Comparative analysis of the clinical course of narcotic poisoning with different combinations of opioids, psychostimulants and alcohol

Abstract. Clinical evaluation of combined drug poisoning is a rather difficult matter, since despite the progress in understanding the pharmacological effects and toxicity of many modern narcotic substances and precursors, their combined action in most cases remains unknown. Aim: to study the features of the clinical course of combined poisoning caused by the simultaneous consumption of drugs of different groups and alcohol. Materials and Methods. The medical data of 212 cases of drug poisoning (overdose) were studied. Clinical and laboratory parameters of patients with various combinations of opioids, alcohol and psychostimulants were evaluated. Statistical analysis was carried out using the Microsoft Excel 2019, Student's t-test for paired samples, Pearson's correlation analysis, p≤0.05 was used. Results. The use of opioids, alcohol, and psychostimulants in various combinations leads to the development of a specific picture of poisoning. Depending on the combination of narcotic substances and alcohol, these or other toxic symptoms and syndromes occur, which differ in nature, duration, intensity, and frequency depending on the combination and dose of narcotic substances. Combined poisoning with the participation of opioids, alcohol, and psychostimulants differ in the frequency of hypotension, arrhythmias, muscle atony, rhabdomyolysis, electrolyte and metabolic disorders. There was a correlation established between the number of toxicants and the duration of the patient's stay in the intensive care unit (r=0.7864, p=0.00123) and the presence of biomarkers of nephro- and hepatotoxicity (r=0.5285, p =0.00411); the correlation between the number of toxicants and the development of oligo-anuria was not confirmed (r=0.0007, p=0.001). Conclusions. The study of the clinical and laboratory features of the course of combined drug poisoning caused by the simultaneous consumption of 3 or more toxicants is an urgent direction of modern clinical toxicology and emergency medicine. Key Words: drugs, alcohol, combined poisonings.