Endotoxemia - A Syndrome Of Endogenous Intoxication

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Endotoxemia

Endogenous intoxication syndrome (endotoxemia) is the accumulation of endotoxins in the blood and body tissues.

Endotoxins are substances that have a toxic effect on the body. They, in turn, can be waste products of the organism itself, or they can get into it from the outside.

The syndrome of endogenous intoxication is one of the most acute problems in intensive care, as it accompanies a large number of pathological conditions, including shock, pancreatitis, peritonitis, etc. A pronounced syndrome of endogenous intoxication can lead to human death.

Content:

• Endotoxin classification
• Symptoms of the syndrome of endogenous intoxication
• The degree of endogenous intoxication
• Diagnostics of the syndrome of endogenous intoxication
• Treatment of the syndrome of endogenous intoxication

Causes of the syndrome of endogenous intoxication

The causes of endogenous intoxication syndrome can be very diverse. However, this process always develops when endotoxins enter the bloodstream from the sites of their formation. Through the blood, endotoxins are distributed to organs and organ systems, as well as to all tissues of the body. When the amount of aggressive components and endotoxins exceeds the body's natural capabilities in their biotransformation, the syndrome of endogenous intoxication occurs.

There are the following causes of endogenous intoxication syndrome:

• Diseases occurring with a purulent-inflammatory reaction in the body. This includes cholecystitis, acute pneumonia, peritonitis, pancreatitis, etc.
• Severe and complex injuries: crash syndrome.
• Some chronic diseases in the acute stage, for example, diabetes mellitus, thyrotoxic goiter.
• Poisoning the body.

The primary mechanisms of endogenous intoxication syndrome are as follows:

• Resorption mechanism. In this case, there is a resorption of toxic substances (necrotic masses, inflammatory exudate) from a limited focus of infection throughout the body. This process can be started with intestinal obstruction, with abscesses, with phlegmon of soft tissues, etc.
• The metabolic mechanism of the development of the syndrome of endogenous intoxication. It is caused by the excessive production of toxic substances. This developmental mechanism is characteristic of pneumonia, acute pancreatitis, diffuse peritonitis.
• Retention mechanism. According to this type, the syndrome of endogenous intoxication develops if the very process of removing toxins from the body suffers, that is, the work of the detoxification organs is disrupted.
• Reperfusion mechanism. The penetration of endotoxins into the blood occurs from tissues that have been in a state of ischemia for a long time, while the body's antioxidant barrier has lost its viability. This can occur in case of shock, during surgery using AIC, etc.

• The mechanism of secondary toxic aggression, in which tissues respond with a toxic reaction to the effects of endotoxins.
• An infectious mechanism, in which pathogenic microorganisms from foci of invasive infection act as endotoxins.

Endotoxin classification

Endotoxins are those substances that lead to the formation of endotoxemia and endogenous intoxication syndrome.

The following endotoxins are distinguished, depending on the mechanism of their formation:

• Enzymes, which, after activation by one or another pathological process, begin to damage tissues. These can be proteolytic and lysosomal enzymes, as well as products of activation of the kallikrein-kinin system.
• The products of the body's natural activity can act as endotoxins if they are accumulated in high concentrations. This includes urea, bilirubin, etc.
• All biologically active substances that are in the human body. These can be inflammatory mediators, cytokines, prostaglandins, etc.
• Aggressors that arise during the breakdown of foreign antigens and immune complexes.
• Toxins released by microbes or other pathological agents.
• Medium molecular substances (viruses, allergens, cholesterol, etc.).
• Products that arise from lipid peroxidation.
• Products that appear as a result of cell breakdown when their membranes are damaged by destructive processes. These can be proteins, myoglobin, lipases, phenol, etc.
• High concentrations of components of regulatory systems.

Endotoxins are capable of exerting direct and indirect effects on the body; they can affect microcirculation, synthesis and metabolism in tissues.

Symptoms of the syndrome of endogenous intoxication

One of the leading symptoms of endotoxemia is depression of consciousness. Its complete loss or partial decrease is possible. In parallel, the patient develops severe headaches, muscle weakness appears, and myalgia is characteristic.

As the intoxication of the body progresses, nausea and vomiting join. As the patient's body loses fluid, the mucous membranes become dry.

Tachycardia or bradycardia develops. Body temperature can rise and, conversely, go down.

Since endogenous intoxication often occurs against the background of a shock state, the symptoms of endotoxic shock come to the fore. In severe human conditions, certain endotoxins of a bacterial nature will definitely be present in the blood, even in the absence of bacteremia. This does not depend on what provoked the syndrome of endogenous intoxication: trauma, burns, tissue ischemia, etc. Only the severity of the person's condition is important.

The degree of endogenous intoxication

Doctors distinguish three degrees of severity of endogenous intoxication syndrome, each of which has its own criteria:

The first degree of endotoxication The body's reaction occurs in response to the formation of a focus of destruction, or to an injury received: The pulse does not exceed 110 beats per minute. A person's consciousness is not very clouded, he is in a slight euphoria. The skin is not changed, their color is normal. Intestinal motility is impaired and is defined as sluggish. The respiratory rate does not exceed 22 breaths per minute. The volume of urine excreted per day exceeds 1000 ml.

Second degree endotoxication The second degree of endogenous intoxication is characterized by the ingestion of endotoxins into the blood, which enter it from the source of intoxication. With the blood stream, they spread throughout the body and accumulate in all tissues: The pulse quickens and can reach 130 beats per minute. The patient's consciousness is inhibited, or, on the contrary, psychomotor agitation is observed. This parameter depends on the cause of the endotoxic shock syndrome. The respiratory rate increases, the number of breaths per minute ranges from 23 to 30. The patient's skin is pale. The daily volume of urine decreases and ranges from 800 to 1000 ml. Intestinal peristalsis is absent.

Third degree endotoxication This degree of endotoxication is characterized by a malfunction of all organs. The pathological process progresses up to the development of functional multiorgan dysfunction: The patient's pulse exceeds 130 beats per minute. The patient's consciousness is impaired, ranging from a darkened consciousness and ending with a coma. This condition is called intoxication delirium. Breathing increases significantly and exceeds 30 breaths per minute. The skin can have a cyanotic or earthy hue. Hyperemia of the dermis is not excluded. The daily urine volume does not exceed 800 ml. The intestines do not function, there is no peristalsis.

Diagnostics of the syndrome of endogenous intoxication

Diagnostics of the syndrome of endogenous intoxication is based on an assessment of the severity of a person's condition according to characteristic symptoms (skin tone, respiratory and heart rate, etc.). In addition, blood tests are required.

The results obtained are processed, and according to them, a change in such indicators as:

• A significant increase in the number of leukocytes in the venous blood.
• Excess leukocyte and nuclear intoxication index. Although sometimes these indicators can be underestimated, which indicates the failure of the hematopoietic system and detoxification of the body.
• Increased intoxication index. If it exceeds the mark of 45, then this clearly indicates an imminent death.
• An assessment of the concentration of total protein in blood plasma is required.
• Increased bilirubin levels.
• Increased creatinine and urea levels.
• An increase in the concentration of lactic acid.
• Increase in the coefficient of nonspecific defense cells relative to specific defense cells. The serious condition of the patient is indicated by a coefficient exceeding 2.0.
• The most sensitive sign of endotoxication is an increase in the level of the average mass molecule.

Treatment of the syndrome of endogenous intoxication

Treatment of the syndrome of endogenous intoxication involves the removal of toxic components from the body and from the blood with an initial decrease in their concentration. Active detoxification is prescribed when 2 or 3 severity of the pathological syndrome is established.

Biological intoxication is always based on the following mechanisms:

• Biological transformation of endotoxic components in the liver. To start this mechanism, hemo-oxygenation, chemical oxidation of blood (indirect), and its photomodification are performed. It is possible to carry out perfusion through cellular suspensions or xenoorganisms.
• Binding and dilution of endotoxic components. For this purpose, it is possible to carry out sorption measures aimed at removing endotoxic components from the blood, plasma, lymph, and cerebrospinal fluid.
• Removal of endotoxic components. To implement this mechanism, the liver, kidneys, gastrointestinal tract, skin and lungs are involved. The patient undergoes intestinal dialysis, hemodialysis, enterosorption, plasmapheresis, hemo- and ultrafiltration, blood replacement, diuresis is forced.

During the period of acute intoxication, the total daily volume of water, which is injected through a dropper, should be at the level of 4-5 liters. Moreover, 2.5-3 liters should be crystalloid solutions, and the rest - colloidal and protein blood preparations: plasma, albumin, protein.

Forced diuresis is considered a simple and commonly used treatment for endointoxication, which is based on the use of the natural process of removing toxins from the body.

The prognosis for the syndrome of endogenous intoxication directly depends on the severity of the patient's condition and on the root cause that led to the development of pathology.

Author of the article: Alekseeva Maria Yurievna | Therapist

Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.