The official position of Russian doctors on the poisoning of Alexei Navalny differs from the conclusions of German doctors. Alexander Sabayev, the chief toxicologist of the Omsk region, who treated the opposition leader, insists that there was no poison, and if there had been, Navalny would not have survived. At the request of the BBC, reanimatologists Mikhail Fremderman (Israel) and Konstantin Balonov (USA) analyzed Sabayev’s statements and found no arguments to refute Navalny’s poisoning.
The chief toxicologist of the Omsk region and head of the acute poisoning department of the regional emergency hospital No. 1, Alexander Sabaev, personally admitted the politician to the Omsk emergency hospital and claims to know everything about his treatment. Navalny spent two days in Omsk. Of all the Russian doctors who commented on Navalny’s condition, Sabaev provided the most detailed and harsh evidence that the politician fell into a coma due to metabolic problems, calling the version of poisoning with “Novichok” a “fantasy.”
Mikhail Fremderman, a doctor at the TV Medical Clinic (Tel Aviv Medical, Israel), believes that the public is being misled because Russian doctors have neither made nor confirmed a diagnosis for Navalny. Konstantin Balonov, Head of Perioperative Medicine in the Department of Anesthesiology and Resuscitation at Tufts Medical Center (Boston, USA), notes that “Novichok” was discovered by a world-class laboratory, and according to statistics on household poisonings with similar substances, the majority of patients can be saved under conditions of adequate medical care. Both experts pointed to numerous inconsistencies and unsubstantiated statements that cast doubt on the official Russian version.
“This is not even a diagnosis (poisoning with ‘Novichok’ from the group of organophosphorus substances). This is not even a version, but some kind of fantasy. Just some fantastic assumption or conclusion that has not been confirmed in any way, either documentarily or clinically.” “As a toxicologist, I am confident: there is no ‘newbie’. “All the tests show there was no poisoning.”
It is completely unclear why the toxicologist was treating Mr. Navalny if there was no poisoning? And why wasn’t he transferred from toxicological resuscitation to general resuscitation, where metabolic disorders are treated?
The German Armed Forces Toxicological Analysis Laboratory that discovered Novichok is one of 17 laboratories in the world officially certified by the Organization for the Prohibition of Chemical Weapons (OPCW). This is an unprecedented level of objectivity, impartiality and appropriateness of results. The level of this laboratory is global, and there is no reason to believe that the results of its expertise could have been influenced by political forces in Germany or Western Europe.
“If he had been poisoned, he would have died within the first few hours. By 6-10 p.m. he would have died. It’s a fatal poisoning.”
It is unclear on what basis such a statement is made, as there are no statistics on FOS poisoning. There have been cases of the Skripals and other surviving victims, and recently it was made public by the developers that the doses were tested on animals. This means that there could have been an error in dosage, and the purity of “Novichok” could vary in different cases.
The statement that death is inevitable in case of poisoning with chemical warfare agents is questionable, since there are no modern statistical data on poisoning with chemical warfare agents, and according to statistics on domestic poisoning with similar substances, the mortality rate worldwide is about 10%. This is certainly a lot, but the vast majority of these patients can still be saved with adequate medical care.
It is impossible to save a person in case of poisoning with organophosphorus compound without the procedure of ultrafiltration (deep blood purification – BBC). We did not use this procedure because there were no indications, i.e. there was no poisoning.
According to the standards of FOS treatment, ultrafiltration is not performed in every patient with poisoning, but only in severe cases – in those who develop kidney or liver failure, i.e. acute renal-liver insufficiency. This procedure is a certain equivalent of hemodialysis. According to indirect signs, both Russian doctors and German colleagues reported at the time that the condition was serious, but there was no threat to the patient’s life, it can be assumed that Navalny did not have acute kidney or liver failure. So it was possible to save him without ultrafiltration.
Mandatory ultra-hemofiltration is not included in the standards for the treatment of FOIS poisoning because it may be necessary only in cases of renal failure, which is not always present in FOIS poisoning.
“Any toxin, and this is definite – any toxicologist will tell you – that passes through our natural detoxification organs, which are the liver, lungs and kidneys, will leave a trace. In this particular clinical case, neither the kidneys nor the lungs nor the liver were damaged during the entire stay. Therefore, it can be said that there were no toxins in the patient’s body. “The organism did not react to the poison, so there was no poison. These are obvious things.
To leave no trace does not mean to do no harm. But the Germans found such a trace. How can it be said that the body did not react to the poison when the person was in a coma of unknown origin?
It is not necessary to demonstrate the degree of liver, lung, and kidney damage to make a diagnosis of “phosphate organophosphorus poisoning” because they are not specific. According to De Zeit, German specialists note that the substance with which Navalny was poisoned could be a two-component poison that has not been encountered before and, according to German media, is more lethal than other drugs in this group. The number of bids should remain. An additional component used with the cholinesterase inhibitor may have significantly altered the clinical picture of poisoning.
We explain quickly, simply, and clearly what happened, why it matters, and what will happen next. The number of episodes should remain: episodes. End of story. Podcast advertising. This is certainly not a “beginner,” this is not a phosphorus-organic compound at all, this is not poisoning at all. This is a disease. This is metabolic syndrome. “This is a metabolic coma that occurred as a result of a metabolic disorder. The crisis occurred on the night of August 20-21, and in the following hours we were able to stabilize the patient and bring him to a positive trend”. According to Sabaev, within 44 hours, doctors were able to “control the metabolic acidosis, control the lactate acidosis” and “bring the blood glucose levels back into the normal range. Atropine is an important antidote for surgical poisoning. However, as Sabaev claims, it was administered situationally, based on the clinical picture: “We knew there was no organophosphorus compound, but atropine is not only an antidote for organophosphorus compounds.” He told Reuters that only 3 mg of atropine was administered because of lung problems, while Navanly’s sugar level was four times normal and he had pancreatitis.
This statement does not exclude the manifestation of a non-classical picture of poisoning. Metabolic syndrome is a chronic condition characterized by high levels of sugar and fat and is common in obese people. It is still unclear what happened to the sugar levels. Earlier, Omsk doctors talked about hypoglycemic coma – that is, about the fact that Navalny’s sugar dropped, was very low, and therefore (the head of Russia Today) Margarita Simonyan reasoned about the “Raphaelka” (which would have saved Navalny with a low blood sugar level). Now it turns out that the glucose level jumped somewhere there. Metabolic acidosis is not a diagnosis. It is data from the analysis of the acid-base composition of the blood. Statements about alleged lactate acidosis and atropine are actually contradictory. Lactate acidosis is a condition in which the body produces too much lactic acid and cannot metabolize it quickly. It usually occurs in severe trauma associated with pronounced hypoxia of organs and tissues – type A – or exacerbation of chronic metabolic disorders (for example, in diabetics), as well as in excessive doses of drugs and poisonings – type B. The list of assumptions is extensive. So, which type was treated in Navalny’s case, or does the toxicologist of the Omsk region not know this classification? No one talked about hypoxia of organs and tissues, there is no other data from the medical history, except maybe some medication or external intoxication with some substance. In other words, the only reason for Navalny’s lactic acidosis could necessarily be related only to poisoning. Lactic acidosis is often initially accompanied by pronounced tachycardia (rapid heartbeat), there is a risk of developing severe arrhythmias, and the administration of atropine is contraindicated. But Sabaev claims that atropine was administered to Navalny not as an antidote to OPs (organophosphates), but on the basis of indications. What indications could there be for atropine in the case of lactate acidosis? Acute pancreatitis can occur as a result of acute oral poisoning, such as from food or drink.
Anonymous members of the Council of Physicians in Omsk told “Meduza” that atropine was administered based on the symptoms of poisoning in Navalny, but after several doses, it was discontinued because Navalny developed severe tachycardia.
Metabolic syndrome is a chronic disease that has nothing to do with Navalny’s condition. And the categorical denial of the possibility of poisoning, confirmed by one of the world’s leading toxicological laboratories, is at the very least strange. Metabolic disturbances, especially acidosis, may be associated with poisoning – multiorgan failure, changes in acid-base balance, tachycardia, reaction to atropine and other drugs may occur. From the information that has been made public, it is clear that the doctors treated correctly based on symptoms and lab data rather than diagnosis. As a rule, it is not necessary to treat pulmonary pathologies with atropine unless they are caused by FOS poisoning. The question remains as to how Navalny survived if he was not given a large dose of atropine. To understand this, it is necessary to know all the elements of the treatment: what medications were administered to him and the components of the new poison. As an antidote, an alternative to atropine could be an acetylcholinesterase reactivating drug from the oximes group, such as pralidoxime. So why was atropine administered – for the lungs or for the cholinergic syndrome confirming the diagnosis of FO poisoning? In general, the listed things fit into the concept of a two-component poison as an explanation for the blurred clinical picture.
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As reported by “Meduza” with reference to doctors from the Council on Navalny’s condition in Omsk, the politician had myosis (constricted pupils), hypersalivation (increased salivation), sweating and muscle hypertonia – all these are typical signs of poisoning with organophosphorus compounds. At the time of the consultation, there were no signs of bronchospasm and bronchorrhea of the lungs; there were also no problems with the gastrointestinal tract – vomiting and diarrhea were absent in the intensive care unit.
“The acidification of the body happens quickly. We suspect that all of this has probably accumulated the day before. It doesn’t accumulate overnight on a plane. It was over the course of a day, two days, maybe even five days. And he had digestive problems. He couldn’t focus on his health in his work because there were numerous projects, that’s what we were told. We also wanted to say that we were aware of this information – that the person was unwell. “The data of the anamnesis, that is, the history of the disease from the words of the accompanying persons, his spouse, indicated that there were problems with digestion for 5-7 days, there were problems with nutrition. The patient used some diets associated with weight loss during these days. Everything that the patient provided – a laboratory complex of metabolic changes – was taken a few days before admission”.
These are groundless allegations. Everyone can see from Navalny’s Instagram pages how he runs long distances. I doubt that these are photos of an unhealthy person. At the same time, we were not told what medications Navalny was taking for weight loss during his business trip to Siberia and how they might interact, for example, with the water of the lake in Tomsk. In the photos of Navalny drinking tea before the flight and standing next to people, he looks perfectly healthy – there is no pain in his eyes or other symptoms. Of course, a politician can “put on a face” for photos. But his entourage claims that he swam, attended a film shooting and worked the day before. However, the pain in his stomach and digestive problems cause a great discomfort that is difficult to hide.
On the one hand, it is claimed that the acidification happened quickly, on the other that it accumulated over five days. The latter is very doubtful. 5-7 days is long enough for symptoms to manifest a few days before hospitalization. In the absence of advanced diabetes, it is unlikely that a person would suddenly lapse into a coma requiring intubation and mechanical ventilation based on diet alone. And anyway, Navalny doesn’t look like someone who needs to go on a diet. If he wasn’t sick, but clearly started feeling bad suddenly – what does the diet have to do with it?
“This situation could have been caused not only by dieting, but also by some alcohol, maybe excesses that we do not know about.” According to him, the deterioration of the oppositionist’s well-being could have been caused by even prolonged exposure to the sun or overcooling. “Any external factors could have caused the sudden onset of some deterioration. Even the banal absence of breakfast”.
That’s true if we’re talking about a chronically decompensated patient – an alcoholic or an 85-year-old grandmother with cardiovascular disease and metabolic syndrome. As far as Navalny is concerned, this statement is correct in form, but in essence it is a mockery.
Shifts of this level in the body could not have occurred due to digestive problems or fatigue. Even if we assume that he had a glass of wine the night before, and traces of alcohol were found in his urine, it could not lead to the clinical picture that the doctors in Omsk witnessed.
“A large team of doctors worked, eight conferences were held, only 60 biochemical studies were performed, including 11 on acid-base status, 25 on blood sugar levels, several electrocardiograms, continuous monitoring of the body systems with good equipment, instrumental and radiological diagnostic methods – two computer tomographies, one magnetic resonance tomography, abdominal tomography with contrast”. Also, according to Sabayev (September 3), laboratory studies were conducted on various alcohols, narcotics, medicinal preparations of various groups, including sleeping pills, sedatives, neuroleptics, psychotropic substances: “The range of toxicological studies was very wide. They also obtained a negative result”.
All these data confirm that Navalny was treated as a patient in a coma of unclear origin, and ordinary doctors, unlike the management, doubted the conclusions published by the chief toxicologist of Omsk. The Omsk resuscitators successfully fought hypoxia, provided lung ventilation and nutrition through a tube, administered atropine, and took preventive measures against secondary complications – they managed to prevent the development of pneumonia and renal failure, and compensated for metabolic acidosis. But the public is being deceived: Russian doctors never had and still have no diagnosis for Alexei Navalny.
Neither computed tomography (CT) nor magnetic resonance imaging (MRI) shows toxicity. It is obvious that Navalny had non-specific symptoms, doctors did not understand what caused them.
“Phosphorganic compounds are highly toxic substances, and it is not possible to use them to poison a single person. The patient was in an enclosed space in the plane. Such substances are highly toxic, and even in small doses they cause sufficiently fatal changes in the body. If someone had tried to expose the patient to this substance the day before the flight or during the flight, symptoms of intoxication would have been observed in the people around him, but this did not happen”.
This is a description of the effects of toxicants from the toxicology textbook of the 1970s and 1980s. The only case of mass use of substances from the “Novichok” group is the sarin poisoning in the Tokyo subway and, to some extent, the “Skripal case”. We do not know the statistics of the “Newcomer” campaign.
A person poisoned by a nerve agent is not always a source of infection for others – for example, if they received the toxin in a liquid, it should not have remained on their hands or been expelled by coughing or breathing. There is a possibility that the stomach contents containing the poison could have landed on someone’s skin during vomiting, if it occurred, but most likely the substance managed to leave the stomach and be absorbed into the intestines within two hours from the moment Navalny drank tea at the airport.