Intestinal lavage as a method of relief of alcoholic delirium in acute poisoning

Introduction. Acute poisoning (AP) often occurs in people who abuse alcohol. The course of acute poisoning in such patients may be accompanied by alcohol withdrawal syndrome (AAS), a severe variant of which is delirium alcohol (AlD). Its formation aggravates the condition of patients, increases the risk of complications, increases the length of hospital stay and mortality. Standard methods of combating AlD may not be consistent with some aspects of the AP treatment paradigm, so the search for approaches to resolving this contradiction is relevant. One of the options for this approach may be the use of intestinal lavage (IL) as a method of relieving AlD in AP.

The aim of the study is to increase the effectiveness of therapeutic measures using intestinal lavage for delirium alcoholic against the background of acute poisoning with psychopharmacological drugs and corrosive substances.

Material and methods. We examined 106 patients, 59 of whom suffered from acute poisoning with psychopharmacological drugs (APPD) and 47 from acute poisoning with corrosive substances (APCS), who were in the department of acute poisoning and somatopsychiatric disorders of the N.V.Sklifosovsky Scientific Research Institute of Emergency Medicine of the Moscow City Health Department in 2019–2023, AlD developed.

The patients were divided into two groups: a study group of 56 patients, whose treatment complex included IL using enteral solution (ES) for the purpose of detoxification of endotoxemia and correction of homeostasis disorders, and a comparison group consisting of 50 patients who received standard therapy aimed at relieving AlD. The decision to use IL in the study group was made immediately after the diagnosis of AlD was established. IL using ES, which was administered through a nasogastric dual-channel tube, was carried out according to the method we developed. In 50 patients in the comparison group, standard AlD therapy was used. The compared groups of patients were comparable in severity of the condition, assessed in points on the DELIRIUM RATING SCALE-R-98, age and gender. The endpoints of the study were: duration of AlD, incidence of pneumonia, length of stay of patients in the intensive care unit and mortality.

Results. The severity of AlD, expressed in points on the DRS-R-98 scale, before the start of its relief in the study and comparison groups was comparable and, depending on the type of poisoning against which AlD developed, averaged from 28 to 31 points. The patients tolerated the inclusion of IL in the complex treatment of AlD against the background of acute respiratory distress syndrome and acute atrial fibrillation satisfactorily, without complications. AlD due to APCS was stopped after IL within 1 day, which is 8 times earlier than in the comparison group. This difference was statistically significant (p<0.05; criterion M–W). In case of APPD, the duration of AlD after IL was on average one day, and with standard treatment – 9 days. This difference in the timing of relief of AlD was statistically significant (p <0.05; criterion Mann–Whitney). It was found that against the background of AlD in patients with APCS, pneumonia developed in 23% of cases in the study group, and in 95.2% in the comparison group. Against the background of AlD in patients with APPD, these figures were 6.6 and 55.2%, respectively. The length of stay of patients with AlD in the intensive care unit during acute respiratory viral infection and acute atrial fibrillation in the study groups was on average 4 days, and in the comparison groups 6 and 7 days, respectively. Mortality in the same groups was 7.7 and 33.3% (APCS), and 10 and 17.3% (APPD), respectively.

Limitations. The research concerned the effectiveness of IL as a method of AlD relief in male and female patients, the limitations of which were: alcoholic delirium against the background of poisoning with psychopharmacological drugs and poisoning with corrosive substances, the age of patients (from 18–65 years), the volume of enteral solution 12 (9;15) liters for perfusion of the gastrointestinal tract during IL.

Conclusion. The inclusion of IL in the complex of treatment for AlD in AP contributes to a noticeable improvement in treatment results: reducing its duration against the background of APCS and APPD by 8 and 9 times, respectively; reducing the incidence of pneumonia by 4.1 and 8.4 times, reducing the length of hospitalization by 1.5 and 1.75 times, respectively. Mortality in the same groups was 4.3 and 1.73 times lower, respectively. Intergroup differences in all compared indicators were statistically significant (p<0.05; criterion χ² and criterion Mann–Whitney).

Compliance with ethical standards. The protocol of this study was approved by the local ethics committee of the State Budgetary Healthcare Institution "Research Institute for Emergency Medicine named after N.V. Sklifosovsky" DZM No. 4-22 dated 04/26/2022. All participants gave informed voluntary written consent to participate in the study.

Authors contribution:
Vorobyova A.G. – collection of clinical material, statistical processing and analysis;
Matkevich V.A. – the idea, concept and design of the study, writing the text;
Potskhveriya M.M. – research design and organization;
Zubareva O.V. – research design, results;
Klyuev A.E. – organization and performance of laboratory tests, analysis of the data obtained.
All co-authors – approval of the final version of the article, responsibility for the integrity of all parts of the article.

Conflict of interest. The authors declare no conflict of interest.

Funding. The study had no sponsorship.

Received: May 29, 2024 / Revised: Jule 24, 2024 / Accepted: December 18, 2024 / Published: February 25, 2025