RU2463954C1 - Method of determining optimal volume of infusion therapy for patients who got thermal burns in state of drug intoxication with use of desomorphine - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to combuistology, resuscitation and intensive care, narcology. For this purpose determined are burn disease severity, degree of drug intoxication expression, area of burn surface, physiological needs and pathological loss within a day. After that volume of infusion therapy is calculated by formula: V=(Cb×ABS)+(Cdi×MVDIT)+PN+PL, where V is volume of infusion therapy, in ml; Cb is coefficient of burn disease severity: 0.5 in case of mild burn shock; 0.75 in case of medium burn shock; 1.0 in case of severe burn shock; 1.5 in case of extremely severe burn shock; ABS is area of burn surface, in cm²; Cdi is coefficient of drug intoxication expression: 1.0 in case of changed reactivity to drug substance; 1.5 - in case of presence of psychic dependence (obsessive attraction); 2.0 - in case of presence of physical dependence (compulsive attraction); 2.5 - in case of abstinence syndrome; MVDIT is minimal volume of deintoxication infusion therapy with use of desomorphine, equal 1250 ml per day of infusion solutions; PN - physiological needs of organism during a day, in ml; PL - pathological loss within a day, in ml.

EFFECT: method makes it possible to ensure adequate infusion therapy in patients at different periods of burn disease and with different degree of expression of drug intoxication with desomorphine.

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Description

The present invention relates to medicine, namely to combustiology, traumatology, resuscitation and narcology.

The main problem is the determination of the volume and qualitative composition of infusion media in the treatment of victims of thermal burns during various periods of a burn disease, and especially patients who entered intoxicated with the use of psychoactive substances. Such patients develop a syndrome of "mutual burdening", there are risk factors for the development of encephalopathy of complex genesis as a result of the use of narcotic surrogates and the course of thermal trauma by analogy with patients who are intoxicated. But the severity of clinical manifestations in individuals who have used narcotic surrogates, in particular desomorphine, is significantly superior to those that may occur with alcohol intoxication. The lack of criticism of the severity of the state in the state of drug intoxication leads to late hospitalization, which leads to the development of complications of a burn disease (Lykov A.V. Clinical features of burn encephalopathy / A.V. Lykov, I.V. Ismagilov, P.I. Mironov / / Collection of scientific papers of the 1st Congress of Russian Comustiologists. - M .: 2005. - P.67-68.).

Desomorphine addiction is one of the new wave addictions, which is based on the artisanal production of desomorphine, which in the criminal environment has received the name “crocodile”. This medical-social phenomenon became widespread after 2000, therefore, the average age of modern desomorphine addicts is 24-25 years old, and tends to involve young people, schoolchildren. It began to spread especially rapidly after 2005, taking on the character of a hidden pandemic. According to the level of consumption in Russia, the share of artisanal desomorphine in the total volume quickly rose to 25-28%, taking second place after heroin (55-58%). Among all types of injuries received in a state of drug intoxication or addictive behavior of drug addicts, the most frequent and severe type of injury is thermal burns. The treatment of such victims requires considerable effort and material costs.

The concept of “mutual burden” syndrome is used in the diagnosis and treatment of burns with concomitant somatic pathology or combined trauma. This is due to the fact that in burn patients a combination of several nosological forms or diagnoses is noted. Somatic burden in patients with thermal burns is determined by the initial level of health due to drug use and injury. The treatment of such patients requires not only significant efforts and material costs, but careful monitoring of the condition, behavior and the threat of severe complications in the mental and somatic spheres.

Diagnosis and treatment of such patients is an urgent problem for combustiologists, resuscitation anesthetists, therapists and narcologists - specialists of burn departments and centers.

The need for infusion therapy appears for burns with an area of 10% in children, in adults - 15%, depending on the location (Water-electrolyte and acid-base balance: first transl. From English / Ed. St. Petersburg. - M.: Nevsky Dialect "-" Publishing house BINOM ", 1990. - 320 p.).

Burns cause hypovolemia due to the massive movement of fluid from the intravascular space into the extravascular space and its exudation through damaged skin. The fastest fluid loss occurs in the first hours after an injury with a gradual slowdown in their pace after 48 hours (Intensive care of a burn disease / Kligunenko E. [et al.]. - M .: MEDpressinform, 2005. - 144 p.).

The goal of therapy at the first stage of treatment of intoxication due to the use of psychoactive substances is to conduct infusion detoxification therapy to relieve excesses, withdrawal symptoms and normalize somatic state using vitamins in the regime of hypervitaminization (Guide to Psychiatry / Edited by G.V. Morozov. - В 2 t. T. II. - M .: Medicine, 1988. - 640 p.).

Recipes for infusion therapy, proposed by various authors, are not accurate, binding and do not take into account pathological losses associated with the use of psychoactive substances, in particular desomorphine.

Many schemes (formulas) for the administration of colloidal and crystalloid solutions for the treatment of burn patients have been developed. These formulas take into account the total burn area, the patient’s body weight, the severity index of the lesion, and other indicators, the general characteristic is the use of the formulas below on the first and second days of burn shock and do not take into account pathological losses associated with concomitant pathology and the use of psychoactive substances.

Evans formula

V = 2 ml (A × B) +2000,

where A is the percentage of the burned surface of the body, B is the body weight of the patient. The formula is applied on the 1st day after the defeat. On the 2nd day, the amount of transfused fluid should be limited to half. Colloidal solutions (plasma, albumin, dextran, blood) should be transfused in the amount of (A × B) ml, in the same amount (A × B) ml, electrolyte solutions are also used (Ringer's solution, polyionic liquid, 0.9% sodium chloride solution ) and 2000 ml of glucose solution to cover the cost of evaporation.

Formula of the medical center in Brooke (Brooke).

V = 0.5 (A × B), V = 1.5 ml (A × B)

This formula is a modification of the Evans formula in which the volumes of transfused solutions are reduced by half: 0.5 (A × B), but the volume of electrolytes is increased: 1.5 ml (A × B). Currently, Brooke's formula is used more widely than the Evans formula.

According to the formula No. 1 (Karvayal X.F., Park D.X., 1990)

V = 2-4 ml ×% OPO × MT;

as amended by L.E. Gelin (cited by H.F. Karvial, D.X. Parks, 1990) for mild burn shock, the initial number of infusates is 2, for severe - 2.5 and extremely severe - 3 ml.

According to the formula No. 2 proposed by V.K. Sologub et al. (1978) and confirmed by A.G. Klimov et al. (1998),

V = 2 ml × (MT × ITP),

where the magnitude of the index of severity of the lesion (ITP) with the defeat of 1% of the surface of the body (PT) burn I-II Art. is 1 point, III A Art. - 1.5 and III-IV Art. 3 points.

According to the formula No. 3 (Nazarov P.I. et al., 1994)

V = 3 ml ×% OPO × MT,

Where

OPO - total burn area,

and according to the formula No. 4 (Reed A.P., Kaplan J.A., 1995)

V = 2 ml ×% OPO × MT.

The maximum OPO value in these formulas should not exceed 50% of the PT (Chernousov S.V. On determining the volume of infusion therapy for burn shock / Chernousov S.V., Durov V.B., Kulikov A.A., Stepanov B.N. , Boyko V.V .: Materials of the scientific and practical conference - Chelyabinsk: Nizhny Novgorod Research Institute of Traumatology and Orthopedics, A.V. Vishnevsky Institute of Surgery, RAMS, 1999. - 342 p.).

The above formulas are applied on the first and second days of burn shock and are applicable only to the adult patient population and for mass admission without taking into account pathological losses and associated pathology due to anesthesia.

Addiction is characterized by the presence of a number of symptoms of the disease, which can be manifested by a change in the duration and frequency of use, as well as the quality of the used psychoactive substances and / or narcotic surrogates. The main criteria for assessing the course of drug addiction are: a) a syndrome of altered reactivity to a narcotic substance; b) a syndrome of mental dependence; c) syndrome of physical dependence.

The syndrome of altered reactivity changes during the course of the disease, as its constituent symptoms change: the form of consumption, tolerance, the form of intoxication. The concept of altered reactivity syndrome includes: a change in the form of consumption, a change in tolerance (tolerance), the disappearance of protective reactions in case of an overdose, and a change in the form of intoxication. This characteristic undergoes changes in the initial stages of the use of narcotic substances and surrogates. Regular use of the drug causes certain dysfunctions in a healthy person, especially in the first stages of its use. The systematic use of the drug, against which mental and physical comfort is possible, indicates a changed body reactivity to this drug. As other signs of the disease appear, as the mechanisms of addiction deepen, anesthesia becomes continuous. Systematic anesthesia is now compelled. The mechanisms that support it are expressed in the clinic by symptoms of attraction, withdrawal symptoms, and externally visible condition is high tolerance. In some forms of narcotism, the form of abuse takes on a cyclical character (stimulants). The ability to take regularly indicates that drug tolerance has increased.

The increase in drug tolerance can also be assessed as a manifestation of altered reactivity. Tolerance, at the height of the disease, exceeds the initial, physiological 5-10 times (barbiturates), 8-12 times (sedatives), 100-200 times (opiates) shows that the body of the addict tolerates lethal doses of the drug.

The disappearance of protective reactions is observed shortly after the start of regular anesthesia. Protective reactions are manifested in the form of a gag reflex (alcohol), initial itching (opiates), profuse sweat, hiccups, salivation, pain in the eyes, feelings of lightheadedness, nausea. The decrease, and then the disappearance of the protective reactions indicates the transition of the body to a new level of response, at which the previous high doses are now non-toxic, do not require protection.

A change in the form of intoxication appears with the formed systematic use of the drug, after a high tolerance has been established and the protective reactions to an overdose have disappeared. This symptom is the last in time from the syndrome of altered reactivity and develops against the background of other existing drug addiction syndromes. This coincides with a decline in tolerance. An increase in dose does not give the expected effect, which reflects the development of the addiction process.

The syndrome of mental dependence includes mental - obsessive attraction to the drug and the ability to achieve mental comfort in intoxication. Mental attraction is expressed in constant thoughts about the drug, mood lift in anticipation of taking, depression, dissatisfaction in the absence of the drug. Often attraction is accompanied by a struggle of motives. In combination with the obsessiveness of thoughts about the drug, this gives reason to call the psychic drive obsessive. If compulsive attraction dictates the patient's behavior, then the psychic, obsessive determines the mood, emotional background. In its course, the obsessive attraction is undulating. It is not expressed if the necessary rhythm of anesthesia is observed without delay, in which case the resulting attraction is satisfied immediately. It can be temporarily suppressed by a major conflict due to anesthesia, hospitalization of the patient, any emotionally strong hobby that is not related to the drug. Attraction is aggravated by unpleasant experiences, meetings with drug addicts, talking about drugs.

The patient's attraction to the drug is nonspecific. It can be satisfied with any other narcotic substance. Therefore, drug addicts in remission can change the form of narcotism, causing the development of polydrug abuse.

Gradually, the anesthetized begins to realize that only under the influence of the drug is his mental well-being satisfactory. This mental comfort in intoxication by its exclusivity also differs from that mental comfort in intoxication, which is observed in a healthy person. If a healthy person is able to enjoy and experience mental comfort in a number of situations, then a drug addict - only on condition of taking the drug.

Physical dependence syndrome includes: 1) physical (compulsive) drive; 2) the ability to achieve a state of physical comfort in intoxication; and 3) withdrawal symptoms.

Physical (compulsive) attraction is one of the widely known signs of drug addiction, expressed in an irresistible desire for anesthesia. Attraction reaches a high intensity, displacing even such vital drives as hunger and thirst. Compulsive attraction differs from obsessive one not only in its intensity, but also in that it is able to subordinate the entire content of consciousness at the moment, leaving no room for other not related to anesthesia ideas. Compulsive attraction not only determines the mindset and affective background, it dictates behavior, suppresses and eliminates conflicting motives and control. Compulsive attraction determines the actions of patients, the motivation of their actions. With compulsive attraction, everything is aimed at finding a drug and overcoming obstacles to it. In addition, compulsive attraction is accompanied by characteristic autonomic manifestations in the form of dilated pupils, hyperhidrosis (excessive sweating), dry mouth, hyperreflexia, tremors, even with those addictions for which tremor is not typical. Three types of compulsive attraction can be distinguished: 1) arising out of intoxication; 2) included in the structure of withdrawal syndrome; 3) arising from intoxication.

A symptom of the ability to achieve a state of physical comfort during intoxication can be distinguished by analogy with a symptom of the ability to achieve a state of mental comfort during intoxication. Almost simultaneously with the development of the compulsive attraction of the bright period (without intoxication), the patient is convinced that his health improves only with intoxication, and without the drug he no longer feels satisfied and healthy. Out of anesthesia, the patient is unassembled, works with difficulty, he feels bad, thoughts run away. This condition is accompanied by an attraction of one degree or another of severity. Having taken some individually necessary dose, the addict experiences both mental and physical comfort, although this dose is still insufficient for euphoria. This dose is called necessary to meet the need.

An even more indicative indicator that satisfactory functioning is not possible with an addict without anesthesia is withdrawal symptoms. Withdrawal syndrome does not develop with all forms of addiction. For example, when some psychodysleptics are abused, the formation of the disease is limited to compulsive attraction. It is formed gradually, at different times with various forms of addiction. It occurs after the termination of anesthesia after some time after the last drug use (from several hours with alcoholism to 20-24 hours with opioid addiction and hashishism). The time of complete formation of withdrawal symptoms is determined by a particular form of narcotism. Slow withdrawal symptoms are formed with alcoholism, more likely with hashishism, even faster with the abuse of sleeping pills and stimulants, and the shortest period is with opiate addiction.

Withdrawal syndrome consists of phases that appear sequentially and naturally in time. This time sequence is visible both when observing a specific case of withdrawal syndrome, and when analyzing its gradual formation in the process of the development of the disease. Withdrawal syndrome is represented by symptoms that can be divided into two groups: mental symptoms and vegetative symptoms, somatoneurological. In the picture of abstinence, the specific gravity of the symptoms of psychopathological and vegetopathological is different, which is determined by the form of addiction. For example, psychopathological symptoms are more prominent when taking sleeping pills, and vegetopathological - when depriving hashish and opiates. The difference is also determined by the duration of the disease. Tolerable conditions of withdrawal symptoms at the beginning of the disease and at the end of it are different.

Withdrawal syndrome is an indicator of the formed physical dependence on the drug. This condition is characterized by the need for the constant presence of the drug for the relatively normal functioning of the body, now on a qualitatively different level. An organism that has adapted to the level of constant intoxication in the absence of a drug gives the first signal that a new dose of the drug is needed. There is a compulsive attraction, which is vital for the patient (http://www.psynow.ru/index.php?option=com_content&view=article&id=4:20 10-01-15-16-18-12 & catid = 11: -2 & Itemid = 16).

The prototype of the invention is a method for determining the optimal volume of infusion therapy in the treatment of burns, which consists in determining the area of the burn surface in cm ² , the physiological needs of the body in ml and pathological losses in ml (vomiting, evaporation from the surface of the wounds, temperature of the patient and the environment) during the day, the severity of the burn disease and calculate the volume of infusion therapy according to the formula: V = K × POP + AF + PP, where V is the volume of infusion therapy, in ml; K - burn disease severity coefficient (0.5; 0.75; 1.0; 1.5); POP - burn surface area, in cm ² ; AF - physiological needs of the body during the day, in ml; PP - pathological losses during the day, in ml. The severity factor of a burn disease takes into account the area, depth of the burn, the severity of the burn shock (mild, severe, extremely severe), the period of the burn disease (shock, the period of acute burn toxemia, acute burn septicotoxemia), the clinic of the burn disease and the individual characteristics of each patient (RF patent No. 2349325, 2009). However, this method does not consider the syndrome of "mutual burden" with thermal injury in various periods of burn disease in patients with varying degrees of severity of anesthesia.

The objective of the invention is to develop a method for determining the optimal volume of infusion therapy for victims who received thermal burns during various periods of a burn disease when intoxicated with the use of desomorphine.

EFFECT: adequate implementation of infusion therapy in case of thermal injury during various periods of a burn disease in patients with varying degrees of anesthesia, prevention of “mutual burden” syndrome, prevention of encephalopathy of complex genesis, psychoses.

The proposed method for determining the volume of infusion therapy in victims of thermal burns is as follows. In patients with thermal burns when intoxicated when using desomorphine, the severity of a burn disease, the degree of anesthesia are determined: the presence of a syndrome of altered reactivity to a narcotic substance, a syndrome of mental dependence (obsessive attraction), a syndrome of physical dependence (compulsive attraction) and withdrawal syndrome, burn area surface in cm ² , the physiological needs of the body in ml and pathological losses in ml (vomiting, evaporation from the surface of wounds, pace patient and environment temperature) during the day, after which the volume of infusion therapy is calculated by the formula

V = (Ko × POP) + (Kn × MODIT) + FP + PP,

where V is the volume of infusion therapy, in ml;

Ko - burn disease severity coefficient: 0.5 for mild burn shock; 0.75 with moderate burn shock; 1.0 in severe burn shock; 1.5 with extremely severe burn shock;

POP - burn surface area, in cm ² ;

Kn - coefficient of severity of anesthesia: 1.0 - with altered reactivity to a narcotic substance; 1.5 - in the presence of mental dependence (obsessive attraction); 2.0 - in the presence of physical dependence (compulsive attraction); 2.5 - with withdrawal symptoms;

MODIT - the minimum amount of detoxification infusion therapy with desomorphine, equal to 1250 ml of infusion solutions per day;

AF - physiological needs of the body during the day, in ml;

PP - pathological losses during the day, in ml.

The burn disease severity coefficient (Ko) takes into account the area, depth of the burn, the severity of the burn shock (mild, severe, extremely severe), the period of the burn disease (shock, the period of acute burn toxemia, acute burn septicotoxemia), the clinic of the burn disease and the individual characteristics of each patient. The coefficient of severity of anesthesia (Kn) takes into account the criteria for evaluating the course of drug addiction: the presence of a syndrome of altered reactivity to a narcotic substance, a syndrome of mental dependence, a syndrome of physical dependence and withdrawal syndrome.

Calculation of physiological needs is made: from 1 to 10 kg - 100 ml of fluid per day; 11-20 kg - 50 ml; over 20 kg - 10 ml (body weight 70 kg, physical requirement will be: 10 × 100 + 10 × 50 + 50 × 10 = 2000 ml) (http://www.medmoon.ru; http: //ochilds.narod .ru / 0192.html). Pathological losses associated with burns and drug intoxication are 1000 ml per day. The cause of pathological losses is an increase in the evaporation of fluid from the surface of burn wounds, an increase in body temperature during acute burn toxemia, dehydration of the body as a result of alcoholization, diarrhea, and vomiting (Karvayal H.F., Parks D.Kh. Children burns: transl. From English . - M .: Medicine, 1990, 512 p .; http://oritl.narod.ru/algor/infusia/infuz.htm). The volume of infusion therapy in the treatment of intoxication with the use of psychoactive substances and / or desomorphine with various degrees of severity of anesthesia is taken as 1250 ml per day of infusion solutions. This volume is taken as the MODIT indicator - the minimum amount of detoxification infusion therapy with the use of psychoactive substances and / or desomorphine.

Example No. 1: determination of the volume of infusion therapy in a patient with mild burn shock when consuming desomorphine with altered reactivity syndrome, weight 70 kg, height 170 cm, lesion area 20% of the body surface, according to the proposed method according to the formula V = (Ko × POP) + (Kn × MODIT) + FP + PP, will be presented as follows:

V = (0.5 × 3400 cm ² ) + (1.0 × 1250 ml) +2000 ml + 1000 ml, V = 5950 ml,

where 0.5 is the coefficient of severity of a burn disease during a mild burn shock,

3400 cm ² - the area of the burn surface,

1,0 - coefficient of severity of anesthesia with altered reactivity to a narcotic substance,

1250 ml - the minimum amount of detoxification infusion therapy with the use of desomorphine,

2000 ml - physiological need for a person weighing 70 kg and a height of 170 cm,

1000 ml - pathological losses.

Example No. 2: determination of the volume of infusion therapy in a patient with mild burn shock when using desomorphine in the presence of physical dependence (compulsive attraction), weight 70 kg, height 170 cm, lesion area 20% of the body surface, according to the proposed method according to the formula

V = (Ko × POP) + (Kn × MODIT) + FP + PP,

will be presented as follows:

V = (0.5 × 3400 cm ² ) + (2.0 × 1250 ml) +2000 ml + 1000 ml, V = 7200 ml,

where 0.5 is the coefficient of severity of a burn disease during a mild burn shock,

3400 cm ² - the area of the burn surface,

2.0 - coefficient of severity of anesthesia in the presence of physical dependence (compulsive attraction),

1250 ml - the minimum amount of detoxification infusion therapy with the use of desomorphine,

2000 ml - physiological need for a person weighing 70 kg and a height of 170 cm,

1000 ml - pathological losses.

A distinctive feature of the proposed method for determining the optimal volume of infusion therapy for victims of thermal burns when intoxicated with desomorphine is the determination of the severity of a burn disease and the degree of severity of anesthesia: syndrome of altered reactivity to a narcotic substance, mental dependence syndrome (obsessive), physical dependence syndrome ( compulsive) and withdrawal symptoms, burn surface area, accounting for the minimum volume of infusion therapy, physiological needs and pathological losses during the day. At the same time, the qualitative composition of the infusion media and the rate of infusion do not undergo significant changes.

In the available sources of scientific, medical and patent information, the authors did not find an identical way to determine the optimal volume of infusion therapy for victims of thermal burns when intoxicated when using desomorphine according to the formula taking into account the severity of the burn disease, the severity of anesthesia, the area of the burn surface, and the minimum volume infusion therapy, physiological needs and pathological losses during the day. Thus, the claimed invention meets the criterion of "novelty."

The authors have proved that the proposed method for determining the optimal volume of infusion therapy for victims of thermal burns when intoxicated when using desomorphine according to the formula taking into account the severity of the burn disease, the severity of anesthesia, the area of the burn surface, the minimum volume of infusion therapy, physiological needs and pathological losses during the day ensures adequate infusion therapy in patients with thermal burns in drug intoxication with the use of desomorphine, prevention of the syndrome of "mutual burden", the prevention of encephalopathy of complex origin, psychosis. Thus, the claimed invention meets the criterion of "inventive step".

This method was used to treat 15 patients with thermal burns and varying degrees of severity of anesthesia in the burn department of the Municipal Clinical Hospital No. 18 of Ufa. In all cases, the specified technical result was achieved.

We give an example of clinical use of the proposed method.

Example No. 3.

Patient G., 35 years old, I.B. No. 2017, was admitted to the burn department of the Municipal Clinical Hospital No. 18 of Ufa in 2010 with a diagnosis of a burn of the II-IIIAB degree of the trunk, upper and lower extremities 52% (35%). Flame injury. Upon receipt of a severe shock burn. Anesthesia with changes in reactivity, mental and physical dependence. Infusion therapy of burn shock was performed in the intensive care unit. The calculation of the volume of infusion therapy per day was carried out according to the proposed method

V = (Ko × POP) + (Kn × MODIT) + FP + PP,

V = (1.0 × 8840 cm ² ) + (2.0 × 1250 ml) +2000 ml + 1000 ml, V = 14340 ml,

where 1,0 is the coefficient of severity of a burn disease during a severe burn shock,

8840 cm ² - burn surface area,

2.0 - coefficient of severity of anesthesia in the presence of physical dependence (compulsive attraction),

1250 ml - the minimum amount of detoxification infusion therapy with the use of desomorphine,

2000 ml - physiological needs,

1000 ml - pathological losses.

In the course of treatment, after 3 days, the condition stabilized, the state of burn shock was stopped, and the effects of the “mutual burden” syndrome in the form of encephalopathy and psychosis did not develop.

The proposed method is easily reproducible in a hospital environment and when it is used, the indicated technical result is achieved. Thus, the claimed invention meets the criterion of "industrial applicability".

Claims (1)

A method for determining the optimal volume of infusion therapy for victims of thermal burns when intoxicated when using desomorphine, characterized in that they determine the severity of the burn disease, the severity of anesthesia, the area of the burn surface, physiological needs and pathological losses during the day, and then calculate the volume of infusion therapy according to the formula:
V = (Ko · POP) + (Kn · MODIT) + FP + PP,
where V is the volume of infusion therapy, ml;
Ko - burn disease severity coefficient: 0.5 for mild burn shock; 0.75 with moderate burn shock; 1.0 in severe burn shock;
1.5 with extremely severe burn shock;
POP - burn surface area, cm ² ;
Kn - coefficient of severity of anesthesia: 1.0 - with altered reactivity to a narcotic substance; 1.5 - in the presence of mental dependence (obsessive attraction); 2.0 - in the presence of physical dependence (compulsive attraction); 2.5 - with withdrawal symptoms;
MODIT - the minimum amount of detoxification infusion therapy when using desomorphine, equal to 1250 ml per day of infusion solutions;
FP - physiological needs of the body during the day, ml;
PP - pathological losses during the day, ml.