Forced diuresis: indications; contraindications
To eliminate intoxication from drugs the patient often use forced diuresis method. The main goal is to bring the body to a dangerous, toxic components, by increasing fluid and accelerating urination. Applies only in stationary conditions under the supervision of a physician and introduction of solutions that do not cause violations. Has serious consequences and is widely used in medicine. Relevant to deducing how one group of toxic elements, and the presence of several types of medications in the body. At home conduct is prohibited.
What is the diuresis by the method of forcing?
The method of using forced diuresis considered as a versatile tool for the treatment of intoxication.
The method of forced diuresis allows the use of to eliminate intoxication (poisoning) of the human body by accelerating the excretion of large amounts of urine. This is achieved by the introduction of diuretics, while giving the patient drink plenty of liquids. Is normal urination in an adult, healthy person, is 0.7—1.3 ml/min using the method of figure increases to 8-10 ml/min. When the forced diuresis it is possible to bring the toxic breakdown products of medicines from the patient’s blood. Drugs for boosting is used to improve the filtration of the kidneys and the ability to quickly remove harmful substances from the flow of urine.
On the effectiveness of forced diuresis is affected by the degree of activity of the fixation cells of toxins. This is due to the transition of some toxic elements from the extracellular into the intracellular membrane. Being in the outer shell, the substances dissolve easily in water, and the products of their metabolism be freely diuresis. If the functionality of the diuretic on lowered, and the degree of intoxication is high, the selected remedy for diuresis may not work.
Action means for reducing the intoxication depends on the level of acidity of urine (pH). When the pH is less than 7,0, well-removed toxins with the main properties at a pH above 7.0 — poisons with acidic effect. For example, alkalization of urine up to 7 on the pH scale allows us to improve the excretion of phenobarbital 5 times, and salicylic acid — 10 times.
Indications and contraindications
Use the crossing to eliminate the high toxicity of barbiturates, «Fenaminom, alkaloids, salicylates, «Diphenhydramine», «Haloperidol», «Diprazinom,» methanol, «Raunatin». This to a large amount of water is added a drug that stimulates the kidneys. Indications for use the forced method:
- the presence of strong toxic substances in the body of the patient;
- poisoning medicines;
- intoxication undetermined poisons;
- poisoning combined with medicines.
Contraindications of the use of accelerated method:
- shock in a patient;
- the presence of pulmonary edema;
- the presence of brain edema;
- detection of renal and cardiovascular failure;
- acute intestinal obstruction;
- the presence of interior hematomas, thrombosis.
Forced diuresis in case of poisoning is carried out exclusively in hospital environment. The doctor performs a preliminary assessment of the kidneys, determines the rate of excretion of urine. Is a large vessel where the catheter is placed. Through him, introduced a diuretic drug. To estimate the rate of filling of the bladder, it also set a catheter. Injected hypertonic solution, then the solutions to maintain the electrolytes in the blood, measured alkalinity of urine.
First introduced 2 liters of fluid at 1000 ml/HR, then reduced to 500 ml/h and do equal to the rate of formation of urine. With an average degree of intoxication in men is introduced 8 liters of fluid, and women — 6 l In a more dangerous and serious cases the amount of fluid is 12 l and more. At the time of the crossing every 3-4 hours add funds «Furosemide» and «Prostaglandin E» to stimulate blood flow in the body. The duration of the procedure depends on the degree of accumulation of toxins and the severity of the connection with proteins and lymph. Increasing the amount of fluid, the doctor checks that it is equal to the volume of urine. Only at a speed not less than 100 ml/HR of urination diuresis is considered to be uprated. At home this procedure is not carried out.
The stages of the methodology
Application for elimination of toxins forced diuresis is carried out in 4 stages:
- Introduced 500 ml of three percent sodium bicarbonate, and 1,500 ml of «Lactalis» («Acesol» or «ringer»). The mixture is introduced into 2000 ml of 2-Kh components with a speed of 80 drops/minute 100 drops/min.
- Apply 15% solution «Minneola» (except in patients with brain edema) 1 g/kg body weight of the patient by adding 240 mg «Aminophylline». Jet is introduced.
- Then used 5% glucose (1 l) by adding 40 ml of a 7.5% emulsion of potassium chloride, 50 ml of 10% calcium chloride.
- The doctor inserts 1-1,5 l of protein or other protein preparation.
The catheter must be connected to the elbow or subclavian vein. The second catheter should be introduced into the bladder (to track the speed of filling). Ongoing monitoring by a specialist on a cardiac monitor and check water and electrolyte balance, respiration, and hemodynamic data. Composition of solutions used in the forced method depends on the types of toxins and the degree of poisoning them, as well as, and the overall functionality of the body.
Treatment uprated method requires observation and constant changes in the application. Is followed by introducing high doses of electrolytes. They can appear when the violation of the rules of application of the method and the wrong technique. In this case, it is possible the emergence of hypokalemia, fluid overload, hypochloraemia. Long term use of osmotic diuretics can develop osmoticheski nephrosis. To avoid this, they recommend to combine with saluretikami. In violation and excess of the dose acidophilous or alkiliruushim agents in the forced method, the slipping of the normal parameters of acid-base balance. To avoid any complications from the action of remedies is possible only if stable control of the physician over the process and correct technology use.