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Delirium complicating regular use of psychoactive substances remains one of the major issues of critical care, toxicology, and psychiatry. However, the pathogenetic mechanisms of delirium development in patients with 1,4-butanediol poisoning have been poorly studied until now.The aim of the study was to reveal specific patterns of delirium in patients with 1,4-butanediol poisoning as well as to study the changes in systemic hemodynamic parameters, respiratory function, and body fluid compartments during the treatment.Material and methods. The study was prospective and treatment-randomized. Forty-eight male patients aged 20 to 45 years with delirium and acute 1,4-butanediol poisoning were enrolled. Of them, 24 patients were administered with succinate-containing drug 40 ml daily, 24 patients received standard treatment without antihypoxic agents. We studied the evolution of delirium, changes in anaerobic metabolism parameters, systemic hemodynamics, respiratory function, and the volume of fluid compartments. Impedance measurement method adjusted for interference was used in the study.Results. At the «peak» of delirium (days 1–3), the hyperdynamic circulation, increased systemic arterial tone, stroke output, respiratory function parameters, and metabolic lactate acidosis were recorded. A decrease in total fluid volume and extracellular fluid volume was clearly observed during day 1 of intoxication delirium along with increased permeability of cell membranes. On day 3 of delirium, a decrease in intracellular fluid volume and increase in extracellular fluid volume were noted. After the cytoflavin administration, shorter delirium duration (7.5 [6; 8] days), more rapid correction of lactate acidosis, stabilization of respiratory parameters and stabilization of cell membrane permeability by day 5 were found. In the control group, delirium persisted for up to 14 [11; 15] days (z=-5.9; P=0.00011) with more frequent development of complications such as nosocomial pneumonia (χ2=8.4, P

Abstract In 21 male patients aged 20 to 40 years, metabolic disorders in post-toxic delirious syndrome caused by gamma-hydroxybutyric acid poisoning and its precursors were studied. In the examined group of patients, hyperammonemia was detected in 71.4% of cases, metabolic lactic acidosis was revealed in 76.2%. The direct correlation between the severity of metabolic disorders and delirious syndrome according to DRS-R-98 scale was established. The statistically significant increase in capillary blood levels of lactate on day 3 of psychotic period was 4.9 mlmol/L and ammonia on day 5 was 187.0 mmol/L. The greatest severity of metabolic disorders was found in patients over the age of 27 years who systematically use the studied substances with narcotic effects for 7 months or more and combine their intake with other psychoactive substances.

The aim of the study is to explore the best intensive care strategies for acute 1,4-butanediol poisoning complicated by post-intoxication delirium.Materials and methods. The data of the laboratory testing and treatment of 40 men with acute severe poisoning with 1,4-butanediol, complicated by post-intoxication delirium were analyzed. Twenty patients received succinate-containing drug, others were treated with conventional methods. The control group included 18 healthy male patients aged 25 to 40 years. Clinical course of delirium, parameters of glutathione system and lipid peroxidation in patients' red blood cells, oxygen transport function (by indirect calorimetry), gammahydroxybutyric acid level in the biological fluids by gas chromatography/mass spectrometry were evaluated during the study.Results. An increases in levels of reduced glutathione by 50.3% by day 7 (from 3.68±0.57 to 5.53±0.35 pmol/g), hemoglobin (Hb), antioxidant enzymes and glutathione reduction enzymes were found; glucose-6-phosphate dehydrogenase increased by 17,1% (from 3.68±0.26 to 4.31±0.41 pmol/g Hb) and glutathione reductase increased by 15% (from 174.1±16.3 to 200.2±4.11 pmol/min/g Hb). At the same time, the MDA lipid peroxidation system activation was decreased by 41.9% (from 7.78±1.06 to 4.52±0.28 nmol/g Hb).Conclusion. The obtained data proved high efficacy of a succinate-containing drug in slowing down the progression of post-intoxication delirium through increasing the level of the main cellular antioxidant, the reduced glutathione.