Effect of hyperammoniemia on the course of delirious syndrome in acute severe poisoning with 1,4-butandiol and methods of its correction

Introduction. The article presents an assessment of the effect of hyperammonemia on the course of delirious syndrome in acute severe poisoning with 1,4-butanediol and methods of its correction.

Purpose of the study. To analyze the effect of free ammonia on the severity of delirium in acute severe poisoning with 1,4-butanediol and to develop methods for correcting hyperammonemia.

Material and methods. In the course of the work, a prospective examination was carried out of 59 male patients aged 20 to 45 years (the average age was 29.2 ± 4.47 years) of the intensive care unit and intensive care center of the center for the treatment of acute poisoning of the St. I.I. Dzhanelidze with acute severe poisoning with 1,4-butanediol, complicated by delirious syndrome. The results were statistically processed using the Statistica for Windows software (version 10).

Results. During the study, patients with delirious syndrome were diagnosed with transient hyperammonemia of moderate severity according to the classification proposed by Lazebnik L.B. et al. (2019) with hepatocellular insufficiency syndrome. The factor of the increase in free ammonia in the blood was protein catabolism and tissue hypoxia. The use of a hepatoprotector based on a compound of arginine and glutamic acid “Glutargin” made it possible to correct metabolic disorders and significantly reduce the duration of exogenous psychosis and minimize post-delirious complications in the form of psychoorganic syndrome and severe postpsychotic asthenia.

Limitations. When studying the effect of hyperammonemia on the course of the delirious syndrome in acute severe poisoning with 1,4-butanediol, a prospective examination of 59 male patients of the intensive care unit was carried out, whose intensive care included arginine glutamate (Glutargin), which made it possible to establish the cause of the prolonged course of delirium and improve the tactics of its treatment.

Conclusion. Obtained in the present The study results demonstrate the high efficacy of the hepatoprotector “Glutargin” in relation to slowing the progression of the clinical course of post-intoxication delirium in acute severe poisoning with 1,4-butanediol.

Compliance with ethical standards. The study was approved by the Local Ethics Committee of the I.I. Janelidze St. Petersburg Research Institute of SP Protocol No. 1 of 12.02.2021.

Author contribution:
Lodyagin A.N. — concept and design of the study, collection and processing of material, statistical processing, writing the text, editing;  
Sinenchenko A.G. — collection and processing of material, statistical processing, writing the text;  
Batotsyrenov B.V. — concept and design of the study, editing;  
Sinenchenko G.I. — concept and design of the study, writing the text.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version. 

Conflict of interest. The authors acknowledge that there are no known conflicts of interest related to this publication.

Funding. The study was not sponsored.

Received: November 23, 2021 / Accepted: July 21, 2022 / Published: August 30, 2022