Hyperendotoxinemia in severe oral poisoning with corrosive substances and intestinal lavage as a way to reduce its level

Introduction. Elimination of hyperendotoxinemia in acute poisoning has life-saving significance, therefore it is an urgent task.

The aim is to assess the level of endotoxinemia in severe oral poisoning with corrosive substances and the effectiveness of intestinal lavage as a way to reduce its level.

Material and methods. Forty-seven women and men aged 47 (34.0; 57.5) and 42 (32.5; 54.5) years with severe oral poisoning with corrosive substances, acid or alkali, were examined. For the purpose of detoxification, 26 patients (study group) underwent five-hour intestinal lavage (IL) through a gastric tube in a volume of 12 (9; 13) liters. In the comparison group (21 patients), standard therapy was carried out. The endotoxin (ET) content in blood plasma in the study group was determined (before and after IL, and in the comparison group – before treatment and after 5 hours) on an Agilent 7890B gas chromatograph with an Agilent 7000 mass-selective detector. The reference values ​​of ET concentration were 1.05–7.89 ng/ml.

Results. Before treatment, the ET concentration was 17.2 (9.68; 22.0) and 16.6 (15.3; 21.3) ng/ml, respectively, in the study and comparison groups, which exceeded the reference value by more than 2 times. After IL, its concentration decreased to 6.65 (13.0; 19.4) ng/ml – the level of reference values.

Against the background of standard treatment, the ET concentration decreased to 10.3 (7.56; 20.8) ng/ml, without reaching the reference value. Thus, after IL, the decrease in the ET level in the blood of patients was 1.6 times more pronounced than in the comparison group, the difference was statistically significant (p<0.05).

Discussion. The effectiveness of IL as a method of reducing the level of endotoxinemia in acute poisoning can be explained by the fact that as a result of intestinal cleansing, a depot of not only free lipopolysaccharide (as a chemical substance) is removed from it, but also as part of the oral gram–negative flora, an endotoxin producer, as a result of which the rate of entry of these pathogens into the blood stops or decreases. Against the background of the elimination of intestinal depot, the elimination of endotoxin from the blood is accelerated.

Limitations. The age of men and women is 18–65 years, oral poisoning with alkali or acid, the concentration of ET in the blood is above the reference value, the stages of the study are before treatment and after 5 hours, intestinal lavage in the volume of 9 to 13 liters.

Conclusion. In severe oral poisoning with corrosive substances, hyperendotoxinemia is detected. After 5 hours of IL, the concentration of ET in the blood of patients decreased by an average of 61.3%, reaching the reference value. Against the background of standard treatment, the level of ET in the blood decreased by an average of 38% without leaving the hyperendotoxinemia zone. The intergroup difference in the results was statistically significant (p<0.05; cr. U).

Compliance with ethical standards. The protocols of this study were approved by the local ethics committee of the N.V. Sklifosovsky Scientific Research Institute of Emergency Medicine of the Moscow City Health Department (protocols No. 5-16 of 11/21/2016 and No. 4-22 of 04/26/2022). All participants gave informed voluntary written consent to participate in the study.

Authors contribution:
Matkevich V.A. – the idea, concept and design of the study, writing the text;
Potshveriya M.M. – research design and organization;
Stolbova N.E. – data collection, systematization, statistical analysis;
Vorobyeva A.G. – ccollection of clinical material, statistical analysis;
Tyurin I.A. – organization and execution of chemical and toxicological research, analysis of the data obtained;
Maksimov A.A. – development of the methodology and implementation of the chemical-toxicological study, analysis of the obtained data.
All co-authors – approval of the final version of the article, responsibility for the integrity of all parts of the article.

Funding. The study had no sponsorship.

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

Received: August 8, 2024 / Accepted: December 18, 2024 / Published: February 25, 2025