Forced diuresis what is it, preparation and conduct

If a person has severe poisoning, it is necessary to cleanse the body. Various methods are used to remove harmful substances.

Forced diuresis – what is it

It is an effective technique for treating poisoning. It is used for emergency detoxification of the body. For example, if a person is poisoned by chemical agents, drugs. This procedure is carried out exclusively in medical institutions. It allows you to quickly stabilize the patient’s condition. At home, you should not try to do forced diuresis. As it is life threatening.

Forced diuresis is understood as detoxification of the body due to the accelerated formation and excretion of urine. The effect is achieved due to the introduction into the body of a large volume of fluid with the simultaneous administration of diuretics. If the minute urine output is 0,5-1,0 ml per minute, then with the forced form, this value reaches 8-10 ml in a similar period of time.

Indications and contraindications

Forced diuresis is indicated in cases where a person has been poisoned, but the substances that caused intoxication cannot be determined in the laboratory. They also hold an event when a person is poisoned with medicines, combined drugs, strong toxins are present in the blood. Doctors prescribe forced diuresis to remove barbiturates, morphine, and heavy metals from the body.

But not all patients are allowed such a detoxification procedure. Forced diuresis is contraindicated if:

  • There is edema of the brain, lungs.
  • The patient is in a state of shock.
  • There is an acute intestinal insufficiency.
  • Internal hematomas were identified.
  • Thrombosis was diagnosed.
  • There is pancreatitis.
  • I have heart problems.
  • A person has peritonitis.

    Prepare

    Before carrying out forced diuresis, the patient is prepared. First, the doctor assesses the severity of the patient’s condition. Urine is collected for analysis to detect kidney function. Also, a person is interviewed and examined to exclude the presence of those pathologies that are contraindications for the detoxification procedure.

    Проведение

    If the patient’s condition allows, they begin the event. A special catheter is inserted into a large vessel located in the elbow fold or under the collarbone. A catheter is also placed in the bladder. This is necessary in order to measure the volume of excreted urine and compare the resulting figure with the amount of injected fluid.

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    Then a hypertonic glucose solution with a volume of 800 milliliters is injected into the patient’s body through a catheter. In the second step, solutions containing magnesium, calcium, sodium and potassium are injected to maintain plasma electrolyte levels. This takes into account the acidity of toxins and urine.

    A few hours later, a solution of Furosemide is introduced. Sometimes drugs are added that improve blood circulation in the kidneys. For example, Euphyllin, Heparin. They also use detoxifying agents Reopolyglyukin and Gemodez. Finally, 1,5 liters of protein solution are introduced. The volume and rate of administration of all drugs are determined individually for each patient. The degree of intoxication, the state of the kidneys are taken into account.

    The total volume of the solutions is about 3 liters. The initial rate of administration is 1 liter per hour. Then it is reduced to 0,5 liters per hour. Towards the end of the procedure, the rate is equalized with the rate of urine formation. Women are recommended to consume 6 liters per day, and men 8 liters of liquid.

    Throughout the procedure, the doctor monitors:

  • The patient’s breath. X-rays of the lungs are taken to prevent swelling.
  • Cardiac activity of the patient. Using an ECG.
  • Urine acidity level. A general urine test is done.
  • Blood pressure. Using a tonometer.

    Therapy, depending on the severity of the condition, can last from three hours to four days. As a result, the duration of the intoxication of the body is reduced, and the probable complications of poisoning are minimized.

    When carrying out forced diuresis, the reaction of urine is taken into account. Quinine, nicotine, quinidine, phenamine, novocainamide and other substances showing alkaline qualities are eliminated faster if the urine reaction is weakly acidic. To excrete elements that exhibit acidic properties (methyl and ethyl alcohol, salicylates, barbiturates), urine must be slightly alkaline. If the urine is neutral, then bromides, meprotan, fluorides, phenacitin, analgin are well removed.

    If the patient’s condition does not improve in the first two days of forced diuresis, it is inappropriate to carry out the event further. They refuse the method and start looking for another option for removing intoxication.

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    Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

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