From Big Medical Encyclopedia

PHOSPHORUS (Phosphorus, P) — chemical element of the main subgroup

of the V group of a periodic system of elements of D. I. Mendeleyev, belongs to chemical bio-elements; along with oxygen, carbon, nitrogen and calcium forms the ground mass of living material.

T. is a part of the major bioorganic connections: nuk

leotid, nucleic acids (see), phospholipids (see Phosphatides), phosphoproteins (see), phosphoric ethers of carbohydrates (see), a number of vitamins (see) and the coenzymes (see) participating in various metabolic processes and players one of the main roles in life activity of all organisms. The energy-rich bonds in molecules ATP and creatine phosphate formed by atoms F., cause use of these connections as universal carriers of energy in live systems (see Vysokoergichesky connections). Contents F. in blood (see Fosfatemiya) is one of the most important indicators of a condition of mineral metabolism (see) and one of the main diagnostic characters of a number of diseases and patol. states, such as rickets (see), a spasmophilia (see), a hypoparathyrosis (see), a hyperparathyreosis (see), Laytvud's syndrome — Albright (see JI of an aytvud — Albright a syndrome), an acromegalia (see), a diabetic ketosis (see a diabetes mellitus), leukoses (see), an acute fatty hepatosis (see Hepatoses), Itsenko's disease — Cushing (see Itsenko — Cushing a disease), a multiple myeloma (see), a nephropathy, etc. Nek-ry phosphorus compounds apply in medicine as pharmaceuticals. Radionuclide 32P is used as radiofarmatsevtiche-sky drug (see), in particular for diagnosis of tumoral diseases (see. Radio isotope diagnosis). Thanks to ability to join in certain biochemical systems of an organism 32P it is used also in medical - biol. researches during the studying of the biochemical processes proceeding in a brain, a liver, bones, a myocardium, fabric of malignant new growths during the studying of exchange of proteins, carbohydrates, phosphatides, nucleic acids. T. and its connections apply in agriculture as mineral fertilizers, insecticides and pesticides, to fight against rodents, besides, T. use in chemical synthesis, production of phosphorus plasticizers, etc. Many connections F. are very toxic for the person and animals; chemical warfare agents (see) sarin, GD and herd represent phosphorus compounds. On the productions connected using or receiving F. and its connections, it can represent professional harm.

Sequence (atomic) number of phosphorus 15, atomic weight (weight) 30,97376; T. is nonmetal.

Six radioisotopes F are known. — 28P, 29P, 30P, 32P, 33P, 34P. Applied in biology and medicine 32P it can be received by bombing by neutrons in the nuclear reactor или^ deuterons in a cyclotron of nek-ry stable isotopes (scarlet phosphorus, sulfur, chlorine, silicon). Radioactive F. represents pure (3 radiator with the simple scheme of the disintegration which is coming to the end with formation of a stable isotope of sulfur pos-

32 32

le of radiation of a r-particle: ^Р - * • r 4-^5.

Half-life 32P makes 14,3 days. Energy of r-particles 32P is ranging from 0 to 1,701 Mei (average 0,69 Mei) that defines their rather small penetration in fabrics (as much as possible on

depth of 7 — 8 mm).

Opening F. attribute it. to the alchemist Brand (N. of Brand), to-ry in 1669 at evaporation of urine and calcinating of the formed rest white phosphorus received.

Elementary F. exists in several allotropic modifications (see Polymorphism in chemistry). White, or yellow, T. it is poisonous, reactive and quickly is oxidized on air. Red F. it is chemically steady and is not poisonous, and black F., also difficult entering chemical reactions, unlike white and red F., carries electric current. T. — the strong reducer, in connections most often shows valencies +5 or +3. During the burning in the atmosphere with the excess oxygen content 02 oxide of phosphorus (Y), phosphoric anhydride, or P205 (P4O10) phosphorus pentoxide, and with the insufficient content of 02 — oxide of phosphorus (III), or P203 (P406) phosphorous anhydride is formed. Broad scientific and industrial application is found by phosphoric acids (see); on the basis of phosphoric to - t and their connections produce phosphoric fertilizers.

Due to the high reactivity F. in a stand-at-ease in the nature does not meet. Natural phosphorus compounds most often are phosphates. With metals F. forms phosphides, e.g. Sa3r2, Mg3P2, etc. With hydrogen F. forms PH3 hydrogen phosphide, or phosphine, to-ry represents very poisonous colorless gas with a garlick smell. T. is a part of nearly 200 natural minerals, from to-rykh insoluble and almost insoluble salts phosphoric to - you Ca5 apatites [(P04)3F] and phosphorites [trisubstituted Sa3(r04) calcium phosphate 2] are most spread.

Contents F. in crust makes 8-10_2% on weight (according to other data, 9,3-10'2% on weight). In the soil contents F. (in terms of P205) makes up to 0,2% of the 100-th shares of percent, and only apprx. 1% of phosphorus of the soil is in a type of soluble salts of phosphorus to - the t directly available to assimilation by plants. Strongly gumirovan-ny soils are rich with organic compounds F. In sea water F. only 7 contains • 10-6% on the weight since from water it is easily besieged in the form of insoluble minerals and is taken live organisms.

Contents F. in plants (on average 230 — 350 mg! 100 g of dry weight) are the highest in fruits and seeds (in oily plants to 1,6%). In an organism of marine animals concentration F. reaches 400 — 1800, land animals — 1700 — 4400, at bacteria — apprx. 3000 mg! 100 g of dry weight. Contains in a body of the person apprx. 1% of phosphorus, and in terms of the dry weight of 2,5%. About 80 — 87% only F., contained in a human body, is in a skeleton, apprx. 0,2% — in blood. Concentration F. in tissues of the person makes: in a bone tissue more than 5000, in tissue of a brain apprx. 4000, in muscles of 220 — 270 mg! kg of dry weight. In live opraiiimiax F. pyativalenten the hl also enters. obr. in composition of the phosphates derivative orthophosphoric to - you, and to a lesser extent — in structure piro-and polyphosphates. Mineral part of a bone tissue of the person and animals consists generally from crystal hydroxyapatite ЗСа3(Р04) of a 2-S (0H)2 and carbonate apatite ЗСа3(Р04) 2-Sas03-H20 and an amorphous kaltsiyfosfat, to-ry is that reserve F. in a human body and animals from where it can come to blood at gi-pofosfatemn. Significant amount F. contains in apatite (a ftorfosfata of calcium) of teeth.

Soluble F. in an organism vkho dit in structure inorganic (potassium phosphates and sodium) and nek-ry organic compounds (so-called inorganic and organic F.). Phosphate ion is one of the most important anions of a live organism. Inorganic phosphate of blood plays an essential role in maintenance of acid-base equilibrium in it (see). The ratio of concentration hydrophosphate ions and digidro-

phosphate ions [NRO */Н2РО^] is equal in a blood plasma to about 4:1. Concentration of inorganic inro-phosphate (anion pyrophosphoric, or two-phosphoric, to - you) in a blood plasma makes 1 — 10 µmol! the l, In uniform elements of blood contains in the basic organic F.

The major connections F. inorganic polyphosphates are found in live organisms (salts polyphosphoric to - t) — linear polymers, in to-rykh the remains of ortho-phosphate are connected among themselves by energy-rich (high-energy) fosfoangidridny bonds (see Vysokoergichesky connections). The number of the remains of ortho-phosphate in polyphosphates fluctuates from two (pyrophosphate) to hundreds and even thousands. In ys okomo l of EC I rny a floor ifo with f and you are found in l in bacteria, actin p-tsetakh, mushrooms, at microorganisms significant amounts of polyphosphates sometimes collect (e.g., at yeast under certain conditions of cultivation abundance of gyulifosfat can reach 10 — 20% of dry weight of biomass). At the higher plants and animals concentration of polyphosphates is usually small (1 g of crude fabric contain only tens — hundreds of micrograms of phosphorus of polyphosphates). Polyphosphates can be used like ATP as donors of phosphate and suppliers of energy for the major fiziol. processes. The role of gyulifosfat at hmikroorganizm is especially big. The pyrophosphate is also the makroergichesky connection connected with the power processes happening in mitochondrions (see) animals and mesosom of bacterial cells and with process (photosynthesis (see) at plants.

Exchange F. in a human body and animals (see. Phosphoric exchange) is regulated by hormones (see), hl. obr. hormones of epithelial bodies (see), and also vitamin D (see Calciferols) also depends on exchange of calcium (see), an acid-base condition of blood and qualitative structure of food. Disturbances of exchange F. cause profound biochemical changes, including disturbance of energy balance.

Circulation F. in the nature svyazy-iat exchange F. at animals, plants and microorganisms. Soluble phosphate salts are removed by plants from the soil and water; T. collects in plants in the form of organic and inorganic compounds. Plants become a source F. for animals and the person. T., contained in fabrics of the died animal hl. obr. in the form of its organic compounds, comes to the soil where again there is a transformation organic F. in inorganic.

Main source organic and inorganic F. for the person food serves. Requirement in F. for 1 day for adults makes 1200 mg (for pregnant women and feeding — 1500 mg), for newborns — 120 mg, for children at the age of 1 — 6 month — 400 mg,

7 — 12 months — 500 mg, 1 — 3 years — 800 mg, 4 — 6 years — 1450 mg, 7 — 10 years — 1650 mg, 11 — 17 years (boys) — 1800 mg, 11 — 17 years (girl) — 1650 mg. For optimum comprehensibility F. preservation in food of a certain quantitative ratio between phosphorus and calcium is necessary (1 — 1V3: 1). Security of an organism F. depends as on its absolute contents in food, and on the content in it of proteins, fats and carbohydrates. The recommended ratio F. and proteins in a diet of the adult makes 1: 40; at a low-proteinaceous diet requirement in F. at the person sharply increases. At a shortcoming F. in food the organism can a nek-swarm time use stocks F., deposited in bones. At experimental animals, especially at young people, a shortcoming F. in a diet led to a growth inhibition of a skeleton and diseases of bones.

The most valuable sources easily assimilable F. eggs (especially a yolk), a liver, meat, milk, cheese, beans, peas are. In cereals (especially in the crude grains) and vegetables F. contains in a form of badly assimilable fitat — the insoluble mixed calcic and magnesian salts fitovy to - you (hexaphosphate of inositol). In a stomach under the influence of salt to - you from organic compounds F. the remains phosphoric to - you, however in a stomach of absorption F are chipped off. does not occur. T. in the form of inorganic phosphate it is soaked up in an upper part of a small bowel. To absorption F. vitamin D promotes. A considerable part of the soaked-up phosphate goes for formation of organic compounds of phosphorus; 50 — 80% of the phosphates excreted from an organism are removed by kidneys, and the most part remained F. — through went. - kish. path. In urine 1/3 inorganic F. it is connected with calcium and magnesium (see), and 2/3 — with sodium (see) and potassium


To definition F. in biol. objects the mineralization usually precedes (see): burning of test in a sealed tube with concentrated nitric to - that or mix nitric and sulfuric to - t or burning of test in the concentrated chamois to - those with addition of oxidizers — nitric or chloric to - you, or pergidrolya (across Kyeldal), alloyage with alkalis or oxidizers or burning of test in the flask filled with oxygen. In all cases F. phosphate ion is defined in a look (except for weight definition of P205 after burning of test in a tube in current of oxygen).

The most important from the point of view of a wedge, researches is definition F. in blood and urine. In blood distinguish two fractions F.: acidsoluble F., remaining in a filtrate after sedimentation of proteins trichloroacetic to - that, this fraction includes inorganic F., organic efirosvyazanny F. gekso-zo-and triozofosfat, ATP, ADF and other nucleotides; and kislotonerastvorimy F., including F. phospholipids, alcohol-soluble and ethyl ether, and T. nucleinic to - t of a pla of proteins, insoluble in alcohol and consisting of insignificant quantity F. nucleoproteids (see) and phosphoproteins (see).

By the most widespread method of definition F. the colorimetric method is (see Colorimetry). Usually F. define in the organic or inorganic environment in the form of painted in yellow or blue color phosphatomolybdic and fos - forno - molybdenum-vanadium to - t or their derivatives. Most often make a kolorimetrirovaniye of the phosphatomolybdic complex painted in blue color — molybdenic blue; as reducers in this case use eykonogen (1,2,4-aminonaftosul-background to - that) by a method of the Fisc — Sabbarou (see the Fisc — Sabbarou a method), ferrous sulfate (Sumner's method), ascorbic to - that (Briggs's method — Yuzilevich), stannous chloride (a method to Dooza — Alimova), and also hydrochinone, amidol (2,4-di-aminophenol), Elon (d-metilamino-

sulfate), semidiya, HJ hydrogen iodide, KJ potassium iodide, etc. Specificity of these methods increases at extraction of a phosphatomolybdic complex organic solvent and carrying out staining reaction in the received extract. Usually similar methods allow to define several microgram of phosphorus in test of quite small volume. E.g., for definition F. in blood or urine by a method Dooza — Alimova needs only 0,05 ml of blood serum or 0,1 — 0,5 ml of urine. Also other staining reactions on phosphorus, including reactions with malachite green and quinaldine red are developed. Apply direct spektrofotometrichesky definition monofos-forno-molybdenum to - you on absorption in UF-light at 320 nanometers, and also spektrofotometrichesky definition phosphorus-molybdenum-vanadium to - you. On colorimetric definition F. also methods of its definition by means of the autoanalyzer are based. By widespread methods of definition F. also methods of flame photometry and an atomic and absorbing spektrofotometriya are also komileksonometrichesky, enzymatic (sensitivity of the last makes

0,5-10-3 mg of phosphorus in 1 ml). Among methods there are definitions F. (e.g., in samples of a bone) activation F is of great interest. a bremsstrahlung (see) with the subsequent comparison of intensity of positron radiation 30P in samples and standards. Sensitivity of this method for F. makes 0,12%. By methods of definition F. the analysis of the major phosphorus compounds is based: phosphoric ethers of carbohydrates, phospholipids, nucleotides, creatine phosphate, etc. Definition F. make also during the calculation of size of the relation of P/O (i.e. amounts of the inorganic phosphate which joined in molecule ATP, in terms of each absorbed oxygen atom) characterizing efficiency of oxidizing phosphorylation (see biological oxidation). By quantity formed inorganic F. define also activity of many enzymes (phosphorylases, alkaline and acid phosphatases, ATP-ases, kinases, etc.), besieging magnesian mix inorganic predob-razovanny phosphate in the beginning.

Definition of concentration F. in blood is the major biochemical diagnostic indicator especially valuable at diagnosis of rickets (see) and control of efficiency of its therapy. At normal security of an organism with vitamin D contents inorganic F. equally in a capillary and venous blood also makes in plasma of adults 2,5 — 6 d? / 100 ml. Contents inorganic F. in plasma it is a little increased at newborns (4,2 — 8 mg / 100 by ml) and children aged from 1 month up to 2 years (4 — 7 mg / 100 in ml). Children of 2 — 14 years have a contents inorganic F. in plasma makes 2 — 5 mg! 100 ml. At artificial feeding contents F. in blood of children above, than during the breastfeeding. A hypophosphatemia, at a cut concentration F. in blood decreases to 3 — 0,6 mg / 100 ml, note at children already at the beginning of a disease of rickets when a wedge, thisptoma are expressed still poorly. At normalization of a metabolism contents F. is returned to blood to norm, preceding a wedge, to recovery. The hypophosphatemia against the background of a wedge, recovery usually indicates a complication of rickets by a spasmophilia (see). Concentration organic F. in a blood plasma at rickets almost does not change. At rickets especially informative biochemical indicator is the size of the relation of concentration of calcium and phosphorus in a blood plasma. At the healthy baby it makes 1,9 — 2, at rickets exceeds 3, and at a tetany (see) the size of this relation

lower than 1,5. The work of concentration of calcium and phosphorus in mg! The healthy baby has 100 ml equally about 50, and at rickets — lower than 40 (on average apprx. 30). Except idiopathic rickets, a hypophosphatemia at children's age and at adults note at osteomalacy (see), a gipofosfatemichesky form of renal rickets (see), Laytvud's syndrome — Albright (see Layt-vuda — Albright a syndrome), a steatorrhea (see), de Tony's syndrome — Debra — Fankoni (see De Tony — Debra — Fankoni a syndrome), a hyperparathyreosis (see), idiopathic hyper-kalyshemii (see) and calciurias, phosphate, - diabetes (see), a postatsidotiche-sky hypocalcemia (see the Tetany), a hyper dysinsulinism (see), a hypopituitarism (see), a hypothyroidism (see), nek-ry other diseases and patol. states. The hyperphosphatemia is observed at gipopar an athyreosis (see), a pseudohypoparathyroidism (see), a hypervitaminosis of D (see Hypervitaminoses), changes in a stage of healing, a diabetic ketosis, an acromegalia (see), an addisonovy disease (see), toxic dystrophy of a liver (see), giiyerfosfatemichesky type of rickets, nefroza (see. Nephrotic syndrome), Itsenko's disease — Cushing (see Itsenko — Cushing a disease), heavy alcoholism (see an alcoholism), in nek-ry cases of a leukosis (see) and a pylorostenosis (see), and also at preferential milk diet. The hyperphosphatemia at diseases of kidneys demonstrates decrease in the filtering ability of kidneys concerning a number of substances.

Quantity F., excreted with urine, changes depending on quantity F., arrived with food, and from quantity F., soaked up in intestines. On quantity removed with urine F. also acid-base condition of blood, and also content in blood and fabrics of calcium, magnesium, sodium influences. With urine

0,5 — 2 g of phosphorus are usually removed per day; newborns have respectively 0,7 mg. Increase in excretion F. observe at a hyperparathyreosis, a hypovitaminosis of D, acidosis (see), long immobilization, in the period of an aggravation of a nephrosis, sometimes at phosphate diabetes, a leukosis, diathesis (the SI.). Excretion F. with urine decreases at a hypoparathyrosis, a hypovitaminosis of D at the increased content of calcium in a diet, inf. diseases, toxic dystrophy of a liver, an acromegalia, at heart failure of the II—III degree.

With a stake 0,4 — 0,8 g of phosphorus a day are removed. The increased removal F. with a stake note at a hypovitaminosis of D, a steatorrhea, and decrease — at intoxication vitamin D.

At introduction to a human body 32P with the medical or diagnostic purposes its distribution is caused first of all by blood supply of body and permeability of fabrics. Further there is a utilization 32P fabrics, edges is defined by three factors: existence in an organism of a certain stock of the general F., giving in to updating; speed of updating of F., edges depends on intensity of exchange processes in an organism in general and phosphoric exchange in particular; speed of formation of new fabrics. Radioactive F. joins preferential in the growing and again formed fabrics. 32P it is brought out of an organism through kidneys and went. - kish. path. Speed of its removal depends on a way of introduction. After reception of per os in the first 6 — 7 days it is allocated apprx. 23% entered 32P, and at intravenous administration — apprx. 50%. In the first case 32P the hl is removed. obr. through went. - kish. a path, in the second — through kidneys. Apprx. 25 — 30% accepted inside 32P it is allocated from an organism, without being acquired. Duration of stay 32P in fabrics and bodies is defined by the effective period of its semi-removal (see the Period to a floor of removal), i.e. removals the account of biologically caused allocation and radioactive decay. For 32P, entered into an organism in the form of solution of disubstituted Na2H32P04 sodium phosphate, the effective elimination half-life makes

8 — 12 days. The means accelerating removal 32P are not revealed yet, however more bystry removal 32P of an organism is promoted by a diet with the high content of the non-radioactive F.

Fosfor as professional harm. Highly toxic white: (yellow) F. carry to the poisons (see) possessing local irritating and resorptive — neurotoxic, geiatotoksichesky — the action caused as assume, oppression of oxidizing processes in cells and direct necrotizing action on cells of a liver (see Poisonings). However finally mechanism of toxic action F. it is not found out. Production F. by the most part it is based on electrothermal sublimation of phosphorites in ore furnaces in the presence of silicon dioxide and carbon. Disturbance of tightness of the equipment, existence of processes with fuming (plums of slag and ferrophosphorus), deviations from a techno of l. regulations (e.g., build-up of pressure in the furnace), emergencies (e.g., break of electrodes), insufficient efficiency of ways of catching and neutralization of the aspirated gases, works on repair contaminated F. the equipment can lead to allocation in air of production rooms of vapors F., its oxides, phosphine, and also carbon oxide. In these cases F. and its inorganic compounds can get into a human body of hl. obr. with inhaled air. Receipt F is possible. in went. - kish. a path with saliva. Hit F. on skin can lead to its self-ignition, burns of the II—III degree and absorption iyesgorevshy F. through a wound surface. F is deposited. preferential in a liver.

Lethal dose white F. for the person at single intake of poison inside — 0,05 — 0,5 g; inhalation of phosphine in concentration of 10 mg! m within several hours can end with death.

Hron. poisoning F. can develop after 3 — 5 years of work in contact with it. Originally in patol. process the mucous membrane of an oral cavity and teeth are involved: note an inflammation of gums, emergence of phosphoric strips on foreteeth, periodontosis (see). Damage of a bone tissue is characteristic.

At persons with carious damage of teeth the so-called phosphoric necrosis of jaws can develop what confirm a dentagra, destruction and dedentition, purulent fistulas with spread of an infection on bones of eye-sockets and a meninx. Radiological and radiografichesk in a jaw note osteo -

a porosis (see), sequestration (see the Sequester) decrease in height of alveolar edge, expansion of cracks of a parodont (see). In tubular bones at hron. intoxications F. there are epiphyseal strips (excess adjournment of calcium), osteoporosis (see). There can be an ostealgia, restriction of movements in large joints, unstable gait at the expressed muscular weakness. Development of anacid gastritis (see), colitis (see), hepatitis is characteristic (see), the hypochondrium and an outcome in postnecrotic cirrhosis (see) with disturbance of its metabolic and barrier function is more often persistent, but quite often acute with pain in right. In blood quite often establish the increased content of bilirubin, change of activity of nek-ry organospetsifichny enzymes, accumulation of nedookislenny intermediate products of a metabolism, increase in concentration F is possible. At hron. intoxications F. noted development hron. rhinitis (see) and bronchitis (see), moderate emphysema of lungs (see), symptoms of a myocardial dystrophy (see), disturbance of conductivity of a myocardium, hemorrhage in a conjunctiva and a retina of eyes, oppression of function of adrenal glands and a thyroid gland. In hard cases hron. intoxications F. sexual weakness, functional changes of c develop. N of page in the form of astenovegetativny and asthenoneurotic syndromes (see. Asthenic syndrome). Functional changes of c. N of page can be replaced by its organic lesion, toxic encephalopathy (see).

The diagnosis is made on the basis of results of inspection of the victim, the analysis a dignity. - a gigabyte. working conditions, length of service on this production.

Treatment at hron. intoxications F. symptomatic.

Reason of acute poisonings F. on production inhalation of phosphine most often is. They are shown by a fever, feeling of constraint in a breast, a retrosternal pain, suffocation, sensation of fear, dizziness, weakness, heart failure, gait of the victim becomes uncertain, there are twitchings of muscles of extremities, the short-term loss of consciousness is possible. In hard cases there can come death.

Acute poisonings at acceptance F. inside are followed by abdominal pains, vomiting (the luminescence of emetic masses in the dark is characteristic), a diarrhea, a meteorism, heart failure with symptoms of a myocardial infarction, a loss of consciousness. Yellowness of scleras and skin, spasm, hallucination are characteristic also pain in a liver, nasal and went. - kish. bleedings, hamaturia, passing hyperglobulia.

Diagnosis of acute poisoning F. put taking into account a hygienic situation on production and features a wedge, pictures.

First aid and emergency treatment. At acute poisoning F. in case of reception of poison inside the affected

1% needs as soon as possible to allow to drink solution of copper sulfate (to drink teaspoons before emergence of vomiting), then to make frequent repeated gastric lavages at first of 0,2 — 0,3% solution of copper sulfate or solution of potassium permanganate (1: 1000) before disappearance of a smell of garlic in rinsing waters; then solution of sodium sulfate — 30 g of sodium sulfate in 250 ml of water (in 2 hours to repeat). Repeated cleansing enemas are recommended. At acute poisoning with phosphine of the victim it is necessary to take out on fresh air, to provide inhalation of oxygen, to enter cardiacs, to give tea, coffee; in hard cases at the ABP not lower than 105 — 100 mm of mercury. bloodletting (200 — 300 ml) is shown. In case of hit F. in eyes washing by water within several minutes is obligatory; at hit F. on skin the struck surfaces it is necessary to process 5% solution of copper sulfate, to carefully collect and remove all pieces F. a tampon to apply the water drying dressing with solution of potassium permanganate (1: 1000). Salve dressings are absolutely contraindicated: they promote dissolution and the best absorption of poison a wound surface. Intravenously enter 20 ml of 40% of solution of glucose with ascorbic to - that (300 mg), 10 ml of 10% of solution of calcium chloride, vitamins. At a serious poisoning — A KT of, a cortisone, glyukozonovokainovy mix (50 ml of 2% of solution of novocaine in 500 ml of 5% of solution of glucose). At abdominal pains subcutaneously appoint: Atropini sulfas of 0,1% — 1 ml, a platifa length hydrotartrate of 0,2% — 1 ml, Promedolum of 1% — 1 ml. It is necessary to korrigirovat water and electrolytic balance and to carry out treatment of a toxic hepatopathy. Symptomatic further treatment.

Prevention of poisonings with phosphorus consists in strict observance tekhnol. regulations and prevention of emergencies; sealing of the equipment and communications, use of anticorrosive materials at production of the equipment are necessary; effective local exhaust and all-exchange ventilation (see), giving of an induced air in a working zone; timely removal and neutralization of passages F., phosphoric slime: control of neutralization of acidic phosphorus return waters, etc. It is necessary to observe strictly measures of individual protection (see Footwear, Clothes special, Gas masks, Respirators) and personal hygiene: careful washing of hands and the person, after work the general shower, toothbrushing by powder is obligatory; preventive rinsing of a mouth solution of potassium permanganate (1: 1000). Meal and smoking in workplaces are inadmissible as well as storage there house clothes and overalls; the last shall be disinfected and be erased timely.

At employment it is necessary to consider medical contraindications strictly. To carry out periodic medical examinations of the I times in 12 months (see. Medical examination).

The expert and for working capacity. Diseases of teeth and gums are subject to immediate treatment with discharge of the diseased for this time from contact with F. or its toxic connections. Existence even of unsharply expressed specific symptoms hron. poisonings F. is an absolute contraindication for further work with it.

Maximum allowable concentration of vapors and dust F. in air of a working zone of 0,03 mg/m3, phosphine — 0,1 mg! m.

Minimum z N and h and m and I am activity of drugs radioactive F., not demanding registration or obtaining permission of bodies of the State sanitary inspection, makes 10 mkkyur.

Phosphorus in the medicolegal relation. White F. is rare and hardly accessible poison therefore poisonings with it are rare. At peroral hit F. in a lethal dose death usually comes on 5 — the 10th days. In nek-ry cases approach of death directly after reception of poison owing to defeat of c is possible. N of page and development of an acute heart failure.

At a research of a corpse of the person who died of acute poisoning F., note characteristic yellowness of skin and mucous membranes, poorly expressed cadaveric spasm (owing to fatty dystrophy of cross-striped muscles), the phenomena of a catarrh of a mucous membrane went. - kish. a path, dot hemorrhages under serous covers of bodies, sharp fatty dystrophy of a liver, kidneys and a myocardium. The weight and the sizes of a liver and kidneys are increased, a surface their smooth. A liver on a section okhryaio-yellow with multiple and a tackle' at l nymp hemorrhages, kidneys — yellowish-gray with the bulked-up bast layer, a myocardium flabby yellowish-gray color.

At gistol. a research of a liver find heavy degree of fatty dystrophy with the death of hepatocytes (beginning on the periphery and extending to the center of segments) and emergence of kruglokletochny infiltrates. Also fatty dystrophy and a necrosis preferential of an epithelium of gyrose tubules of kidneys and fatty dystrophy of a myocardium is characteristic.

For a chemical toksikol. researches send a stomach with contents to laboratory, contents of distal departments of intestines, 200 g of a liver, a kidney, 200 g of blood. For high-quality detection of volatile compounds F. their oxidation reaction to phosphoric acid serves, to-ruyu find by means of reaction with ammonium molybdate in nitric to - those or magnesian mix and molybdenic blue (Denizhe's reaction). Quantitative definition F. it is based on its oxidation and definition in the form of magnesium pyrophosphate.

Conclusion about poisoning F. as to a cause of death the wedge, yielded, results of a research of a corpse, court is based on complex assessment. - chemical and court. - gistol. researches.

Drugs of phosphorus. In medical practice drugs F. find limited application. For practical purposes use drugs, to-rye deliver in an organism F. or facilitate its delivery and utilization by cells, activating the fermental systems responsible for process of phosphorylation (see). Sometimes sufficient is an introduction to a diet of products with the high content of F., e.g. fishes. Therapeutic effect of drugs F. it is connected with its ability to stimulate growth and development of a bone tissue, to normalize oxidation-reduction processes in an organism, to improve blood supply of bodies and fabrics. Among drugs F. the greatest distribution was gained by the following: adenosine triphosphoric acid (see Adenozintri-fosforiaya acid) — Acidum ade-nosintriphosphoricum, edges is produced in the form of dnnatriyevy or monocalcic solen, and muscular and adenylic drug (see), close on action to acid adenosine triphosphoric.

Phytin (see) — complex drug organic F., contains inosine-trifosfornye to - you in the form of calcic and magnesian salts, is a part of the tablets «Hefaephytinum» containing 0,125 g of phytin and 0,375 g of dry beer yeast.

Phy-toferrolactolum also contain F., the speaker sinergnsty gland, as in case of iron of glycerophosphate (see Iron, drugs).

Calcium glycerophosphate (Calcii glycerophosphas) is used as fortifying means at exhaustion and a nervous breakdown, rickets, and also in the stomatologistAI at treatment of caries (see Calcium, drugs).

Phosphadenum — 5-monophosphorus efir-9-R-V-ribo-furanozid adenine — represents inodorous white crystal powder, acid on taste, low solubility in water and it is good — in alkalis. Apply fosfaden as means of metabolic therapy to correction of disturbances of biosynthesis of protein and protoporphyrin. Phosphadenum is used at treatment of a porphyria, stenocardia and myocardial infarction, heart failure, vascular frustration (in particular — obliterating defeats of vessels of the lower extremities), trophic ulcers, postburn wounds and slow granulations, and also at lead poisoning, asthenic states, an amyotrophic side sclerosis and multiple sclerosis. Sometimes fosfaden appoint at hron. diseases of a liver and pancreas, napr, at chronic pancreatitis, and also at hepatocerebral dystrophy.

Phosphadenum is usually well had and, as a rule, does not cause side effects. At use of high doses there can sometimes be dizziness, appear a sonitus, nausea, tachycardia, allergic reactions.

Phosphadenum is appointed inside in tablets on 0,025 g or on 0,05 g, and in the form of disodium salt in the form of 2% of solution (in ampoules on 1 ml) intramusculary on 20 — 40 — 60 mg (a daily dose to 300 mg).

Store drug in the dry, protected from light place at a usual temperature.

The tablets «Tserebro-letsitin» (Xie-rebro-lecithinum), coated, produce 0,05 g. Apply 3 — 6 tablets a day at overfatigue, a neurasthenia, the general breakdown and anemia. Store in the dry, dark place at a usual temperature. See also Letsitina (as pharmaceuticals).

Lipo-cerebrinum contain phospholipid-nye of substance, extracted from brain fabric of the lethal cattle. Produce 0,15 g, apply 1 — 2 tablet 3 times a day at exhaustion of c. N of page (neurosises and a neurasthenia), overfatigue and hypotension, as fortifying means. Store in the dry and dark place at the room temperature.

With the medical purposes use also radioactive phosphorus, to-ry apply hl. obr. in the form of the two-replaced Na2H32P04 sodium phosphate less often — insoluble colloid Sg32r04 chromium phosphate (for intersticial introduction). Specific activity of drug 1 — 10 mkyuri/ml. Radioactive phosphorus in the form of solution of disubstituted sodium phosphate is entered into an organism most often by per os, more rare intravenously and subcutaneously. The speed and completeness of absorption of radionuclide are influenced by a way of administration of drug. At introduction 32P inside in a dose 1 — 2 mkkyur (3,7 * 104 — 7,4 *

• 104 Bq) on 1 kg of body weight note emergence of radionuclide in blood in 30 min., and the maximum activity — through 4V2 hour. At hypodermic introduction 32P radioactivity in blood reaches the maximum in 20 — 30 min. The intravenous way of introduction 32P is most effective. During the use 32 P in quality to lay down. means the therapeutic effect is reached by impact of p-radiation on tumor cells. For treatment of patients with a polycythemia, erythremia, leukoses 32 P enter per os. Thus the fractional method is more often used — on 2 mkyur (7,4-107 Bq) on reception at an interval of 5 — 10 days [the general activity makes 6 — 10 mkyur (22,2-107 — 37 • 107 Bq)].

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