Infusion therapy in the internal diseases’ propaedeutics

Abstract

Background. Infusion therapy (IT) is one of the main methods of drug therapy optimization. The essence of IT is to correct homeostasis disorders in order to detoxify, to restore the disrupted microcirculation and tissue perfusion, to eliminate the disorders of rheological and coagulation blood properties, to eliminate metabolic disorders, to improve drug delivery to the pathological focus, to restore circulating blood volume, to normalize fluid and electrolyte and acid-base balance. Objective. To describe modern IT. Materials and methods. Analysis of the literature sources on this topic. Results and discussion. Requirements for modern plasma substitutes include safety, sufficient and long-lasting volemic effect, rapid renal excretion, lack of accumulation and effect on the coagulation system, maximum similarity to blood plasma, and availability. There are several classes of plasma substitutes, and each of them has its own indications. For example, crystalloids are prescribed for dehydration, and colloids – for hypovolemia. The infusion volume is calculated based on the physiological needs of the organism, taking into account pathological fluid loss (fever, shortness of breath, postoperative wound drainage, vomiting, polyuria). Endogenous intoxication (EI) – a pathological condition that occurs as a result of exposure to toxic substances of exogenous or endogenous nature, which cause dysfunction and the development of extreme conditions – is an important field of IT application. EI can accompany chronic heart failure, peripheral vessels atherosclerosis, autoimmune and allergic diseases. Toxins have a direct (direct destruction of proteins and lipids, blocking of synthetic and oxidative processes in the cell) and indirect (microcirculation system and vascular tone disorders, changes of blood rheological properties) adverse effects. Clinical manifestations of EI include fever, malaise, and the dysfunction of various internal organs. As EI depletes the natural mechanisms of detoxification, worsens the clinical course of the disease, reduces drug sensitivity, suppresses immunity, it is an indication to detoxification via infusion. The tasks of the latter are to improve tissue perfusion, to provide hemodilution with a decrease in the toxins’ concentration, to stimulate diuresis, to eliminate acidosis, and to maintain the functional state of hepatocytes. For this purpose, solutions of polyatomic alcohols (Reosorbilact, Xylate, “Yuria-Pharm”) can be used. Reosorbilact increases the circulating blood volume, improves microcirculation and rheological blood properties, increases tissue perfusion, promotes “wash-out” of toxins, corrects acidosis and fluid and electrolyte balance, normalizes hepatocyte function, improving the own detoxification mechanisms. In case of microcirculation disturbances, it is reasonable to use the combined IT with the inclusion of Reosorbilact, Latren and Tivortin (“Yuria-Pharm”). Latren increases the elasticity of erythrocytes, reduces the aggregation of erythrocytes and platelets, normalizes the electrolyte composition of blood plasma, and Tivortin acts as a substrate for the formation of nitric oxide – the main signaling molecule of the endothelium. In addition to EI, IT usage is often prescribed for diabetic ketoacidosis. In such cases, it is advisable to use Xylate (“Yuria-Pharm”), which has antiketogenic properties, improves hemodynamics, corrects acidosis, and does not increase blood glucose levels. Xylate is recommended to be used only after preliminary rehydration with the help of isotonic saline solutions. Conclusions. 1. IT is an important method of treating a number of diseases. 2. EI accompanies not only diseases that involve intoxication syndrome, but also almost all internal diseases. 3. Reosorbilact and Xylate are the optimal solutions for detoxification. 4. It is reasonable to use combined IT, for example, the combination of Reosorbilact with Latren and Tivortin.