What to do if a person drinks alcohol after an IV?

The drug Reamberin occupies a special place among infusion therapy products. Its main difference from other solutions is the presence of succinic acid, a key participant in the tricarboxylic acid cycle. The presence of a substrate antihypoxic agent, which exerts an antihypoxic effect in conditions of energy deficiency, determined its successful use as a local and systemic metabolic and energy corrector in a variety of pathological conditions, the list of which is constantly growing.

Metabolic functions in critically ill patients are characterized by their pronounced activation and profound disorders at all levels, from the microsystems of cells to the macroorganism as a whole [1]. In critical situations, metabolic disorders quickly develop from functional and reversible into morphological and irreversible; stress without correction develops into distress. Multiple organ failure syndrome (MODS), intoxication, hypoxia are conditions that are difficult not only to diagnose and monitor, but also to effectively correct. Specialists working in critical care medicine, including anesthesiologists and resuscitators, must find the fastest and most effective solution to the problem. But even if correctly selected and implemented in a timely manner, it does not always lead to the desired, seemingly “programmed”, positive result [2].

Cancer patients are more likely to have a negative energy balance, which is a consequence of reduced energy intake due to anorexia and/or hypophagia. The mechanism of this hypermetabolism is a sharp increase in the activity of the so-called Cori cycle and the alanine cycle. In conditions of the absence or insufficient number of mitochondria (for example, in red blood cells, muscles, tissues with insufficient oxygen supply), aspartate aminotransferase is synthesized through the process of converting glucose into lactate, which cannot be further oxidized and accumulates. With the bloodstream, it enters the liver, which is the main site of accumulation of gluconeogenesis enzymes (glucose synthesis from non-carbohydrate compounds). Here lactate is used to synthesize glucose. A feedback loop similar to the Cori cycle also exists in the alanine cycle, which also involves pyruvate. The alanine cycle begins with the proteolysis of proteins. Skeletal muscles are actively involved in the metabolism of amino acids - during fasting, muscle proteins serve as the body's energy reserve. They are hydrolyzed to amino acids, which enter the liver. Here, the carbon skeleton of amino acids is converted into intermediate products of the citrate cycle, including acetoacetyl-coenzyme A and acetyl-coenzyme A. These amphibolic compounds are oxidized in the tricarboxylic acid cycle or are included in the process of gluconeogenesis; with intense anaerobic glycolysis, metabolic acidosis develops [3— 7].

In the complex treatment of intensive care patients, the use of antioxidants is justified, since they have a predominant pronounced activation of oxidative processes with simultaneous inhibition of antioxidant protection. However, it should be taken into account that patients with heterogeneous pathologies, varying degrees of severity of the underlying syndrome and different states of homeostasis are often treated in the intensive care unit. Consequently, the pathogenesis of the damaging effects of free radicals on cells and the body as a whole will have its own characteristics. Therefore, it is necessary to include drugs with antioxidant properties in complex therapy taking into account these features; only in this case will antioxidants be most effective [8, 9].

Infusion therapy is an essential component of the management of patients in critical condition; its main objectives are correction of the volume and rheological properties of blood, biochemical and colloid-osmotic correction of the composition of blood and tissue fluid, detoxification, administration of drugs, and parenteral nutrition. To solve these problems, various infusion agents are used, which, according to their basic physiological properties, can be divided into hemodynamic and detoxification blood substitutes, preparations for parenteral nutrition, regulators of water-salt and acid-base conditions; blood substitutes with oxygen transfer function, infusion antihypoxants, combination drugs [10, 11]. In connection with the above, the effectiveness of using antioxidants in medical practice, in particular reamberin (meglumine sodium succinate, produced by NTFF POLYSAN LLC, Russia), a medicinal detoxification agent that has an antihypoxic and antioxidant effect, is of interest. The first experience of its clinical use confirmed not only the reliability of the results of preclinical trials and the validity of the initial recommendations for the use of the drug, but also revealed increased interest in it. The latter led to fundamental evidence-based multicenter scientific research and determined the main areas of its application, the primary of which was critical care medicine [11-14].

Among the means of infusion therapy, the 1.5% solution of reamberin occupies a special place due to its multifunctionality and detoxification properties that regulate the water-salt and acid-base state. The main distinctive property of the drug is due to the presence of succinic acid (a substrate antihypoxant) in its composition, which determines its fundamental properties as a metabolic and energy corrector. The drug provides an antioxidant, antihypoxic and energy-protective effect, reduces the production of free radicals, utilizes fatty acids and glucose in cells, normalizes the acid-base balance and blood gas composition [15].

The standard dose of the drug in adults is up to 800 ml/day (400 ml 2 times). For children over 1 year of age, reamberin is prescribed at the rate of 6-10 ml per 1 kg of body weight, for newborns and children of the 1st year of life - 1 ml per 1 kg of body weight. The drug serves as a base solution when using other medications. The indication for use is its effect on the main links in the pathogenesis of critical conditions, consisting of three main pathophysiological processes: hypoxia, intoxication and immunosuppression. Reamberin is widely used in the medicine of critical conditions, regardless of the etiology of their occurrence (blood loss, endotoxemia, hypoxia, etc.) [16-18]. The drug should be used with caution in alkalosis; contraindications are the condition after a traumatic brain injury, accompanied by cerebral edema, severe renal dysfunction, pregnancy and lactation, as well as hypersensitivity to the components of the drug [9, 10, 12]. By Order of the Government of the Russian Federation No. 376-r dated March 29, 2007, reamberin was included in the List of vital and necessary medicines.

Understanding the mechanisms of action of the drug makes it possible to more reasonably prescribe it in complex infusion therapy for critical conditions [19]. In critical conditions, along with a significantly increased level of metabolic needs, certain limitations often arise in compensating for the increased oxygen demand of tissues. At the organ level, these changes lead to the formation of MODS, which accounts for the majority of hospital deaths. It is important that by the time these complications develop, the causes that caused them (sepsis, trauma, blood loss, purulent surgical pathology, burns, etc.) either do not have a decisive significance or are eliminated [20].

The clinical effect of reamberin infusions for MODS is manifested in the acceleration of compensation of organ dysfunction and normalization of the severity of the patient's condition (according to the SOFA and APACHE II scales), relief of metabolic abnormalities: reduction of lactatemia, hyperglycemia, normalization of lactate/pyruvate, glucose/lactate indices, inhibition of hyperactivity of the peroxide system lipid oxidation and restoration of the body's antioxidant system, reducing the severity of hypermetabolism/hypercatabolism syndrome (increasing the effectiveness of parenteral and enteral nutrition). In addition, the time frame for compensation of endotoxicosis is reduced, the production of substances of low and medium molecular weight, including their high-molecular, “catabolic” pool, is reduced, with an increase in their excretion in the urine. On the part of the respiratory system, compensation occurs faster for the metabolic (restoration of the metabolism of glucose, lactate and pyruvate from the inflowing venous blood) and detoxifying function of the lungs, stabilization of their antioxidant system with a subsequent reduction in the period of relief of respiratory dysfunction.

On the part of parenchymal organs (liver and kidneys), there is a much faster decrease in bilirubinemia, fermentemia, azotemia, creatinine levels in the blood, restoration of waste excretion in the urine, and a moderate increase in the initially reduced glomerular filtration (this is associated with a moderate diuretic effect of the drug). At the same time, we must not forget that all the obtained positive effects of timely early administration of Reamberin are associated with the complex use of symptomatic and etiopathogenetic intensive therapy for MODS and cannot be a justification for their cancellation [21, 22].

In clinical practice, the assessment of the role and place of the drug is determined by the effect of its use in “problematic” areas of modern intensive care, including acute intoxications of various etiologies [23].

Belarusian colleagues conducted a randomized study of complex treatment of 138 patients with the toxic stage of widespread purulent peritonitis. It has been established that with the development of purulent inflammation of the peritoneum, the electrical activity of the small intestine is significantly reduced, and free radical oxidation processes are disrupted. It has been proven that the use of reamberin in the complex treatment of patients with widespread peritonitis helps restore the motor-evacuation function of the small intestine by the 3rd day of the postoperative period, effectively correcting the imbalance in the free radical oxidation system. The inclusion of the drug in the treatment regimen reduced mortality from 16.49 to 9.76%. Other authors [3, 24, 25] also note that in case of peritonitis, thanks to the connection of reamberin infusions to the main treatment, stabilization of central hemodynamic parameters, correction of metabolic parameters, endotoxicosis, cellular immunity, MODS, relief of hypermetabolism/hypercatabolism syndrome, reduction in the frequency of complications, length of hospitalization and mortality.

A sufficiently long course of reamberin infusions in acute pancreatitis reduces the time for restoration of organ blood flow in the hepatopancreatoduodenal zone, increases the potential of the antioxidant system, anticoagulant and fibrinolytic activity, relieves metabolic disorders, endotoxicosis, and normalizes the functional state of the liver. In the postoperative period during pancreaticoduodenectomy, reamberin helps prevent postoperative disorders of the morphology of internal organs (stomach, small and large intestines, liver, pancreas, kidneys, lymph nodes), metabolism, endotoxicosis, hyperbilirubinemia, hyperenzyme (alanine aminotransferase - ALT, aspartate aminotransferase - AST, amylase ), hypoproteinemia, hypoalbuminemia, potentiates the effectiveness of early enteral nutrition, reduces the incidence of postoperative complications (hepatic, renal dysfunction, pneumonia, encephalopathy) and hospital mortality [26-28]. After gastroduodenal bleeding, on average, within 4 days of using Reamberin, correction of hemodynamic and metabolic disorders, oxygen delivery, consumption and utilization occurs, compensation of the lipid peroxidation system/antioxidant system (LPO/AOS), reduction in the frequency of post-hemorrhagic organ dysfunctions, intensive care bed-day and hospital stay mortality [29, 30].

The use of reamberin in the treatment of sepsis significantly faster allows for the correction of hemodynamic and metabolic disorders (lactatemia, pyruvatemia, glycemia, nitrogen metabolism, restoration of cytoplasmic and mitochondrial redox status, elimination of mitochondrial dysfunction and limitation of the hypermetabolic response to inflammation), including in the hepatosplanchic zone , as well as normalization of kidney function (diuresis and creatininemia), increased activity of the protein C system, decreased synthesis of acute phase proteins (C-reactive protein, fibrinogen). As a result, patients who received the drug as part of the treatment regimen showed a decrease in the severity and frequency of organ dysfunction and hospital mortality [31-33].

The inclusion of reamberin in the treatment regimen for destructive lung diseases allows one to improve health in a shorter time, reduce the leukocyte index of intoxication, stabilize hemodynamics, stop the systemic inflammatory reaction, endotoxicosis, encephalopathy, renal dysfunction, reduce the frequency of the disease becoming chronic and reduce the duration of hospitalization [34] .

Infusions of the drug for burn disease of moderate and severe severity from the 1st day to 10-20 ml/kg for 12 days after injury give a pronounced clinical effect: prevention of decompensation of endotoxicosis and metabolic disorders, maintaining the balance of the LPO/AOS system, normalization of water electrolyte balance and acid-base status and, as a result, rapid regression of clinical symptoms, reduction in the number and severity of complications of burn disease (pneumonia, renal dysfunction, sepsis, encephalopathy), intensive care bed days and mortality. The effectiveness of Reamberin depends on the severity of the burn disease, the timing of the start of therapy and its duration; the best results were observed when it was prescribed from the 1st day after the injury [15, 16].

After coronary artery bypass surgery, courses of the drug that are moderate in dose and duration reduce the incidence and severity of postoperative heart failure, the incidence and duration of silent ischemia, rhythm disturbances and postcardiotomy syndrome, and the timing of postoperative recovery of systolic and diastolic myocardial function. Long-term results of surgical treatment are improving: 9 months after surgery, there is a decrease in the duration of recurrent angina, the total duration of myocardial ischemia, the number and duration of painful and painless episodes of ischemia, a decrease in the area of ​​large-focal cicatricial changes and the area of ​​myocardial ischemia [35].

In emergency neurology for ischemic and hemorrhagic stroke, a course of Reamberin for a duration corresponding to the severity of the lesion provides high pharmacoeconomic effectiveness in the form of a significant reduction in the zone of the so-called ischemic penumbra, or penumbra, according to computed tomography, and a reduction in the time required for correction of psychoneurological deficits (E.I. Gusev scale , Glasgow-Pittsburgh, etc.), metabolic disorders, endotoxicosis, stabilization of the LPO/AOS system, increasing the effectiveness of enteral nutrition, reducing the incidence of nosocomial pneumonia and mortality, including in the first 60 days of the disease [36-38].

High pharmacoeconomic effectiveness of the drug in obstetrics and gynecology was noted. Thus, in case of postpartum endometritis, it helps to correct hemodynamic, hemorheological disorders and endotoxicosis [39]. In severe gestosis, in combination with other drugs, there is an increase in tissue oxygenation, a decrease in interstitial hyperhydration, and normalization of acid-base status [40, 41].

In clinical practice, the assessment of the role and place of the drug is determined by the effect of its use in the “problematic” areas of modern intensive care:

- decompensated diabetes mellitus, ketoacidotic coma: correction of hyperglycemia, maintenance of compensatory capabilities of the cardiovascular system, prevention of hypodynamic circulatory disorders, increased delivery and consumption of oxygen by brain cells, restoration of psychophysiological characteristics, manifested by increased stability of attention, improvement of thinking and memory processes as in early , and in a period remote from the episode of cerebral hypoxia [42];

— pneumonia: increasing the rate of correction of blood gas composition, arterial hypoxemia, endotoxicosis, hyperthermia, acid-base disorders, improving the well-being of patients and reducing intensive care bed days. The membrane-stabilizing effect of reamberin was noted in the form of increasing the resistance of erythrocytes to hemolysis [43];

- influenza, severe and complicated forms: relief of intoxication syndrome, restoration of pulmonary ventilation, bronchial obstruction, trophic processes in the myocardium, increasing the antioxidant potential of blood serum and nonspecific resistance of the body, prevention and treatment of complications of influenza and other acute respiratory diseases (pneumonia, neuroinfection, viral hepatitis) [44];

— chronic viral hepatitis with severe symptoms of intoxication: relief of endotoxemia, cytolytic and mesenchial-inflammatory syndrome, deficiency of enzymatic and non-enzymatic components of the AOD system, lipid peroxidation, laboratory manifestations of secondary immune deficiency (subpopulation imbalance, hyperproduction of anti-inflammatory cytokines, decreased phagocytosis), increasing the effectiveness of antiviral therapy , nephroprotective effect, reducing the use of hormones in treated patients, reducing the length of hospitalization [45];

— acute intestinal infections with severe symptoms of intoxication: correction of endotoxicosis (decrease in the content of substances of low and medium molecular weight, C-reactive protein, circulating immune complexes, leukocyte index of intoxication), microcirculation disorders, hemorheology, high blood and plasma viscosity syndrome, reduction of hyperfibrinogenemia , improving the aggregation and deformability of red blood cells, reducing the duration of infusion therapy and hospitalization;

— dysentery with pronounced symptoms of intoxication: reduction in the severity and duration of the intoxication period, fever, general infectious symptoms, disorders of the LPO/AOS system, timing and severity of the systemic inflammatory reaction [46];

- acute poisoning with neurotropic poisons: correction of oxygen transport and restoration of energy metabolic balance, which allows saving life even in cases where traditional therapy, as a rule, led to death, reducing the duration of stay in a coma and the duration of mechanical ventilation, restoring transport and disposal oxygen in conditions of hypoxia, relief of endotoxicosis and metabolic disorders, stabilization of the LPO/AOS system, reduction of respiratory complications, intensive care bed days and hospital mortality [3];

— poisoning with acetic acid (at the stage after recovery from exotoxic shock, relief of hemolysis and restoration of diuresis): correction of liver dysfunction, endotoxemia, acceleration of repair processes of damaged tissues [47];

— relief of withdrawal syndrome: the mechanism of action of succinate in acute and chronic alcohol intoxication is to restore the oxidative capacity of the liver with the subsequent removal of ethanol and acetaldehyde; this mechanism is carried out by stimulating the cycle of tri- and dicarboxylic acids in the presence of succinate [48].

Considering the universality of the pathogenetic links of various human diseases, the positive effect of including reamberin in dermatology therapy has been noted:

- with active psoriasis (numerous factors are involved in the formation and implementation of clinical manifestations of psoriasis, among them a special place belongs to changes in the microcirculatory bed, increased activity of lipid peroxidation with a decrease in the antioxidant system): the introduction of the drug into the complex therapy of psoriasis reduces the severity of the manifestations of the disease without the use of hormone therapy , extends the period of remission, improves the quality of life of patients with psoriasis, corrects indicators of oxidative stress, reduces endogenous intoxication, improves tissue blood flow, which leads to faster stabilization of the skin process (resolution of infiltration, absence of new rashes and transition from the progressive stage to the stationary stage) [49 , 50];

- in the treatment of atopic dermatitis (the degree of hypoxic state reliably correlates with the severity of the disease and the activity of lipid peroxidation processes, which requires metabolic correction): the use of reamberin in the treatment of children suffering from atopic dermatitis of varying severity has demonstrated its high clinical effectiveness and good tolerability with absence of side effects and complications, helping to mitigate the further course of the disease and prolong the period of remission [50];

— in the treatment of chronic urticaria with and without angioedema, in combination with and without pyridoxal phosphate [51].

Clinical data on the use of reamberin in pediatrics (perinatology and anesthesiology) have been accumulated. The most important problem of modern perinatology is the search for ways to reduce perinatal mortality, morbidity and early childhood disability. Perinatal factors cause 70-80% of diseases of the nervous system, leading to disability and social maladjustment. The results of numerous scientific studies and experiments on the mechanisms of post-hypoxic damage to the central nervous system indicate that only timely pharmacological intervention in the cascade of processes initiated by hypoxia can in some cases prevent damage to cells of the nervous tissue, limit the lesion and improve the neurological outcome. The period of time - the “therapeutic window” during which cerebroprotective therapy can be effective ranges from 6 to 100 hours of life and, according to most researchers, is limited to the first 48 hours of life. In a study on the use of reamberin for this purpose at Hospital No. 8 in Moscow in 2003-2004. 89 infants were included who were born prematurely and required resuscitation and intensive care (children with malformations of the brain and internal organs were not included in this study). The researchers concluded that the use of sodium succinate-based infusion solutions has a significant cerebroprotective effect in newborns who have suffered perinatal hypoxia. It was noted that the cerebroprotective properties of the drug are most pronounced when administered early to premature newborns (in the first 12 hours), and the positive effects of this therapy persisted throughout the neonatal period. It was noted that the use of Reamberin significantly reduced the incidence of periventricular leukomalacia of the brain in premature newborns requiring mechanical ventilation and intensive care. The systemic antihypoxic and antioxidant effect of the drug made it possible to reduce the duration of mechanical ventilation and reduce the incidence of complications associated with its use [52].

In case of perinatal hypoxia, the use of reamberin at a dose of 5 ml/kg/day for 5 days ensures a decrease in the level of neurospecific proteins (gliofibrillar acidic protein, neurospecific enolase, myelin basic protein), a reduction in the number of peri- and intraventricular hemorrhages, including severe, focal ischemic brain damage in the form of periventricular leukomalacia, timing of mechanical ventilation and the use of high concentrations of oxygen in the respiratory mixture. The positive effects of the drug are much more pronounced with early (in the first 12 hours after birth) than with delayed (48 hours after birth) administration of the drug [17].

Intraoperative brain damage occupies a leading place in the statistics of anesthetic complications. The main causes of these complications are hypoxic conditions of the brain, caused either by impaired cerebral perfusion or by hypoxemia of various origins. As a result of the search for an alternative and quick way to correct hypoxia and oxidative stress and, consequently, cerebral and somatic disorders, the use of succinates (succinic acid salts), which fully satisfy all the requirements for correcting the listed cellular metabolic complications, has been proposed. A study of the effectiveness of the drug in newborns in order to eliminate post-anesthesia depression and activate (accelerate) the period of restoration of adequate spontaneous breathing after mechanical ventilation showed that the restoration of consciousness and adequate spontaneous breathing was reduced in time by 1.5 times, complications after the administration of reamberin were not identified, systemic indicators hemodynamics in none of the examined groups did not undergo significant changes [11, 12, 18].

The effect of the drug on the oxygen status of the brain during recovery from anesthesia in children aged 1 to 14 years was studied. It was found that reamberin at a dose of 2 ml/kg, administered 2 times at the end of the operation, helps to increase the oxidized fraction of hemoglobin and cytochrome oxidase, regional saturation of brain tissue with oxygen, which indicates an increase in the potential for activation of metabolism in neurons. Protecting the brain from hypoxic-ischemic damage during general anesthesia and during recovery from it is considered one of the most difficult tasks. Moreover, hypoxic conditions in children are observed more often than in adult patients. Subsequently observed neurological disorders occupy one of the leading places in the statistics of anesthesiological complications [3, 17, 30, 38]. The effectiveness of Reamberin was assessed by improvement of cerebral perfusion and oximetry (increase in regional hemoglobin oxygen saturation, oxyhemoglobin content, moderate increase in the reduced fraction of cytochrome oxidase and decrease in deoxyhemoglobin), more rapid restoration of clear consciousness and adequate spontaneous breathing in the postoperative period (results obtained with the use of narcotic analgesics and antipsychotics during anesthesia). The drug also promotes dose-dependent restoration of disorders of the blood antioxidant system [11, 12, 52].

The small but significant experience of using reamberin in oncology, in particular in patients with breast cancer, deserves special attention. Against the background of its administration, a decrease in the cardiotoxic consequences of the use of polychemotherapy regimens with anthracyclines was noted: a decrease in the frequency and severity of disturbances in repolarization processes, stabilization of indicators of systolic and diastolic myocardial function during all courses of polychemotherapy, maintenance of functional reserves of the cardiovascular system, prevention of the development of heart failure, while no effect of the drug on the level of antitumor effect of polychemotherapy was detected [53]. The results obtained are optimistic, since the organ toxicity of chemotherapy is often a serious obstacle to the implementation of treatment protocols for oncological diseases, and the late toxic effects of cytostatic therapy have become widely studied only now, when significant material has been accumulated on the convalescence of the oncological process [54].

The purpose of the study is to study and generalize the accumulated experience of using reamberin in critical conditions that develop during the implementation of modern treatment programs for children with malignant neoplasms and blood diseases.

Pharmacodynamics and pharmacokinetics

The active substance protects the heart muscle, nerve cells, liver and kidneys from toxins . It also has antihypoxic, antioxidant and detoxification activity. By inhibiting the reactions of fat peroxidation , during hypoxia and ischemia antioxidant are stimulated .

The membranes of brain , kidney, liver and heart are stabilized The product also has a diuretic effect.

Sodium N-methylammonium succinate penetrates cell mitochondria and participates in the Krebs Cycle , inhibiting oxidation reactions and increasing intracellular energy potential ( creatine phosphate and adenosine triphosphate ).

Penetrating into the body, the drug does not accumulate, but is completely consumed.

Pharmacological properties

Pharmacodynamics
REAMBERIN® has an antihypoxic and antioxidant effect, having a positive effect on aerobic processes in the cell, reducing the production of free radicals and restoring the energy potential of cells.
The drug activates the enzymatic processes of the Krebs cycle and promotes the utilization of fatty acids and glucose by cells, normalizes the acid-base balance and gas composition of the blood. Has a moderate diuretic effect. Pharmacokinetics
When administered intravenously, the drug is quickly utilized and does not accumulate in the body.

Instructions for use of Reamberin (Method and dosage)

Depending on the severity of the patient’s condition, different rates of administration and daily dosages are prescribed.

Instructions for use of Reamberin for alcohol intoxication : the drug is administered intravenously , the injection rate is 90 drops per minute. The daily dose is 400-800 ml.

For children, an IV is placed based on the principle of 8 ml of the drug per kilogram of the patient’s weight. The maximum amount of Reamberin is 400 ml per day.

The course of treatment is no more than 11 days.

Drug interactions and special instructions

The medicine is used mainly only in hospital settings. It is sold in pharmacies only with a doctor's prescription. With long-term use, it is possible to decrease the level of glucose in the blood, as well as change the color of urine.

The shelf life of the drug is 3 years from the date of production. Storage conditions: in a dark place at a temperature of 0-25 degrees, can be frozen without re-freezing. It is not allowed to use a solution with a changed appearance or color.

"Reamberin" acts as an antagonist to barbiturates. If the patient systematically uses Phenobarbital and other drugs of the same series, the doctor must be told about this in advance. Temporary cancellation of the main course of therapy is possible.

Analogs

Level 4 ATC code matches:
Calcium Chloride

Calcium chloride

Magnesium sulfate

Sodium chloride

Potassium chloride

Rheosorbilact

Analogues of the product are: xylate, potassium chloride, glyxyl, calcium chloride, lactoxyl, magnesium sulfate, sodium bicarbonate, sodium bicarbonate, sodium chloride, plerigo .

Results and discussion

The study revealed that in patients of group 1 (neurosurgery), the inclusion of reamberin in the complex therapy regimen improved oxygen metabolism, central hemodynamics and functions of the central nervous system (positively influenced the dynamics of activation of consciousness and cognitive functions).

The inclusion of reamberin in the treatment regimens for patients of group 2 reduced the severity of clinical manifestations of endogenous intoxication syndromes and MODS, which improved the immediate results of polychemotherapy: children showed an earlier normalization of the acid-base state of the body.

In patients of group 3, the membrane-stabilizing effect of the antioxidant on liver cells was manifested by a significant and rapid decrease in the level of transaminases. The administration of Reamberin was accompanied by a moderate diuretic effect, and the detoxification effect was correspondingly enhanced. Signs of metabolic changes on the ECG in children who received Reamberin were observed less frequently; the level of cardiac output on EchoCG did not change significantly. The drug was well tolerated by patients; no adverse events were detected during administration or after infusion. All of the above-described cases of inclusion of reamberin in complex therapy regimens for patients with cancer were accompanied by an overall reduction in the length of stay in the ICU by an average of 1-2 bed days.

Reviews of Reamberin

Reviews about Reamberin are good. The drug copes well with the task of freeing the body from toxins and rehabilitation after severe infectious diseases. In itself, while not being a panacea for any specific disease, the medicine significantly speeds up the healing process. Sometimes side effects occur, and therefore the drug is not recommended for use outside the hospital.

Reviews of Reamberin for psoriasis : The use of the drug in the treatment of this disease is a controversial issue, but some experts prescribe the drug in order to free the body of toxins, improve metabolic processes, improve liver function and, as a result, cure a person of psoriasis. With long-term use in courses, under the supervision of an experienced doctor, the medicine gives good results.

Indications and contraindications for the use of the Reamberin dropper

A dropper with Reabmerin solution is placed as prescribed by a doctor in the following cases:

• hypoxia, for example, due to problems with the heart, lungs, after surgery;
• poisoning of the body (intoxication);
• cholestasis;
• hepatitis of toxic and viral nature;
• state of shock due to illness, accident or other origin.

In some cases, it is impossible to put an IV - the Reamberin product has several contraindications:

• pregnancy, breastfeeding at any stage;
• allergies, individual intolerance to individual components;
• alkalosis;
• swelling of the brain (especially against the background of a traumatic brain injury).

Side effects of using the drug include:

• anaphylactic shock;
• skin rashes;
• hives;
• angioedema;
• dyspnea;
• increased heart rate;
• cough;
• jumps in blood pressure - there can be either an increase or a decrease;
• tremor;
• anxiety states;
• convulsions;
• nausea.

Reamberin price, where to buy

The price of Reamberin in 1.5% packages is about 142 rubles per 250 ml.

The cost of 500 ml of the drug with the same dosage is 162 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

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• Reamberin (vial 1.5% 200ml) Polisan NTFF
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• Reamberin (vial 1.5% 400ml) Polisan NTFF

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• Reamberin 1.5% 200 ml solution for infusion TOV NTFF Polisan, Russian Federation
  74 UAH order
• Reamberin 1.5% 400 ml TOV NTFF Polisan, Russian Federation

  92 UAH order

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• Reamberin infusion Reamberin solution inf. 200ml Russia, Polisan

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Material and methods

In a prospective study for 2010–2017. included 127 patients with malignant neoplasms who received treatment at the Regional Oncohematology Center for Children and Adolescents named after. prof. IN AND. Geraina Chelyabinsk Regional Children's Clinical Hospital.

The age of the patients ranged from 1 month to 17 years and 10 months (average 6.5 years), boys predominated in a ratio of 1.3:1. All patients were treated in the ICU from 1 to 52 days (average 5.7 days).

For etiological reasons for the condition, patients were divided into the following groups: group 1 ( n

=47) consisted of patients in the early postoperative period. Of these, 26 (55.3%) neurosurgical children were admitted to the ICU from the operating room after brain surgery for tumors, 21 (44.7%) patients - after removal of an abdominal tumor. Reamberin was prescribed to this group of patients to restore brain function after hypoxic-ischemic disorders that developed during recovery from general anesthesia.

2nd group ( n

=36) consisted of patients with MODS and life-threatening conditions that developed as a result of progression of the tumor process in combination with antitumor therapy for life-saving indications. These patients were prescribed the drug in complex therapy (along with inotropic, systemic antibacterial and antimycotic therapy) with an antioxidant, energy-correcting purpose for the effective correction of metabolic acidosis and endotoxicosis.

To the 3rd group ( n

=44) patients with sepsis (21 patients), cerebrovascular accident (13) and signs of toxic hepatitis (10) were combined.

All patients, based on age, were prescribed reamberin as follows: children over 1 year of age at the rate of 10 ml per 1 kg of body weight, children 1 year of age (and body weight less than 10 kg) 1 ml per 1 kg of body weight, course from 2 to 12 times.

Noninvasive hemodynamic monitoring was performed using tracking equipment. Blood pressure, heart rate, and cardiac output were assessed (using an ultrasound scanner). Initial signs of cardiotoxicity were assessed using ECG, EchoCG, manifestations of hepatotoxicity were recorded by assessing ALT, AST, GGTP, alkaline phosphatase, bilirubin, and albumin levels. The parameters of the acid-base state of venous blood were determined with an ABL-500 radiometer: blood pH, buffer capacity (BC), and capillary blood saturation were assessed.

As a comparison, we used retrospective data from medical histories of patients with similar pathology who received standard therapy. Despite the fairly large number of patients whose data were included in the study, significant differences in clinical and laboratory data within the groups did not allow for full statistical processing of the results.

In what cases is an anti-hangover drip needed?

Hangover syndrome is a consequence of general intoxication with acetaldehyde and other compounds formed during the breakdown of ethyl alcohol, and disruption of the production of basic neurotransmitters. At the initial stage of alcoholism, withdrawal is relatively easy to bear, and by and large you can cope with its symptoms on your own. Helps:

• cold and hot shower;

• drink plenty of fluids (rehydration solutions and still mineral water are ideal)
• sound sleep (but in no case should you take sleeping pills or sedatives without a doctor’s prescription);
• moderate physical activity, walks in the fresh air;
• a gentle diet, limiting caffeine-containing drinks.

But as addiction progresses, the intensity of withdrawal symptoms increases. In addition to increased cravings for alcohol, the following symptoms are typical:

• tremor of the fingers, lower jaw, tongue, eyelids (in later stages, the trembling spreads to the whole body);
• irritability, emotional lability, aggressiveness towards family members that prevent continued drinking;
• nausea;
• sleep disorders: difficulty falling asleep, nightmares, waking up with a feeling of severe anxiety and restlessness;
• tachycardia with a feeling of heartbeat in the temples, ears, chest, hypertension;
• excessive sweating;
• diarrhea;
• increase in temperature, etc.

To get rid of these symptoms, you definitely need a hangover drip. Otherwise, against the background of progressive insomnia and realistic nightmares, there is a high probability of developing alcoholic psychosis. It is manifested by affective disorders, disturbances of consciousness, hallucinosis, persecution mania, at the peak of which a person can harm both himself and others. And in such a situation, a dropper against a hangover is no longer enough; serious intensive therapy with potent antipsychotics is necessary.

Content:

1. In what cases is a hangover dropper needed?
2. Medicines used.
3. Possible options for detoxification:

1.1. Dropper for hangover at home. 1.2. Hospital treatment.

Each person has their own experience of first “acquaintance” with alcohol. For some, alcohol causes unpleasant drowsiness and weakness, for others it causes emotional uplift, lightness and excitement. This pattern of intoxication predisposes to repeated episodes of drinking, requiring more and more alcohol over time to achieve the usual state. Usually the situation gets out of control unnoticed, episodic drunkenness develops into multi-day binges with a painful hangover. And in most cases, the addict prefers the easiest way to get rid of withdrawal symptoms - to drink again. But such tactics will only lead to a new round of binge drinking, so it is better to resort to professional help and put on an IV for a hangover. Only in this way can you completely get rid of the consequences of many days of drinking and prepare for comprehensive treatment of alcohol addiction.

Possible options for detoxification

The vast majority of modern private clinics offer the service of a narcologist visiting the patient directly, and many prefer this method of therapy. But in some cases hospitalization is required.

Hangover dropper at home

Specialized medical centers operate around the clock, so you can call a doctor at any time of the day. Detoxification begins with a mandatory examination of the patient. The narcologist assesses his well-being, mental and neurological status, measures temperature, blood pressure, pulse rate, and takes an ECG.

Based on the examination results, the doctor determines the list of necessary medications, explains the features of the upcoming procedure to the patient himself (if, of course, he is able to adequately perceive the doctor’s words) and his relatives. Then the patient is placed on the couch and given a hangover drip.

While the procedure lasts, the doctor remains next to the patient, monitoring his condition. After detoxification is completed, the specialist leaves recommendations for further rehabilitation treatment and talks in detail about available methods of combating alcohol addiction.

Hospital treatment

Indications for mandatory hospitalization are:

• temperature rise to febrile levels (39° and above);
• liver, kidney, heart failure;
• symptoms of psychosis (even mild);
• lack of effect from a dropper against a hangover at home;
• severe dehydration and exhaustion;
• elderly age;
• severe tremors, seizures;
• confusion;
• severe alcohol intoxication, drug use.

In the hospital there is the possibility of continuous administration of drugs under the constant supervision of medical personnel. In addition, a hangover drip can be supplemented with intravenous laser irradiation, hemosorption, and physiotherapy. A quick start to psychotherapy also has good results.

A detoxification drip is the only correct option for eliminating binge drinking and relieving hangover symptoms. This procedure can be the first step towards final recovery from alcohol addiction.

Literature:

1. Problems of addiction. Ed. A. M. Rapoport / Mosgorzdravotd. Neuropsychiatric. Institute named after P. B. Ganushkina and Neuropsychiatric. hospital for acute alcoholism. - Moscow / Leningrad: Medgiz, 1934 ([M.]: 16th type of the Polygraph Book trust). — Region, 116 s
2. Alcoholism / Donald W. Goodwin; [Transl. from English B. Pinsker]. - M.: Olimp-business, 2002. - XII, 224 p.
3. A manual on narcology for doctors and paramedics of primary medical care / A. A. Churkin, T. V. Klimenko. / Moscow ; Khanty-Mansiysk: Health and Society, 2006 (Cheboksary: ​​IPK Chuvashia). — 173 p.

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INFLUENCE OF REAMBERIN on clinical and laboratory parameters in drug addicted patients with viral hepatitis

Over the past decades, the World Health Organization (WHO) has been actively involved in research on viral hepatitis, as well as in activities to prevent these diseases. This is due to the fact that hepatitis B virus (HBV) and HCV still pose a serious problem and can cause not only acute, but also chronic forms of the disease with progression to cirrhosis and hepatocellular carcinoma with a fatal outcome [4, 6, 8] .

Among acute CH (AVG), HAV is still common (57%), HBV - 25%, and mixed CH accounts for 12.4%. When analyzing the incidence (6000 patients with CH) of chronic viral hepatitis (CVH) in a specialized clinic for viral infections at the Research Institute of Influenza, Russian Academy of Medical Sciences, it was shown that CHBV accounted for 20%, CHVHC - 21%, CHBV + C - 23% [7].

An important aspect is toxic liver damage, primarily associated with parenteral drug use [1, 5, 6]. If drug addiction is considered from a purely medical point of view, then liver damage, including CH and HIV infection, is one of its main “complications” [1]. It is well known that the incidence of CH and AIDS has sharply increased among parenterally administered drug addicts. It has been shown that HBV markers among drug addicts are detected in 44.4-77.4% of cases; acute and chronic forms of HCV - in 38-52% of cases [1, 5].

Viral hepatitis D occurs almost exclusively among drug users, for example in countries such as Sweden and Spain. Clinically, such VH is extremely difficult, with damage to various organs, often with the development of acute renal failure. Insufficiency of hepatic blood flow, caused by intoxication and concomitant diseases of the cardiovascular system, along with microcirculation disorders and a decrease in oxygen capacity, leads to hypoxia of hepatocytes. In case of CH in combination with endogenous drug intoxication (EI), activation of LPO in mitochondrial membranes leads to impaired membrane permeability and cell death. In addition, oxidative phosphorylation is disrupted, and the synthesis of ATP and creatine phosphate is reduced.

The incidence and severity of clinical manifestations of multiple organ failure syndrome, which occurs as a functional and morphological result of multicomponent cascades of post-hypoxic disorders of tissue metabolism in critical conditions, depend on the nonspecific resistance of the body, and primarily on resistance to hypoxia. In this regard, it is necessary to use drugs with antioxidant activity in complex therapy of such patients.

Currently, succinic acid compounds are used in clinical practice as biologically active substances with a wide pharmacological spectrum of action [2, 3]. The antioxidant and cytoprotective properties of succinic acid are known [3].

The drug Reamberin is a salt plasma replacement solution consisting of a 0.5% solution of sodium methylglucamine salt of succinic acid and a balanced set of trace elements - sodium, potassium and magnesium. The drug has antioxidant, antihypoxic, detoxifying, hepato-, nephro- and cardioprotective properties, has undergone preclinical studies and the first phase of clinical trials, and was well tolerated by volunteers. In this regard, the use of Reamberin is advisable in conditions of a high probability of developing multiple organ tissue posthypoxic disorders, which is observed in severe viral hepatitis, as well as toxic damage to organs and tissues in drug addicts.

The purpose of the study was to study the tolerability and clinical effectiveness of reamberin in severe forms of viral hepatitis and exoendogenous intoxications caused by intravenous drug use.

The criteria for inclusion in the study were: consent of the patient (oral) with viral hepatitis (acute or chronic) with a moderate and severe course, as well as persons with hepatitis due to drug use. Individuals of both sexes aged 18-55 years were selected in the absence of concomitant pathology of the cardiovascular and respiratory systems, as well as patients who had not received other drugs with antioxidant (antihypoxic) activity for six months before our study.

Pregnant women and nursing mothers, persons seropositive for HIV infection, patients with syphilis and gonorrhea were excluded from the studies; persons who took other (not included in our study) drugs with antioxidant (antihypoxic) activity, patients with severe diseases of allergic origin.

The work was carried out in departments for patients with viral hepatitis and in the intensive care unit of the Novgorod infectious diseases hospital, which are the clinical base of the Department of Microbiology, Immunology and Infectious Diseases of Novgorod State University (head of the department - Professor G. S. Arkhipov).

Table 1. Dynamics of the main clinical symptoms of patients with viral hepatitis treated with reamberin

We observed 51 patients with various forms of HBV and HCV aged from 18 to 55 years. The patients were divided into three groups: the first group - 24 patients with CH who received Reamberin (R) against the background of basic therapy (BT); second group (control) - 12 patients with similar forms of CH on BT; the third group - 12 patients who received R in the complex treatment of severe and extremely severe forms of CH that occurred in drug addicts (the presence of exendogenous intoxication).

All patients were examined clinically and biochemically (the content of bilirubin, ALT and AST, thymol test, cholesterol, and bile acids were determined).

The content of metalloenzymes (transferrin - TF and ceruloplasmin - CP) in the blood serum of patients was determined by the method of radial immunodiffusion in agar gel according to Mancini (1965). Anticeruloplasmin and antitransferrin standard sera were used in the work. Static processing of the obtained results was carried out by assessing Student's criteria using a microcomputer SM-1800.

• Clinical effectiveness of reamberin in patients with viral hepatitis B and C

This section provides an analysis of the results of examination of patients of the first and second groups. Here are the clinical characteristics of patients in the first group: five - had icteric variant of acute respiratory tract infection, moderate course; three - AVGV icteric variant with cholestatic syndrome, moderate course; one - a case of AVGV, icteric variant, severe course; nine - HBV on the background of chronic HCV, including seven - moderate and two - severe; three cases of chronic HBV (one - in the stage of cirrhosis with portal hypertension, one - complicated by chronic pancreatitis, one - against the background of toxic hepatitis.

Two patients with CH of unspecified etiology, including one with moderate and one with severe course; one case of chronic autoimmune hepatitis with a high degree of activity and fibrosis. At the time of initiation of therapy R, 12 patients with VH experienced an increase in the clinical symptoms of the disease; six patients were in stable condition; six showed some improvement.

300-400 ml of a 1.5% solution of Reamberin was used intravenously (slowly) once a day against the background of basic therapy in 18 patients with CH on days 1-10 of the icteric period (or exacerbation), in six patients - during the period 14-20 days of jaundice. The course of treatment was three to five days; in three patients, reamberin was administered for seven to nine days in a row. All patients tolerated P infusions well, there were no allergic reactions.

With P, the main symptoms of intoxication (anorexia, nausea, weakness, sleep disturbance) passed faster, jaundice lasted less, pain in the right hypochondrium disappeared, and liver size decreased (Table 1). Positive clinical dynamics with the use of R were noted in 50-82% of patients.

Table 2. Dynamics of biochemical parameters in patients with viral hepatitis during treatment with reamberin

Earlier positive dynamics of biochemical parameters were noted (Table 2). Thus, after R, bilirubin levels below 100 µmol/l were observed in 12 people, and high bilirubin levels were still observed only in six patients (whereas before the start of treatment with R - in 18 patients). ALT values ​​decreased significantly in 12 of 18 patients (63%), thymol test values ​​decreased in 40% of patients (Table 2).

When studying the content of serum metalloproteins over time, a significant increase in transferrin was noted after R compared with the control group of patients (Table 3). It is known that a decrease in the level of TF is characteristic of acute inflammation. In addition, TF (along with lactoferrin) characterize the state of nonspecific resistance of the organism. At the same time, a more significant decrease in the copper-containing protein CP was recorded (p <0.05), which indicates a decrease in the tension of the enzymatic component of the antioxidant system, which is activated under significant oxidative stress. Thus, the use of P in the treatment of HBV and HCV helps to increase the body’s nonspecific reactivity, which is important for recovery from viral-bacterial infections. The antioxidant potential of blood serum increases, which indicates the specific antioxidant effect of R.

It is important to note that after the P course, the use of glucocorticoids was required in six patients with severe forms of CH (24%), while in the second group (clinical control) glucocorticoids were used in 30% of cases. This emphasizes the pronounced detoxification effect of R. The average length of hospital stay was significantly shorter in the first group (treatment with R) than in the second group of patients who received only BT (33.6 days and 40 days, respectively, p<0.05).

Thus, the use of R in the complex therapy of acute and chronic forms of HBV and HCV contributed to faster positive clinical and laboratory dynamics compared to patients in the control group, which justifies the need to use infusions of a 1.5% solution of Reamberin in the treatment of these groups of patients.

• Evaluation of the effectiveness of Reamberin in severe exoendotoxicosis

It is known that severe forms of CH due to long-term drug use are accompanied by multiple organ disorders that have a different clinical picture. In such cases, intensive administration methods are often used in specialized intensive care units using glucocorticosteroids. Despite intensive therapy in full, the mortality rate among such severely ill patients is still significant today.

This section provides materials on the treatment of 12 severe patients with CH with toxic liver damage caused by parenteral use of low-quality heroin and its surrogates. Clinical characteristics of the patients: two patients with HBV+C, complicated by toxic liver damage, extremely severe course, hepatic encephalopathy of the 3-4th degree.

Table 3. Levels of transferrin and ceruloplasmin in the blood serum of patients with hepatitis who received reamberin

Four patients with HBV+C, complicated by toxic liver damage, severe; five had HBV, a severe course, in three cases complicated by toxic liver damage. One case of chronic autoimmune hepatitis of high activity and fibrosis, “small liver failure” syndrome.

The course of a 1.5% solution of Reamberin ranged from three to 12 days (an average of five days). The drug was prescribed intravenously drip against the background of basic therapy when the symptoms of endotoxemia increased; in all cases, the patient's condition required the use of hormones.

In two cases of hepatic coma, the R course began in the most acute period of the disease and lasted from 8 to 12 days. P was discontinued when the clinical condition stabilized. The duration of the coma was three and seven days. Reamberin was part of full-scale intensive therapy (the main method of detoxification was partial replacement blood transfusion, three and six times, respectively).

In other cases, the clinical symptoms for assessing the effectiveness of P were the classic signs of intoxication (anorexia, nausea, vomiting, weakness, sleep disturbance). The dynamics of the severity of intoxication symptoms during treatment with R are presented in Table. 4. It is clear that the intensity of intoxication decreased significantly under the influence of R therapy. It should be noted that after a course of R, the condition of severe patients improved significantly. Thus, appetite normalized in 70% of patients (improved in 30%), nausea and vomiting disappeared in 88% (became pronounced in 12%) of patients. Weakness disappeared in 75% (less pronounced in 25%), sleep returned to normal in all patients.

Table 4. Effect of Remberin on the severity of intoxication syndrome

There was a significant decrease in bilirubin levels after the P course (Table 5). As is known, high concentrations of bilirubin (especially the free fraction) determine the severity of toxic damage to various organs in patients with CH. Under the influence of P infusions, hyperbilirubinemia had a positive decrease in 82% of patients, an increase in bilirubin was observed in 9%, and bilirubin levels remained unchanged in 9% of patients.

Table 5. Effect of reamberin on the level of serum bilirubin in patients with severe endotoxicosis

Thus, the use of Reamberin significantly improved clinical and biochemical parameters in patients with CH with severe manifestations of exoendotoxicosis caused by the use of heroin and its surrogates.

• conclusions

1.Infusions of a 1.5% solution of Reamberin are well tolerated by patients with various forms of viral hepatitis B and C (there were no allergic reactions). Reamberin has been noted to be highly therapeutically effective in the complex therapy of severely ill patients with CH: the drug has pronounced detoxification, antioxidant, hepato- and nephroprotective properties. A reduction in hospitalization time and a decrease in the number of cases of hormone use in treated patients was revealed compared to the clinical control group.

2. Reamberin contributed to the rapid normalization of basic biochemical parameters in patients with CH. The antioxidant potential of blood serum significantly increased, and the body's nonspecific resistance increased.

3. The use of Reamberin in the complex therapy of severely ill patients with CH drug addicts was accompanied by a pronounced detoxification effect with a favorable outcome of extremely severe conditions (hepatic coma).

4. Reamberin is recommended to be included as a mandatory pathogenetic agent in the complex therapy of seriously ill patients with various forms of HBV and HCV, as well as patients with signs of multiple organ damage due to exoendogenous toxicosis.

Literature
1. Vlasov N.N. et al. Viral hepatitis B, C, D and HIV infection in drug addicts // Viral hepatitis and other current infections. St. Petersburg, 1997. "SSZ". T. 1. pp. 133-140. 2. Ivnitsky Yu. Yu. et al. Succinic acid in the system of metabolic correction of the functional state and resistance of the body. St. Petersburg, 1998. P. 82. 3. Kondrashova M. N. Scheme of deviations of the state of mitochondria from the norm and substances that reverse these changes // Reaction of living systems and the state of energy metabolism. Pushchino, 1979. pp. 185-187. 4. Lvov D.K. Viral hepatitis C is a “gentle killer” // Ros. gastroenterologist magazine. 1995. No. 1. P. 4-6. 5. Prigozhina V.K. et al. Clinical and morphological comparisons of mixed viral hepatitis (based on materials from Infectious Diseases Hospital No. 30 named after S.P. Botkin) // Viral hepatitis and other current infections. St. Petersburg, 1997. "SSZ". T. 2. P. 3-7. 6. Sorinson S. N. Viral hepatitis in clinical practice // St. Petersburg. THESIS. 1996. P. 304. 7. Yakovlev A. A., Vinogradova E. N. Experience of the specialized clinic for viral infections of the Influenza Research Institute of the Russian Academy of Medical Sciences // Viral hepatitis and other current infections. St. Petersburg "SSZ". 1997. T. 1. P. 5-8. 8. Yakovlev A. A. et al. Quantitative determination of HBs antigen for the diagnosis of hepatitis B // Ibid. pp. 41-45. 9. Arkhipov G. S., co-author. G. U. Novgorazsky Report on a clinical study of the effect of Reamberin on clinical and laboratory parameters in patients with viral hepatitis. 1999, p. 10.