Pediatric surgery. Manifestation of intoxication (most important)

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Pediatric surgery. Manifestation of intoxication (most important)

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3. Manifestation of intoxication

Intoxication - a condition with a characteristic combination of clinical and laboratory signs of pathology of the nervous system, microcirculation system and water and electrolyte metabolism against the background of an infectious and inflammatory process.

In emergency surgery feature of intoxication is that it occurs against the background of infections caused by staphylococcal or gram-negative bacterial flora. Unlike viral and viral-bacterial infections, neurological symptoms do not prevail in these cases.

Most often, hyperthermia and inhibition serve as a background against which a local process unfolds with a generalized reaction of the microcirculation system. Changes in peripheral blood flow are manifested in rheological disorders, intracapillary disorders with intravascular coagulation and activation of the kinin system.

Frequent involvement in the pathological process of the organs of the gastrointestinal tract leads to isotonic or salt-deficient dehydration.

In combination with the pathology of the transmembrane transfer of sodium and potassium, typical of any intoxication, dehydration causes the symptoms of disorders of water and electrolyte metabolism.

Loss with vomiting or fluid sequestration in paretically distended bowel loops or in peritoneal exudate leads to salt deficiency or isotonic dehydration; hyperthermia or hyperventilation of any origin - to water deficiency.

Hyperproteinemia does not occur with dehydration in children with purulent-inflammatory diseases of the chest and abdominal cavities and with malformations of the gastrointestinal tract, accompanied by hypotrophy of II-III degrees. The level of total serum protein in this pathology may be normal.

Confirmation of hemoconcentration in such situations is a high hematocrit. And, conversely, if isotonic or salt-deficient dehydration develops against the background of anemia, an increase in the number of erythrocytes and hematocrit is not expressed, only hyperproteinemia has diagnostic value.

As long as the body is able to maintain stable hemodynamics, we can talk about the stage of dehydration compensation, decompensation occurs with the appearance of circulatory disorders.

With isotonic and hypotonic (salt-deficient) dehydration, signs of decompensation are arterial hypotension, acrocyanosis, hypothermia and oliguria. Decompensation occurs only with dehydration, corresponding to a loss of 10% of body weight.

If before the operation the phenomena of intoxication and water-electrolyte imbalance are not reduced, then during the intervention, sensitivity to blood loss increases, peripheral blood flow insufficiency worsens, and the prognosis worsens. Hyperthermia caused by the inflammatory process, water-deficient dehydration, intoxication, increases sensitivity to hypoxia and narcotic drugs.

Authors: Drozdov A.A., Drozdova M.V.

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