Aleksei Nikolaevich Lodyagin

RELEVANCE. Acute methanol poisoning is a life-threatening condition that requires emergency medical care. Deep knowledge of the specifics of diagnosing acute methyl alcohol poisoning allows the doctor to promptly verify the diagnosis and begin etiopathogenetic therapy, which determines the prognosis and survival of patients. THE AIM OF THE STUDY. To analyze scientific publications on the topic of “Toxic effects of methanol” over the last decade, and show the possibilities of using various diagnostic methods (laboratory, radiation and forensic) for methyl alcohol poisoning. MATERIAL AND METHODS. An analysis of scientific publications on the topic of “Toxic effects of methanol” over the last decade was carried out. The possibilities of using diagnostic methods in the provision of medical care are shown. Information was obtained by studying the following databases: Scopus, Web of Science, PubMed, RSCI, eLIBRARY, Cyberleninka. RESULTS. The possibilities of laboratory, radiation and forensic diagnostics of methanol poisoning are shown. The characteristic features of identifying this pathology are described. CONCLUSION. A generalization of the data obtained indicates that knowledge of the specific diagnostic criteria for methanol poisoning allows the doctor to timely verify the diagnosis and immediately initiate etiopathogenetic therapy, which is a critical factor in saving the lives of the patients.

Acute methadone poisoning is a serious socioeconomic problem worldwide. THE AIM OF THE STUDY. was to conduct an epidemiological analysis of the prevalence of acute methadone poisoning cases in St. Petersburg from 2022 to 2024, based on data from a multidisciplinary emergency hospital. MATERIAL AND METHODS. A total of 2,812 medical records and toxicology test results of patients hospitalized with acute methadone poisoning during the specified period were reviewed. The epidemiological analysis included a quantitative assessment of the incidence of acute methadone poisoning among St. Petersburg residents per 100,000 people. RESULTS. The study revealed that over a three-year period, the incidence of acute methadone poisoning among St. Petersburg residents varied unevenly, with a predominance of cases in 2022 and 2023, and a sharp decrease in this indicator in 2024 to 10.8 per 100 thousand population, respectively (c2=36, p=0.0002). Male patients were more often hospitalized with this poisoning. An increase in cases of hospitalization with acute methadone poisoning in patients of working age (from 39 to 48 years old) was noted: from 33.8% to 45.7% by 2024. Over the period from 2022 to 2024, the total number of cases of hospitalization in toxicology departments of patients with acute mild methadone poisoning increased from 31.9% to 52.3% (c2=28.2, p=0.0003). In turn, the proportion of patients requiring assistance in the intensive care unit decreased over this period from 68.1% to 47.7% (c2=17.2, p=0.0001). The proportion of patients requiring mechanical ventilation in the intensive care unit ranged from 76.2% to 90.6% without statistically significant changes over the three-year period (c2=2.89, p=0.09). Among hospitalized patients, isolated methadone use was prevalent, accounting for 70.9% of cases. Combined use of methadone with other psychoactive substances or medications was observed less frequently, in 29.1% of cases. The mortality rate during the study period was 70 cases (case fatality rate — 2.5%). CONCLUSION. The study found a decrease in the incidence of acute methadone poisoning among residents of St. Petersburg from 19.9 to 10.8 per 100,000 people over the period from 2022 to 2024.

This report presents a case of acute severe poisoning with methadone and α-pyrrolidinovalerophenone in a 41-year-old male patient complicated by circulatory arrest. The poisoning occurred following the intravenous injection of 0.5 g of methadone and intranasal administration of α-pyrrolidinovalerophenone. The case manifested as a critical circulatory arrest with a significant depression of consciousness, reaching a coma II level, alongside cytotoxic edema affecting the white matter of the brain and corpus callosum. Notably, the serum S-100 protein concentration was increased to 152.1 ng/L. The patient also exhibited acute respiratory failure, mixed acid-base disorders, lactic acidosis, cardiotoxic effects, acute renal impairment, acute hepatic impairment, toxic encephalopathy, post-cardiac arrest syndrome, and subsequent severe neurocognitive deficits, as well as cystic gliosis and atrophy in the anterior and anterior-basic parts of the frontal lobes, along with cyst formation in the basal nuclei. The patient received intensive care, including mechanical ventilation with the Hamilton C2 device in Continuous Mandatory Ventilation (CMV) mode, inotropic support, correction of acid-base and hypoxic disturbances, and nutritional support via percutaneous endoscopic gastrostomy to address protein-energy deficiency. Additionally, antibacterial therapy was employed, along with measures to resolve intestinal obstruction. Following stabilization of the blood’s oxygen transport function, a multicomponent drug containing inosine, nicotinamide, riboflavin, and succinic acid was used, which facilitated correction of hypoxic complications and the acute psycho-organic syndrome, leading to improvements in cognitive function.

The article considers the implementation of the concept of an interdisciplinary (multidisciplinary) approach at all stages of providing emergency medical care to patients with acute poisoning using multimodal technologies in the diagnosis, treatment and rehabilitation of toxic lesions. It is noted that clinical toxicology is closely related to a number of fundamental medical sciences, and the share of advisory assistance from related specialists in the structure of medical services for this pathology is high. Using the example of a multidisciplinary emergency hospital, the key role of interdisciplinary interaction is demonstrated.The work is based on the analysis of data from international (Scopus, Web of Science, PubMed) and Russian (RSCI, eLibrary.RU, CyberLeninka) scientific databases.The systematic introduction of interdisciplinary interaction into clinical practice is a prerequisite for improving the effectiveness and quality of medical care in acute poisoning.Authors’ contribution: Antonova A.M. – concept and design of research, collection and processing of material, writing, editing; Lodyagin A.N., Barsukova I.M., Batotsyrenov B.V. – concept and design of research, writing, editing; Narzikulov R.A., Sinenchenko A.G. – writing, editing; Kuznetsov S.V., Shikalova I.A. – collecting and processing of material, writing text, editing. All co-authors are responsible for approving the final version of the article and ensuring the integrity of all its parts.Conflict of interest. The authors declare that there are no obvious and potential conflicts of interest in connection with the publication of this article.Funding. The study had no financial supportReceived: February 6, 2026 / Revised: March 30, 2026 / Accepted: June 1, 2026 / Published: June 30, 2026

According to the Federal State Statistics Service of the Russian Federation, in 2021, the proportion of victims exposed to carbon monoxide intoxication amounted to 3.2% of the total number of poisonings (about 3.5 thousand people), and in terms of the number of deaths from acute poisoning, carbon monoxide intoxication is in second place and amounts to about 20%. The purpose of the study: statistical toxicological analysis, consideration of the mechanism of toxic action, features of diagnosis and treatment of patients hospitalized with acute poisoning with carbon monoxide and combustion products in the toxicology center of the hospital. Materials and methods of research. The medical records of 483 patients admitted to the Acute Poisoning Center of the State Budgetary Institution «St. Petersburg Research Institute of Emergency Care named after I. I. Dzhanelidze» in 2022–2024 with the diagnosis: «Acute poisoning with carbon monoxide and combustion products» were analyzed. The mechanism of toxic action was studied, statistical, laboratory and instrumental studies were carried out upon admission of patients to a multidisciplinary hospital and in dynamics after intensive care. Research results. According to the reports of the toxicology center of the State Budgetary Institution «St. Petersburg Research Institute of Emergency Care named after I. I. Dzhanelidze», the number of patients with acute poisoning with carbon monoxide and combustion products was: 2022–129 admitted (of which 10 patients died); 2023–141 patients (6 deaths); 2024 — out of 213 admitted with acute poisoning with carbon monoxide and combustion products, 8 patients died. All patients with acute poisoning were in serious condition with disorders of vital organs. Conclusion. Acute poisoning with carbon monoxide and combustion products occupies one of the leading places among acute poisonings of chemical etiology in terms of the number of adverse outcomes. Timely, full and high-quality provision of medical care at the stage of emergency medical care outside a medical organization has a significant impact on the course and prognosis of the disease. Scientific and practical significance lies in the generalization of modern concepts of the pathogenesis of poisoning with carbon monoxide and combustion products, principles of diagnosis and treatment. The materials can be used in clinical guidelines.

BACKGROUND: For many years, methadone poisoning has remained one of the leading causes of death among patients admitted to toxicology departments worldwide. During the COVID-19 pandemic, the number of such patients increased substantially, which may be associated with heightened anxiety, fear, sadness, adaptation difficulties, symptoms of post-traumatic stress disorder, and suicidal tendencies in both the general population and specific subgroups, thereby increasing the risk of drug and alcohol use as maladaptive coping strategies. AIM: To perform a comparative analysis and evaluate the results of methadone detection based on retrospective data from chemical toxicological and forensic chemical investigations conducted in 2020–2022. METHODS: This cross-sectional multicenter sample study employed retrospective medical data from patients who died of acute methadone poisoning. The analysis assessed features of methadone detection in fatal acute poisonings, the comparability of chemical toxicological and forensic chemical investigation results, and the frequency of circumstances affecting interpretation of the obtained findings. RESULTS: The study included data from 131 cases of fatal methadone poisoning. In all reviewed cases, screening in chemical toxicological investigations was performed using immunochromatographic assay. In 20% of cases, the assay was performed 12–48 hours after hospital admission. False-positive methadone detection results in chemical toxicological investigations were recorded in 3.4% of cases, whereas false-negative results were found in 6%. In addition, confirmatory methods were not used in 18% of cases. Moreover, in all cases with false-negative results, high concentrations of substances such as nicotine and caffeine were detected in the samples, which may have affected the reliability of immunochromatographic assay. CONCLUSION: Improving approaches to the selection of biological material, the timing of assay, and the mandatory use of confirmatory methods may minimize the risk of false-positive and false-negative methadone test results in chemical toxicological investigations. This, in turn, may improve diagnostic accuracy, optimize treatment strategy, and provide a more objective assessment of medical circumstances in subsequent forensic medical examinations.

Circumstances of deaths in water are diverse, encompassing both relatively typical drowning cases and rarer causes such as injury from electrogenic aquatic animals. It is not uncommon for medical assistance rendered during or immediately after a water-related incident to contain errors that may result in an unfavorable outcome. The article presents a detailed analysis of a representative case of asphyxia in a child in a swimming pool, which resulted in death 16 days later in a hospital setting. The sequence of medical interventions—from prehospital to specialized care—is described. Special attention is given to the interaction with investigative authorities in distinguishing between possible circumstances of death: drowning versus inadequate resuscitative measures. The necessity of interpreting potential iatrogenic complications strictly within the context of the initial cause of medical intervention is emphasized. The importance of strict adherence to water safety rules is also highlighted. The article identifies contentious aspects of legal qualification in such cases and underscores the lack of a unified methodology for their forensic evaluation. Shortcomings commonly observed in forensic medical examinations of similar situations are noted, emphasizing the inadmissibility of a formal approach. Directions for improving expert practice and eliminating identified disadvantages are proposed.

Poisoning by poisonous mushrooms remains an important cause of morbidity and mortality. Up to 83.38% of mushroom poisoning cases are registered in Russia from July to the end of October, which corresponds to the mushroom growing season. In 95% of cases, mushroom poisoning occurs as a result of incorrect identification of edible and poisonous mushroom species. This is due to both insufficient public awareness of the properties of mushrooms and the lack of sufficient knowledge of their appearance. The purpose of the study: analytical toxicological analysis, consideration of the mechanism of toxic action, features of diagnostics and intensive care of patients hospitalized with toxic effects of poisonous mushrooms in the toxicological center of a metropolis. Materials and methods of research. The medical records of 130 patients admitted to the Acute Poisoning Center of the State Budgetary Institution «St. Petersburg Research Institute of Emergency Care named after I. I. Dzhanelidze» in 2021–2023 with the diagnosis: «Toxic effect of other toxic substances contained in eaten mushrooms» were analyzed. ICD‑10 rubric: T62. The mechanism of toxic action was studied, statistical, laboratory and instrumental studies were carried out upon admission of patients to a specialized hospital and in dynamics after intensive care. Research results. According to the Acute Poisoning Center of the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze, the number of patients with toxic effects of poisonous mushrooms was: 2021–41 admitted (1 fatal outcome); 2022–30 patients (1 fatal outcome); 2023–59 patients. All admitted patients with acute poisoning were in serious condition with disorders of vital organs. Conclusion. The toxic effect of poisonous mushrooms currently occupies one of the leading places among acute poisonings of chemical etiology in terms of the number of adverse outcomes. Timely, full and high-quality provision of medical care at the stage of emergency medical care outside a medical organization has a significant impact on the course and prognosis of the disease. Scientific and practical significance lies in the generalization of modern ideas about the pathogenesis of the toxic effect of poisonous mushrooms, principles of diagnosis and treatment. The materials can be used in clinical guidelines.

Barbiturates are a group of drugs that have a depressant effect on the central nervous system. The toxic effect is determined by the dose taken and is manifested by disturbances of consciousness in the form of depression of the central nervous system from a mild degree of stunning to atonic coma. The purpose of the study: statistical toxicological analysis, diagnostic features and provision of emergency medical care outside a medical organization and at the stage of specialized medical care, hospitalized with acute poisoning with barbituric acid derivatives in the center for the treatment of acute poisoning of a multidisciplinary hospital. Materials and methods of research. The medical records of 1005 patients admitted to the Acute Poisoning Center of the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze in 2021–2023 with the diagnosis: «Acute barbiturate poisoning» were analyzed. ICD-10 rubric: T42.3: A statistical and chemical-toxicological study was conducted upon admission of patients to the hospital and dynamically after intensive care. The results of the study. According to the Acute Poisoning Center of the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze, the number of patients with acute poisoning with barbituric acid derivatives was: 372 admitted (of which 14 patients died) in 2021; 282 patients with acute poisoning (2 died) in 2022; in 2023, out of 351 admitted with acute poisoning of this pathology, two died. All admitted patients were in critical condition with severe disorders of vital organs. Conclusion: acute poisoning with barbituric acid derivatives occupies one of the leading places among acute poisonings of chemical etiology both in frequency and in the number of adverse outcomes. Characterized by severe medical, social and economic consequences. Timely, full and high-quality medical care at the stage of emergency medical care outside a medical organization to patients with poisoning with barbituric acid derivatives has a significant impact on the course and prognosis of the disease. Scientific and practical significance lies in the generalization of modern ideas about the mechanism of toxic action of acute poisoning with barbituric acid derivatives, principles of diagnosis and intensive care. The materials can be used in clinical guidelines.

The article discusses the controversial aspects of conducting medical examinations for intoxication. This work is based on a case report on determining the legitimacy of administrative license revocation, which involved a forensic medicine and toxicology expert. A detailed chronology is provided, from the moment the driver was stopped by a traffic police officer and suspended from driving for an alcohol intoxication test, to the ruling by the magistrates’ court, which was later upheld by the court of cassation. This case study illustrates errors in interpreting the findings of chemical tests for intoxication, which occur when psychoactive substances are incorrectly identified in human biological fluids. This case of γ-butyrolactone detection in a professional car driver highlights the inadmissibility of unreliable methods for chemical compound identification. Moreover, the paper emphasizes insufficient training of clinical laboratory diagnostics physicians, addresses the issue of an overly mechanistic approach to their work, and proposes potential solutions to the identified shortcomings.