Phenazepam is a widely used tranquilizer. The drug is relatively safe and has a wide range of therapeutic effects on the body. Phenazepam is used in neurology, psychiatry and therapeutic practice to relieve conditions associated with anxiety. The medicine is well tolerated by patients and has relatively few side effects. In this regard, patients have questions regarding the combination of Phenazepam with alcohol. The reader will find answers to them in the article.
Data
Acetylsalicylic acid (aspirin) is widely used and is one of the most common substances for poisoning. This happens during suicide attempts in adults and accidentally in children.
According to statistics, the frequency of ASA consumption is:
· Decreased due to association with the development of Reye's syndrome in children and the development of other nonsteroidal anti-inflammatory drugs (NSAIDs).
· Increased due to the prevention of thrombosis of cardiovascular and cerebrovascular diseases.
Aspirin remains one of the most frequently used drugs by patients without a doctor's prescription.
Dosage and Application
Aspirin is taken for a number of reasons, including pain, swelling and cardiovascular disease. It helps relieve pain from menstrual cramps, headaches, rheumatoid arthritis and sprains.
The dosage of the drug varies from 50 mg to 6,000 mg per day. Taking a small amount of this medication daily is generally recommended for vascular and heart disease, poor blood flow, high cholesterol, and diabetes.
Smokers and those who have been diagnosed with a heart attack or blood clot can also take a small dose of aspirin every day.
Etiology and pathogenesis
Absorption and metabolism at acceptable dosage
· Aspirin is quickly absorbed into the stomach and duodenum.
· At therapeutic doses, 90% of salicylic acid is protein bound and therefore restricted to the vascular space.
· The maximum concentration of the substance in the blood serum is achieved within 60 minutes after administration.
Metabolism
Salicylic acid is metabolized in the liver in several ways:
· SC has a t½ of 2-4 hours in therapeutic doses.
· ASA is partially glucinated in the liver to salicylic acid, which is less toxic and is excreted more quickly through the kidneys.
· Only a small amount of ASA is excreted from the body without changes in the urine.
Absorption and metabolism in case of poisoning
· After an overdose, absorption and excretion change dramatically.
· When taking large doses, absorption of acid from the stomach and intestines may take more than 10 hours.
· The maximum concentration of the active substance is observed in the blood serum.
· Cleansing of the body slows down and takes up to 6-8 hours or even longer.
· In large doses, the half-life increases to 20-30 hours.
· As SA levels increase, protein binding decreases to 50% and hepatic detoxification becomes saturated. This way, more salicylic acid reaches the tissues.
Excretion
Since the liver's ability to degrade salicylic acid is saturated, the elimination of salicylic acid will depend on the rate of excretion by the kidneys.
· Therefore, t½ of the drug increases from 2-4 hours to 30 hours.
· Excretion in the kidneys slows down by 4 times with an increase in urine pH from 7 to 8 and by 10 times with an increase in pH from 5 to 8.
Safety of Phenazepam
Phenazepam is a relatively safe drug. But this statement is only true if the patient takes it in accordance with the dosage and in cases prescribed by the doctor. Some drug addicts use the medicine together with the drug to enhance the effect. This is a very dangerous combination that can lead to death. There are also known fatal cases after using Phenazepam and other psychostimulants.
The half-life of Phenazepam from the body does not exceed 10 hours. However, in some patients, especially those with liver disease, this time almost doubles. To safely take Phenazepam, you should wait 2 to 3 days after your last drink.
Alcohol dependence increases the risk of developing dependence on this tranquilizer. Therefore, in case of alcoholism, the drug is prescribed with great caution and for a short time. It is ideal if the patient takes Phenazepam to relieve withdrawal symptoms. Subsequently, the patient is prescribed sedatives that have a milder effect.
Alcoholic drinks are strictly prohibited during treatment with Phenazepam. Only a doctor can tell you when you can drink alcohol after undergoing treatment.
Cellular and systemic effects
Respiratory alkalosis
The overall effect is that patients have respiratory alkalosis or a mixture of respiratory alkalosis and metabolic acidosis—pure metabolic acidosis is rare in adults but can occur in children.
Respiratory acidosis should be suspected in the early stages if there is concomitant poisoning with a respiratory inhibitor.
· Inhibition of cyclooxygenase leads to a decrease in the synthesis of prostaglandins, prostacyclin and thromboxanes.
· Stimulation of chemoreceptors in the medulla leads to nausea and vomiting.
· Activation of the respiratory center in the medulla leads to respiratory alkalosis.
· Effect on cellular metabolism leads to metabolic acidosis.
Acid-base disorders
Various acid-base disorders can occur with ASA poisoning.
· Respiratory alkalosis (phase 1): Through rapid onset of respiratory center stimulation/hyperventilation, giving an early decrease in pCO2 and respiratory alkalosis.
· Metabolic acidosis (phase 2): Increased metabolism, accumulation of acidic metabolites and infusion of ASA from the intestine.
· Vomiting and electrolyte disturbances due to acid-base changes.
Indications for use of Aspirin
Acetylsalicylic acid is a symptomatic drug that should be taken for:
- pain
- inflammation
- feverish
Indications for use:
- toothache
- headache
- muscle and joint pain
- algomenorrhea
- sore throat due to a cold
- back pain
- cold
- ARVI
- Pain of moderate severity arising from inflammation of the joints
Degree of influence and physiological principles of treatment
ASA is a weak acid. Treatments are aimed at increasing systemic pH, that is, reducing the concentration of H + ions, by adding sodium bicarbonate. Salicylic acid anions then enter the bloodstream and, to a lesser extent, cross the blood-brain barrier into the central nervous system.
Alkalinization also increases the secretion of salicylate in the kidneys.
Effect on the central nervous system:
· Salicylic acid may cause changes in mental status through three mechanisms: direct toxic effect in the central nervous system, cerebral edema and neuroglycopenia.
· Increased acidosis promotes the influx of salicylic acid into the central nervous system. SA reduces glucose levels in the central nervous system, so neuroglycopenia is observed despite normal blood glucose levels.
Mortality from ASA poisoning is closely related to CNS salicylic acid levels, and altered mental status due to poisoning is an absolute predictor of hemodialysis.
The effect of ASA poisoning on the lungs is expressed in pulmonary edema. Induced noncardiogenic pulmonary edema and acute lung injury are most common in elderly patients. The condition is treated with hemodialysis.
Diagnosis of the state of poisoning
Diagnostic criteria:
· Clinical suspicion.
· Taking ASA drugs in doses above toxic levels.
· Symptoms of hyperventilation.
· Metabolic acidosis without a known cause.
Diagnosis can only be made by measuring plasma concentrations of salicylic acid. Although there is no absolute correlation between plasma SA concentrations and symptoms, toxic reactions occur in most subjects at values above 3.0 mmol/L in adults and 2–3 mmol/L in children. The usual therapeutic level is 0.7-2.2 mmol/L.
History taking
A person who seeks help complains of a certain malaise. Early symptoms of ASA poisoning include ringing in the ears, fever, dizziness, nausea, vomiting and diarrhea. Serious poisoning results in altered mental status, coma, noncardiac pulmonary edema, and death.
These questions are asked to the patient or his relatives during the initial examination:
1. How many tablets were taken?
2. What type of preparation? Gastroresistant?
3. When did the reception take place?
4. Was the drug consumed all at once or was there long-term consumption (chronic poisoning)?
5. Has the patient taken alcohol, drugs or other pills?
6. Has the patient vomited and is there a desire to vomit?
7.Did you use activated charcoal after this or take other measures to detoxify the body?
Answering these questions allows you to get a more accurate picture of your health and choose the appropriate treatment.
Critical poisoning with acetylsalicylic acid
When using a critical dose of the drug, the following is observed:
· Respiratory depression, often after a period of hyperventilation.
· Effect on the central nervous system and mental changes: irritability, disorientation, speech disorders and hallucinations.
· Severe dehydration, especially in children.
· Low diuresis.
· Bloody vomiting.
· Bleeding, primarily cutaneous from the gastrointestinal tract.
· Increased body temperature, but the absence of fever cannot exclude the diagnosis.
· In the most severe cases, respiratory depression, convulsions and coma, often with cardiac arrest.
Changes in analyses:
· Therapeutic concentration is 0.7-2.2 mmol/L, values above 2.9 mmol/L may be associated with toxicity.
· Values above 7.2 mmol/L are associated with mortality and are considered an absolute value for hemodialysis.
Plasma values should be checked every two hours until the next two readings show decreasing values. An increase in plasma levels should not occur after 5-6 hours due to pylorospasm. When using enteric-coated tablets, it may take up to 35 hours to reach the maximum value.
Contraindications for Aspirin
Prohibitions on taking Aspirin are divided into two types:
- Relative
- Absolute
Taking Aspirin is strictly prohibited if you are allergic to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. In addition to all this, the drug should not be used if there is an increased tendency to bleeding.
Relative contraindications:
- Bronchial asthma
- Combined use of anticoagulants
- Breast-feeding
- Pregnancy
- Chronic stomach diseases
- Kidney dysfunction
- Diabetes
- Age up to 12 years
If there are relative prohibitions, taking the medicine is possible only after approval by the doctor.
Laboratory research
Monitoring plasma salicylic acid levels can assess response to treatment and the need for more aggressive action. Using laboratory tests, the following indicators are determined.
1. Creatinine. Knowledge of renal function in the form of serum creatinine is important since salicylate is excreted through the kidneys.
2. Potassium. Hypokalemia should be treated aggressively in patients with ASA toxicity because the condition reduces the ability to alkalinize the urine.
3. Coagulation. Overdose of ASA causes hepatotoxicity and disrupts vitamin K metabolism, leading to coagulopathy.
Clinically significant bleeding is rare, but if it occurs, the patient should seek immediate medical attention.
Signs of serious poisoning:
· Blood concentrations > 7 mmol/l are life-threatening. Serum concentrations should be assessed depending on the time of drug administration.
· Severe acidosis in the blood.
What to do in case of overdose
A person who has been poisoned by aspirin must take the following measures on his own.
- If no more than 2 hours have passed since administration, induce vomiting.
- Take activated carbon. The cold mixture of 150 mg/ml is effective even without gastric emptying. Adults: 50 g of activated carbon, children: 100-150 ml (15-20 g of activated carbon).
After implementing emergency measures at home and stabilizing the condition, medical attention is required. As with all poisonings, therapy consists of rapid assessment and stabilization of the airway and circulation.
Treatment principle
If you use aspirin in excessive doses, the patient should consult a doctor as soon as possible. He will assess the health risk and provide first aid.
Treatment goals:
· Provide vital functions.
· Minimize poisoning and harmful effects of the drug. Activated carbon will help reduce acid absorption.
· Relieve stomach pain. It often occurs soon after eating.
· Increase excretion by alkalinizing urine output.
· Perform dialysis if necessary.
Plasma acetylsalicylic acid and acid-base measurements should be taken every two hours until they stabilize and the values begin to decrease.
Side effects
Side effects of acetylsalicylic acid include:
- dyspeptic symptoms: nausea, cramps, epigastric discomfort, lack of appetite;
- noise in the ears and head, weakness, dizziness;
- allergic urticaria;
- in severe cases: Quincke's edema or anaphylactic shock.
Aspirin intoxication develops after exceeding the maximum dose. It manifests itself as increased side effects: hearing loss, dizziness, heartburn, dryness and an unpleasant taste in the mouth.
Poisoning therapy
Therapy consists of the following processes.
1. Alkalinization with sodium bicarbonate. At a normal pH of 7.40, most salicylic acid is in the ionic form, which does not cross the blood-brain barrier as well as the uncleaved form (H++ Sal->HSal). If the pH increases, even more HSal will be broken down into ions, which helps clear HSal from the brain. Initially, bicarbonate delivery will increase plasma salicylate due to salicylate release from tissue. Alkalosis is not a contraindication for bicarbonate infusion; plasma pH is <7.60. Urine pH should be between 7.5 and 8.
2. Alkalinization of urine. It is effective because it increases salicylate secretion.
By increasing urine pH from 6.5 to 8.1 by adding bicarbonate, the total excretion of salicylate increases fivefold or more.
3. Intubation if necessary. Great care is advised as intubation may worsen the condition.
4. Oxygen. Oxygen supplements should be given as needed. In case of lung injury, there is a high need for it.
5. Restoring water balance. The patient may be hypotensive, in part due to inappropriate systemic vasodilation. Aggressive fluid delivery is acceptable unless there is cerebral or pulmonary edema.
6. Glucose. ASA poisoning reduces glucose levels in the central nervous system, despite normal peripheral blood sugar levels. Supplementation with 100 mL 50% dextrose (adults) is considered in patients with altered mental status regardless of blood sugar.
7. Vitamin K supplements.
Symptomatic treatment of complications in the second stage of poisoning requires hemodialysis.
Natural alternative
Anti-inflammatory diet
If you are using aspirin to relieve swelling or inflammation, keep in mind that this can be achieved in other, more natural and safer ways. The best place to start is with your diet.
First of all, you need to avoid foods that cause inflammation, swelling and pain: fast food, processed and packaged foods, foods containing artificial ingredients and added sugar, high amounts of caffeine and alcohol.
Instead, focus on eating healthy to help manage inflammation. Anti-inflammatory foods include:
- leafy greens and colored vegetables
- fruits such as blueberries and pineapple
- healthy fats, such as wild salmon and coconut oil
- bone broth
- nuts and seeds, such as walnuts, flax and chia seeds
- high quality free range meat and organic chicken
- anti-inflammatory spices such as ginger, cayenne pepper and turmeric
Ginger
Did you know that ginger has antithrombosis properties? Regular consumption of ginger can actually prevent the occurrence of heart attack and stroke.
In addition, ginger can relieve pain and cope with inflammation. Gingerol, the most powerful healing substance in ginger, affects receptors that are located on our nerve endings.
Research suggests that due to its ability to fight pain and inflammation, ginger is often used as part of natural therapy to treat degenerative diseases such as arthritis and rheumatism, as well as cardiovascular disorders such as hypertension and atherosclerosis.
Turmeric
Research shows that turmeric may even be more effective than some anti-inflammatory drugs, anticoagulants and painkillers. Moreover, turmeric does not have any side effects unless consumed in too much quantity.
Research also suggests that curcumin in turmeric has antithrombotic effects, and daily consumption of this spice may help thin the blood.
Scientists believe that turmeric extract can be used as a pain reliever. A meta-analysis published in the Journal of Medicinal Food found that 1,000 mg of curcumin per day was effective in relieving pain in patients with arthritis.
In fact, five studies found no significant difference between the effectiveness of turmeric and painkillers.
Cinnamon
Cinnamon may not only fight inflammation, but also promote heart health. Research suggests that the main benefit of cinnamon is its ability to reduce the risk of heart disease by lowering blood pressure and cholesterol levels.
Scientists have found that cinnamon acts as a natural coagulant and can speed up blood flow. The spice promotes tissue repair and cell regeneration, which can help your body cope with a heart attack or stroke.
Methylsulfonylmethane
Methylsulfonylmethane (MSM) is a plant-derived adaptogen that helps manage stress and recover from injury, surgery, and exercise. MSM supplements are often used to relieve chronic pain, muscle cramps, lower blood pressure, and relieve eye inflammation.
MSM fights inflammation thanks to the sulfur it delivers to your body. Sulfur helps restore muscle cells. Research has shown that MSM also helps restore flexibility and permeability of cell walls within muscles, which speeds up muscle recovery.
Bromelain
This enzyme is present in pineapples and is often used to treat inflammation caused by diseases such as arthritis. Research suggests it may be used to relieve post-surgical pain and swelling, joint pain and sinus inflammation.
A study published in the journal Biomedical Reports found that bromelain has anti-inflammatory and antithrombotic effects. It effectively speeds up blood flow and strengthens the immune system.
Magnesium
Scientists have found that magnesium deficiency can lead to a range of problems, including hypertension, cardiovascular disease, kidney and liver damage, muscle spasms, decreased immunity and migraines.
Supplementing with magnesium will keep your blood pressure normal and prevent hypertension. A study from the Journal of Clinical Hypertension found that heart diseases such as coronary artery disease, ischemic stroke and heart rhythm disorders can be prevented and treated by simply taking magnesium.
- Aspirin is an anti-inflammatory drug that is used to relieve pain, inflammation, and fever.
- Although taking aspirin daily is recommended for adult men and women to prevent heart attack and stroke, it is important to understand that it carries certain risks. The most dangerous side effects of aspirin include liver and kidney damage, ulcers, hearing loss, hemorrhagic stroke and Reye's syndrome.
- Long-term use of aspirin can be especially dangerous for people with heart failure, liver and kidney disease, asthma, stomach ulcers, bleeding disorders, hypertension, and diabetes.
- Fortunately, there are natural, safer alternatives to aspirin that can help you avoid the side effects associated with taking this drug.
Take care of yourself and your loved ones, buy only healthy products!
When is hemodialysis indicated?
Indications for its implementation are:
· Altered mental status.
· Edema of the lungs or brain.
· Kidney failure, which prevents the secretion of salicylate.
· Fluid overload preventing bicarbonate flow.
· Plasma ASA more than 7.2 mmol/l.
· Clinical deterioration despite aggressive and appropriate treatment.
To prescribe the procedure, the patient must consult a nephrologist.
