic, distributed throughout the entire water sector of the body by free diffusion, and is not metabolized. The drug is non-toxic, but highly concentrated solutions damage the intima of the veins and can cause phlebitis. Long-term stored solutions produce hemolysis. It is used in the form of a 30% solution at a dose of 1.0-1.5 g per 1 kg of patient body weight. If kidney function is impaired, the introduction of urea can sharply increase the nitrogen content in the body, so in such cases it is not used.

Furosemide (Lasix) is a strong diuretic (saluretic) agent, the action of which is associated with inhibition of the reabsorption of Na+ and Cl ions, and to a lesser extent, K+.

The effectiveness of the diuretic effect of the drug, used in a single dose of 100-150 mg, is comparable to the effect of osmotic diuretics, however, with repeated administration, more significant losses of electrolytes, especially potassium, are possible.

The forced diuresis method is a fairly universal way to accelerate the removal of various toxic substances from the body, including barbiturates, morphine, OPI, quinine and pachycarpine, dichloroethane, heavy metals and other drugs excreted from the body by the kidneys. The effectiveness of diuretic therapy is significantly reduced as a result of the formation of strong bonds of many chemical substances that enter the body with blood proteins and lipids. This is observed, for example, in case of poisoning with phenothiazines, librium, leponex, etc. In case of poisoning with toxicants that give an acidic reaction in an aqueous solution (barbiturates, salicylates, etc.), the blood is first alkalized by intravenous administration of sodium bicarbonate (4% solution 500 ml).

Forced diuresis is always carried out in three stages: preliminary water load, rapid administration of a diuretic and replacement infusion of electrolyte solutions.

The following method of forced diuresis is recommended. The hypovolemia that develops in severe poisoning is first compensated for by intravenous administration of plasma-substituting solutions (polyglucin, 400 ml and 5% glucose solution in a volume of 1.0-1.5 l). At the same time, the concentration of the toxic substance in the blood and urine, the hematocrit are determined, and a permanent urinary catheter is inserted to measure hourly diuresis. Urea or mannitol (15-20% solution) is administered intravenously in a stream in an amount of 1.0-1.5 g per 1 kg of the patient’s body weight for 10-15 minutes, then a solution of electrolytes at a rate equal to the rate of diuresis.

The high diuretic effect (500-800 ml/h) persists for 3-4 hours, after which the osmotic balance is restored. If necessary, the entire cycle is repeated, but no more than two times to avoid the development of osmotic nephropathy. The combined use of osmotic diuretics with saluretics (furosemide) provides an additional opportunity to increase the diuretic effect by 1.5 times. However, the high speed and large volume of forced diuresis, reaching 10-20 l/day, pose the potential danger of rapid leaching of plasma electrolytes from the body.

To correct possible salt imbalances, a solution of electrolytes is administered, the concentration of which is slightly higher than in urine, taking into account the fact that part of the water load is created by plasma-substituting solutions. The best option such a solution: potassium chloride - 13.5 mmol/l and sodium chloride - 120 mmol/l with subsequent monitoring and additional correction if necessary. In addition, for every 10 liters of urine excreted, 10 ml of a 10% calcium chloride solution is required.

The method of forced diuresis is sometimes called blood washing, so the water and electrolyte load associated with it places increased demands on the cardiovascular system and kidneys. Strict accounting of injected and excreted fluid, determination of hematocrit and central venous pressure make it possible to easily control the body’s water balance during treatment, despite the high rate of diuresis.

Complications of the forced diuresis method (overhydration, hypokalemia, hypochloremia) are associated only with violation of the technique of its use. To avoid thrombophlebitis at the site of injection of solutions, it is recommended to use the subclavian vein. With long-term use of osmotic diuretics (over 3 days), the development of osmotic nephrosis and acute renal failure is possible. Therefore, the duration of forced diuresis is usually limited to these periods, and osmotic diuretics are combined with saluretics.

The method of forced diuresis is contraindicated in case of intoxication complicated by acute cardiovascular failure (persistent collapse, circulatory disorders II-III stage), as well as in cases of renal dysfunction (oliguria, azotemia, increased blood creatinine content more than 221 mmol/l, which is associated with low filtration volume). In patients over 50 years of age, the effectiveness of the forced diuresis method is noticeably reduced for the same reason.

Therapeutic hyperventilation

Methods of enhancing the natural processes of detoxification of the body include therapeutic hyperventilation, which can be achieved by inhaling carbogen or connecting the patient to an artificial respiration apparatus, which allows increasing the minute volume of respiration (MRV) by 1.5-2 times. This method is considered particularly effective in acute poisoning with toxic substances, which are largely removed from the body by the lungs.

The effectiveness of this detoxification method for acute poisoning with carbon disulfide (up to 70% of it is excreted through the lungs), chlorinated hydrocarbons, and carbon monoxide has been proven in clinical settings. However, prolonged hyperventilation leads to the development of disturbances in the gas composition of the blood (hypocapnia) and the acid-base state (respiratory alkalosis). Therefore, under the control of these parameters, intermittent hyperventilation is carried out (15-20 minutes each) again every 1-2 hours throughout the entire toxicogenic phase of poisoning.

Regulation of enzymatic activity

Biotransformation of toxic substances is one of the most important ways of natural detoxification of the body. In this case, it is possible to increase the activity of enzyme induction, mainly in liver microsomes responsible for the metabolism of toxic compounds, or to decrease the activity of these metabolites, i.e. inhibition, resulting in a slowdown in metabolism. In clinical practice, enzyme inducers or inhibitors are used that affect the biotransformation of xenobiotics in order to reduce their toxic effects.

Inducers can be used in cases of poisoning by substances whose immediate metabolites are significantly less toxic than the native substance.

Inhibitors can be used in case of poisoning by such compounds, the biotransformation of which proceeds according to the “lethal synthesis” type, i.e. with the formation of more toxic metabolites.

Currently, more than two hundred substances are known that can influence the activity of microsomal enzymes (cytochrome P-450).

The most studied inducers are barbiturates, in particular phenobarbital or benzonal, and a special Hungarian drug, zixorin. Under the influence of these drugs, the level and activity of cytochrome P-450 increases in liver mitochondria, which is due to stimulation of their synthesis processes. Therefore, the therapeutic effect does not appear immediately, but after 1.5-2 days, which significantly limits the possibility of their use only to those types of acute poisoning, the toxicogenic phase of which develops slowly and lasts longer than the periods indicated above.

The clinical use of inducers of enzymatic activity is indicated for poisoning (overdose) with steroid hormones, coumarin anticoagulants, contraceptives with a steroid structure, analgesics such as antipyrine, sulfonamides, antitumor drugs (cytostatics), vitamin D, as well as some insecticides (especially in subacute poisoning) from the group carbamic acid (dioxycarb, pyrimor, sevin, furadan) and organophosphorus compounds (actellik, valekson, chlorophos).

The doses of enzymatic activity inducers used in the clinic are: for zixorin - 50-100 mg per 1 kg of body weight 4 times a day, for reamberin - a 5% solution of 400 ml into a vein for 2-3 days. IN last years Chemo-hemotherapy methods using sodium hypochlorite infusions are most widely used as inducers of enzymatic activity; HBO and PHT can also be used for this purpose.

Many have been proposed as inhibitors of enzymatic activity. medications, in particular nialamide (monoamine oxidase inhibitor), chloramphenicol, teturam, etc. However, their clinical effectiveness in case of poisoning with substances that undergo lethal synthesis in the body is limited, since the inhibitory effect develops on the 3-4th day, when the toxicogenic phase of most poisonings is already at an end.

E. A. Luzhnikov, G. N. Sukhodolova

Forced diuresis is a method of detoxification therapy based on artificial stimulation of urination through the simultaneous introduction of fluid and diuretics into the body in order to accelerate the excretion of toxic substances from the body in the urine. The rate of urine formation, which is normally 0.7-1.3 ml/min in a healthy adult, increases with D. f. up to 8-10 ml/min.

The detoxification effect is mainly due to the accelerated elimination of the toxin due to the increased formation of glomerular ultrafiltrate (primary urine) and its rapid movement through the renal tubules, which reduces the reabsorption of the toxin in the tubules, increasing its excretion in the urine. When using the method, it is taken into account that simple substances that are not associated with proteins and have a neutral reaction are excreted mainly by glomerular filtration, and substances that have the properties of weak acids or bases, regardless of their binding to proteins, are secreted by renal tubular cells at a rate depending on Urine pH. With a slightly acidic urine reaction, substances with basic properties are better excreted; with an alkaline reaction, on the contrary, substances with slightly acidic properties are excreted. Thus, alkalinization of urine to a pH of 7.0 or more increases the renal clearance of phenobarbital by approximately 5 times, and of salicylic acid by 10 times.

The main indication for the use of forced diuresis is poisoning with substances excreted from the body primarily in the urine. It is rarely used for infectious intoxication. Contraindications to the use of forced diuresis are severe cardiovascular failure, intracranial, and conditions that threaten its development (for example, cerebral ischemic crisis), digitalis, poisoning with nephrotoxic poisons and substances that have an extrarenal route of excretion from the body, in the stage. A cautious attempt to stimulate diuresis can be made at the beginning of the oliguric stage of acute renal failure, which developed after massive blood transfusion, due to rhabdomyolysis. If there is no effect, treatment is stopped.

The forced diuresis method is used in a hospital setting. It begins with catheterization or puncture of a large vein (subclavian or ulnar); The bladder is also catheterized to visually assess the rate of urination. A hypertonic, usually 20% or 40% glucose solution (800 or 400 ml, respectively) or a 20% mannitol solution (at the rate of 1 g/kg of the patient’s body weight) is first administered intravenously to obtain osmotic diuresis, then, for the purpose of hemodilution, a polyionic isotonic solution containing sodium, potassium, calcium and magnesium to maintain the concentration of these electrolytes in the blood plasma. Such a solution can be, for example, 6 bottles of 400 ml of 0.85% sodium chloride solution and 400 ml of 5% glucose solution with the addition of 15 ml of 10% potassium chloride solution, 5 ml of 10% calcium chloride solution, 3 ml of 25% magnesium sulfate solution. To purposefully change the pH of urine, solutions of either sodium bicarbonate (1-2 bottles of 200 ml of 4% solution) or ammonium chloride (100-200 ml of 1% solution) are also used. Alkalinization of urine to a pH of 7.8-8.5 is advisable for the treatment, using forced diuresis, of moderate poisoning with methyl, ethyl, isopropyl and other alcohols, medium- and long-acting barbiturates, sulfonamides, salicylates, ethylene glycol. Acidification of urine to pH 5.0-4.5 increases the therapeutic effect in case of poisoning with antihistamines, novocainamide, nicotine, xanthine derivatives, imizine, quinine, quinidine, phenamine. When the urine reaction is neutral, meprotane, strychnine, chloral hydrate, bromides, fluorides, phenacetin, and analgin are well excreted by osmotic stimulation of diuresis.

The solutions prepared for infusion are administered at the beginning of the procedure at a rate of 1000 ml/h, then (after infusion of 2-3 l) the infusion rate is reduced to 500 ml/h, bringing it into line with the rate of urination. The total amount of fluid administered is at least 8 liters per day for men and 6 liters per day for women, reaching 12 liters per day or more if necessary. To prevent sodium retention in the patient’s body, during the procedure 40-60 mg of furosemide is administered every 3-4 hours, bringing its dose to 240-480 mg/day. An increase in renal blood flow and glomerular filtration is facilitated by a constant infusion of dinoprostone (prostaglandin E2); For the same purpose, aminophylline, heparin and other drugs that improve blood flow in the kidneys can be used for certain indications.

The duration of forced diuresis can range from several hours to several days. As a result of its use, the duration of toxic coma is reduced and the danger of complications inherent in comatose states is eliminated.

Complications may include acute and pulmonary edema due to intravascular administration of large amounts of fluid; cerebral edema due to osmotic imbalance leading to cell hyperhydration; disturbance of acid-base balance in case of overdose of alkalizing or acidifying agents; hypovolemia with a drop in blood pressure when the rate of diuresis exceeds the rate of fluid infusion; caused by osmotic damage to nephrons or potassium depletion.

To prevent the development of complications during forced diuresis, monitor blood pressure levels, pulse and respiration rates; An ECG is recorded at least every 2 hours, and in case of coma, an EEG as well. During the day, central venous pressure is measured 3-4 times and a chest x-ray is taken 1-2 times, which allows early detection of signs of the interstitial phase of pulmonary edema. The rate of infusion into the composition of the administered solutions is changed depending on the dynamics of the patient’s condition, blood plasma osmolarity, hematocrit, acid-base balance, concentration of total protein, glucose, sodium, potassium, calcium, magnesium, chlorides, and toxins in the blood. They also focus on the dynamics of osmolarity and urine pH.

Indications for enterosorption.
1. Endo- and exotoxicosis.
2. Acute and chronic renal failure.
3. Acute liver diseases.
4. Lesions of the gastrointestinal tract of infectious and non-infectious nature.
5. Allergic diseases.
6. Acute surgical diseases of the abdominal cavity. The daily dose of enterosorbent is 0.5-1.0 g/kg body weight. The dose is divided into 3-4 doses. Duration of treatment is 3-5 days. When performing enterosorption through a gastric tube daily dose can be increased several times, and before insertion into the probe, the enterosorbent is diluted in 5-10 volumes of an isotonic sodium chloride solution or purified water.

Relative contraindications to enterosorption: ulcers and lesions of the gastrointestinal mucosa, paralytic intestinal obstruction.
There are no absolute contraindications.

Forced diuresis.

Forced diuresis- the simplest and most sufficient effective method detoxification therapy, based on increasing the rate of diuresis by introducing large amounts of fluid and diuretics.
Mechanism of action of forced diuresis is based on the excretion of toxic substances passing through the renal barrier in the urine.
Indications for forced diuresis.
1. Endotoxicosis (pancreatitis, peritonitis, acute intestinal obstruction, liver failure).
2. Exotoxicosis (poisoning with sleeping pills, alcohol and its surrogates).

Method of forced diuresis.

A forced diuresis session consists of sequential stages:
1st stage. Introduction of 500 ml of 3% sodium bicarbonate solution and 1000-1500 ml of Ringer's solution (lactasol, acesol) at a rate of 80-100 drops per minute. The total volume of solutions at this stage is 1500-2000 ml.
2nd stage. Injection of a 15% mannitol solution at a dose of 1.0-1.5 g/kg of the patient's body weight in combination with 240 mg of aminophylline at the beginning of the infusion and 240 mg of aminophylline at the end of the infusion.
In patients with cerebral edema, the use of mannitol is dangerous due to an increase in blood osmolarity. In these cases, furosemide is used at a dose of 4 mg/kg body weight.

3rd stage. Administration of a polyion solution (1000 ml of 5% glucose solution in combination with 40 ml of 7.5% potassium chloride solution, 50 ml of 10% sodium chloride solution, 30 ml of 10% calcium chloride solution and 12 U of insulin).
4th stage. Administration of 1000-1500 ml of protein preparations (plasma, albumin, protein).
When carrying out forced diuresis, the following rules must be observed: a) catheterization of the subclavian vein, b) installation of a catheter in the bladder, c) cardiac monitoring, d) careful monitoring of hemodynamics, respiration, and water-electrolyte balance.

The criterion for the effectiveness of forced diuresis is an increase in the rate of diuresis to 80-100 ml/h or more.
To maintain water balance, up to 100-120 ml/kg body weight of electrolyte solutions is used.
Contraindications: acute renal failure with oligoanuria, congestive heart failure, acute pneumonia, anemia (hemoglobin less than 100 g/l, hematocrit less than 0.30).

Peritoneal dialysis.

The basis of peritoneal dialysis lies the diffusion and filtration transfer through the living membrane (peritoneum) of low- and medium-molecular toxins and fluid from the extra- and intravascular space into abdominal cavity.

Indications for peritoneal dialysis.
1. Acute renal failure (including drug-induced), especially in children and elderly patients with severe atherosclerosis.
2. Severe endotoxemia due to destructive inflammatory diseases in the abdominal cavity (peritonitis, pancreatitis, etc.).
3. Acute poisoning barbiturates, hypnotics, sedatives, aniline, nitrobenzene, chlorinated hydrocarbons, organophosphorus compounds.

Peritoneal dialysis used in two modifications - flow and fractional.
Fractional peritoneal dialysis carried out through two perforated tubes, sequentially introduced into the abdominal cavity through a trocar in both iliac regions at the border of the middle and outer third of the lines connecting the navel with the anterosuperior iliac spine. First, the tube is installed on the left. 1.0-2.5 liters of heated dialysate solution is injected into the abdominal cavity within 10-15 minutes; the exposure time of the solution in the abdominal cavity is 30-120 minutes. Then, to remove the fluid, a second tube is installed on the right, through which the dialysate, when the patient is given a semi-sitting position, is removed by gravity from the abdominal cavity. After emptying the abdominal cavity, the cycle repeats. The duration of the session is 2-3 days until a clinically and laboratory registered detoxification effect is obtained.

Flow peritoneal dialysis. In the right and left hypochondrium along the midclavicular line, as well as in the right and left iliac regions, perforated drains are introduced through a puncture into the abdominal cavity. The upper left drainage is placed along the dome of the diaphragm, the upper right one is installed in the right side channel. Lower drainages - left along the left lateral canal upward, right - in men between the rectum and bladder, in women - between the rectum and uterus. Before starting dialysis, about 300 ml of a 0.25% novocaine solution is injected through the upper drainages, then the dialysate infusion is started at a rate of 10-40 ml per minute. The volume of dialysate on the first day is 18-20 liters. Flow peritoneal dialysis allows you to perform mechanical cleaning abdominal cavity from blood, pus, microbes and their toxins, protein breakdown products, etc.
Official solutions are used as a dialysate solution, and in their absence, Ringer's solution.

To obtain a dehydration effect it is shown to increase the osmolarity of the dialysate by adding a glucose solution (20 ml of a 40% glucose solution in two liters of dialysate increases the osmolarity of the solution by 20 mOsm/l), and the osmolality should not exceed 450 mOsm/l, since when a hyperosmolar solution is introduced into the abdominal cavity pain syndrome may occur.
Adding sodium bicarbonate and bringing the dialysate pH to 7.5-8.2 promotes the elimination of barbiturates and non-barbituric hypnotics; reducing the dialysate pH to 7.1-7.25 improves the elimination of exotoxins, which are weak bases (aminazine).

Malfunctions in the body's functioning are sometimes caused by poisoning with various substances. In these cases we talk about intoxication.

To detoxify the body, a safe method such as forced diuresis is used. It is used even in cases of severe poisoning in patients of different ages.

What does it mean to force diuresis?

Forced diuresis is a detoxification method that involves the accelerated removal of toxic substances from the body by increasing the volume of fluid and simultaneously taking diuretics.

At the same time, minute diuresis increases from 1 milliliter per minute to 9-10 milliliters. This method is widely used in medicine and is carried out under the strict supervision of a doctor in a hospital setting. Used to remove one or more toxins.

Detoxification is achieved by increasing the rate of glomerular filtrate and accelerating its passage through the renal tubules. Boosting should begin as early as possible, before toxins move from the outer cell membranes to the inner ones.

The main indications for the use of the forced method are poisoning with substances that are excreted primarily in urine.

The method is not used for infectious intoxication.

The result of the method depends on the degree of penetration of toxins into the cells. If they are in outer shell cells, then it is easy to remove them; if poisons penetrate into the inside of the cell, the method is ineffective.

Indications for use

The forced diuresis method is used in cases of poisoning:

There are a number of applications contraindications:

• swelling of the brain, lungs;
• intracranial hematomas;
• blood clots in blood vessels;
• pericarditis;
• heart failure;
• poisoning with substances not excreted through the kidneys;
• patient's state of shock;
• peritonitis;
• intestinal obstruction;
• pancreatitis.

The method is not effective for removing morphine, antidepressants, codeine.

This method is widely used in. The percentage of water in a child's body is higher than that of an adult. Cell membranes are more permeable, substances in the intercellular and intracellular space are less fixed.

This feature determines the uniform distribution of the injected liquid. Therefore, for children, forced diuresis is considered the fastest and safest method of getting rid of toxins.

Preparation and carrying out the procedure

Held strictly in a hospital and under the supervision of a specialist. Allows you to quickly stabilize the patient's condition. If carried out correctly, it has no serious consequences.

Before the start of forcing assess the severity of the condition patient and work. A catheter is then inserted into a large vessel, usually under the collarbone or in the elbow. Next, a catheter is placed in the bladder to measure the volume of fluid released.

Hypertonic solutions are administered first, for example 20% glucose in the amount of 0.8 liters or a mannitol solution of 1 gram per kilogram of weight. The next stage is the introduction of solutions to maintain blood electrolytes, that is, containing potassium, calcium, sodium and magnesium.

When administered, the acidity of toxins is taken into account and Ph is adjusted. Then, after 3-4 hours, a Furosemide solution is administered. Drugs that improve blood flow in the kidneys are added (Heparin, Eufillin). In addition to those listed, the drugs Hemodez and Reopoliglucin are used, which have detoxification properties.

For each stage, the volume of the drug and the rate of its administration calculated individually, depending on the patient's condition. At the last stage, up to one and a half liters of protein solution is introduced.

First, 3 liters of solution are injected at a rate of 1 liter per hour. Then the speed is reduced to 0.5 liters. Afterwards, the speed is equalized with the rate of urine formation. The volume of fluid per day is 6 and 8 liters for women and respectively.

During the procedure, the doctor controls:

• cardiac activity,
• acid level of urine,
• the patient's breathing.

The duration of therapy depends on the severity of the condition and may vary from several hours to several days. As a result, the duration of intoxication is reduced and complications associated with it are prevented.

To prevent possible complications, in addition to monitoring blood pressure and ECG, they carry out X-ray of the lungs three times a day. This helps prevent swelling. Central venous pressure and blood counts are also measured.

If, when carrying out forced diuresis, improvement does not occur within the first two days, then this method should be abandoned.

Possible complications

Although the method is considered safe, it can lead to some complications. It can be:

1. pulmonary edema;
2. acute heart failure;
3. violation of acid-base balance;
4. renal failure due to potassium depletion;
5. drop in blood pressure due to decreased blood circulation;
6. hyperkalemia;
7. hyperchloremia.

During the procedure it is strictly controlled ratio of injected and excreted fluid, it is necessary that these volumes coincide.

In the video clip you will learn what else diuretics are used for, their types and contraindications for use: