Characteristics of haematological toxicity indices in combined poisoning with methadone and ethanol complicated by acute renal failure

Abstract

In recent years cases of combined poisoning with methadone hydrochloride and ethanol complicated by the development of acute renal failure became more common, and this induced the search for new and more efficient methods of diagnostics and treatment in this category of patients. Objective: to investigate peculiarities of clinical, biochemical parameters and haematological toxicity indices in patients with combined severe poisoning with methadone hydrochloride and assess their predictive value in formation of complications (acute renal failure). Materials and methods. Complex clinical, biochemical and toxicological study of 77 patients with acute poisoning with methadone hydrochloride, who underwent treatment in 2016–2018 in Kyiv Toxicological Centre, was performed. Haematological toxicity indices (nuclear, haematological, leukocytic, systemic response reactivity, sensitization) were studied 24, 48 and 72 hours following admission. Assessment of the confidence of parameters in the study groups was performed by Student's t-test with the significance level of p<0.05; determination factor R2 was used to verify the degree of influence of toxicity parameters on the treatment duration. Results. The patient population consisted of 72 (93.51 %) males and 5 (6.4 %) females aged 20 to 42 years. Patients were divided into 3 groups. The first group included 31 patients with methadone hydrochloride mono-poisoning; the second group included 25 patients with combined poisoning with methadone hydrochloride and ethanol; and group 3 included 21 patients with combined poisoning with methadone hydrochloride and ethanol at the background of acute renal failure. It has been established that unlike biochemical and clinical parameters, haematological intoxication indices have a high degree of correlation with the duration of treatment. Within the first 24 hours, high level of haematological toxicity parameters suggested high potential threat of dangerous complications (acute renal failure, sepsis, etc.) that was confirmed by the high level of determination factor (R2 >0.5) between parameters and treatment duration. The level of correlation between treatment duration and parameters of central haemodynamics and biochemical parameters was low (R2<0.5) that did not allow to use them as the predictive ones. Conclusion. It has been established that estimated haematological toxicity indices are the sensitive markers of the toxic process in combined poisoning with methadone hydrochloride that may form the basis for prediction of early development of acute renal failure and making a decision on early haemodialysis. Key Words: acute poisoning, haematological toxicity indices, methadone hydrochloride.