Autointoxication

AUTOINTOXICATION, a pathological state caused by toxic substances formed within the body itself. The most successful classification of autointoxication was proposed by Senator, who based the division on two factors: the site of formation of the toxic substances and the method of their entry into the bloodstream. Senator distinguishes the following types of autointoxication: 1) occurring due to the retention of normal excretions (retentional autointoxication); 2) occurring due to the decomposition of the contents of normal or pathological cavities and the absorption of the resulting products of putrefaction and fermentation from them (resorptive autointoxication); 3) arising due to disturbances in normal metabolism and changes in the composition of tissue cells, blood, and lymph (dyscrasic and histogenous autointoxication); 4) occurring in infectious diseases due to the formation of toxic products of microbial activity (infectious autointoxication).-Retentional autointoxication is caused by poisoning with carbon dioxide and reduced oxygen absorption due to obstruction of the respiratory passages, as well as by a lower content of oxygen in venous blood accompanied by an increase in carbon dioxide, arising in diseases of the heart accompanied by "cardiac asthma".-Resorptive autointoxication includes those arising a) from the intestine, b) from the bladder (cystogenic) or c) from purulent cavities. In the first case, poisoning can occur from hepatic-enteric (enterogenic) phenoluria (indicanuria) during constipation, intestinal obstruction, or peritonitis; from acetonuria during digestive disorders and excessive intake of fats; from hydrotionemia; Senator also includes malignant anemia due to helminths (broad tapeworm, ancylostoma), tetanus, and eclamptic convulsions in children in this category. In the second case - in cystogenic autointoxication due to absorption from the bladder - poisoning can occur from ammoniemia and hydrotionemia. In the third case - due to absorption from other cavities - poisoning results from phenoluria (indicanuria), hydrotionuria, and bronchiectasis. Combined intoxication due to retention and absorption occurs in jaundice.-The group of dyscrasic and histogenous autointoxication includes diseases resulting from disorders in the function of internal secretion glands - the thyroid, adrenal glands, pancreatic, parathyroid, ovarian, and others. Examples include myxedema, Basedow's disease, strumipriva cachexia. Addison's disease, acromegaly, diabetes, and osteomalacia. This same group of intoxications can arise due to plasmolysis (acidosis - acid intoxication), due to nucleolysis (nephritic diathesis, leukemia). Combined, retentional, respectively resorptive, and dyscrasic autointoxication: uremia due to kidney insufficiency; cholemia due to liver insufficiency. Autointoxication occurring during pregnancy can also be included here; the sources can be 1) the maternal organism or 2) the fetal egg. At the present time, all these processes are united under the general name "toxemias of pregnancy" (see Pathological Pregnancy). In the first case, autointoxication is a consequence of increased formation of toxins due to disturbed metabolism and the activity of internal secretion glands, as well as insufficient excretion and neutralization of these toxins due to reduced kidney function and other organs. In the second case - the cause of autointoxication is, on one hand, the entry into the pregnant woman's body of toxic metabolic products of the fetus, and on the other, toxins formed and coming from the afterbirth, in particular, syncytial elements, which are a foreign protein for the pregnant woman and therefore a toxic substance.-The fourth group of autointoxication, in infectious diseases, arises as a result of poisoning with chemical products of tissue decomposition and altered secretions formed during them. The role of this little-studied factor at the present time cannot be doubted. Simultaneous poisoning of the organism with bacterial toxins should be considered an exogenous intoxication. Observations show that in a number of intoxications, the toxicity of urine increases. Bouchard injected a known portion of the daily urine into the vein of a rabbit of a certain weight and then designated the toxicity of the urine as the "urotoxic coefficient." According to Bouchard, this coefficient denotes the number of kilograms of the rabbit's weight which is killed by the amount of urine corresponding to 1 kg of body weight in 24 hours (Lewin). This number is usually about 0.465. However, as has been established at the present time, the toxic effect of urine depends not only on the chemical substances contained in it, but also, when animals are poisoned with it, a mechanical factor plays a role, consisting of the difference in osmotic tension between blood and urine. Experiments (Posner and Vertun) with the injection of urine into white mice have shown that the toxicity of urine depends primarily on the fact that the molecular concentration of urine is significantly higher than that of blood. The determination of the "urotoxic coefficient" is also of little use because, besides urine, poisons are also eliminated through the skin, exhaled air, the gastrointestinal tract, and the mammary and other glands; sometimes in mild cases of diabetes and in childhood acidosis, acetone is excreted even in larger quantities through the lungs than through the kidneys. The therapy of autointoxication should be causal, i.e., it should consist in removing the sources of formation of toxic products, as well as striving to eliminate or neutralize these substances at the site. Thus, in autointoxication by carbon dioxide, it is necessary, first of all, to eliminate the accumulated CO₂, but since this is impossible in most cases, one must strive to increase the reduced oxygen absorption by inhaling it or enriched air. In resorptive autointoxication, it is necessary to remove the poisons and the bacteria forming them from the organism or to disinfect the formed poisons and convert them into harmless substances. For this purpose, gastric and intestinal washings, uterine washings, bladder washings, and drains are performed. Disinfecting agents are added to the washing fluids or these agents are administered per os or intravenously. In dyscrasic and histogenous autointoxication, alkalies are used, especially in the presence of acidosis. The administration of alkalies is also useful in uric acid diathesis. In disorders of the activity of internal secretion glands, organotherapy is applied. In severe cases, when a significant amount of toxic substances has accumulated in the organism, bloodletting followed by the injection of a physiological solution or glucose is resorted to. The effect in such cases is sometimes almost instantaneous, for example, in uremia. To eliminate the toxic substances accumulated in the organism, one can resort to stimulating vicarious excretion using laxatives, diaphoretics, and agents that increase urine output.