Prognostic significance of various biochemical parameters in acute organophosphorus poisoning

Abstract

Background:Organophosphorus (OP) compounds are a heterogeneous group of insecticides widely used in agricultural industry. These OP compounds are likely to have more adverse effects in developing countries like India due to its easy availability and less awareness which results in high morbidity and mortality.Aims and objectives:1. To estimate plasma cholinesterase, amylase, lipase and, creatine phosphokinase (CPK) in acute OP poisoning. 2. To correlate these biochemical parameters with plasma cholinesterase levels in OP poisoning. 3. To determine the use of a biochemical marker in predicting the severity of acute OP poisoning.Materials and Methods:A hospital based observational study was conducted on 53 subjects who have clinically diagnosed of acute OP poisoning and admitted in emergency unit of a tertiary care rural hospital. Subjects of either gender of all age-groups were included in the study. On admission, plasma cholinesterase, serum amylase, lipase and CPK were measured. Based on plasma cholinesterase activity at the time of admission, subjects were divided into three groups. Group I-having 20-50% of plasma cholinesterase activity; Group II-10-20% of plasma cholinesterase activity; and group III-<10% of plasma cholinesterase activity.Results:Serum amylase, lipase and CPK were negatively correlated with plasma cholinesterase levels. Serum amylase showed statistically significant negative correlation with plasma cholinesterase. Serum amylase showed the highest diagnostic accuracy for assessing severity of poisoning followed by CPK and Lipase.Conclusion:OP poisoning is associated with hyperamylasemia. Serum amylase, lipase and CPK can be used as an additional prognostic indicator with plasma cholinesterase levels. Serum amylase could be considered as a better predictor of severity followed by CPK and lipase.

The Role of APACHE II, SOFA, Serum amylase and Lipase in Assessment of Severity and Outcome of Acute Organophosphorus Poisoning

“…Thus this increase in serum amylase level was coinciding with severity, the same result was reported by Alawadi (2000). These results go with Sumathi et al (2014) who reported significant association with severity of OP poisoning with respect to amylase and lipase.Serum amylase and lipase can be used as a marker for recognition of severity in op poisoning (Adhil and Sudharsan, 2015). Serum amylase levels may be considered as a marker of Organophosphorous intoxication, since it enables the early recognition of severity and to identify those at risk of developing the complications of Organophosphorous poisoning (Salame and Wani, 2017).…”

“…Banerjee et al (2012) postulated in their study that male to female ratio was 1:1.38. On contrary to many other studies males were more affected than females (Muley et al, 2014;Sumathi et al, 2014;Ghaniger et al, 2016).Causes of female predominance in the current study may be attributed to emotional liability of female to life stress and strains in our society than male also due to easy availability of OP compounds in the home as a household product (Z'gambo et al, 2016).…”

“…OP poisoning is associated with many biochemical abnormalities. Among which hyperamylasemia often noted in cases of OP poisoning, may be due to the fact that acute pancreatitis is caused by excessive cholinergic stimulation of pancreas by OP compounds (Sumathi et al, 2014).Hyperamylasemia was reported in this study more in died and complicated than discharged and noncomplicated patients. Thus this increase in serum amylase level was coinciding with severity, the same result was reported by Alawadi (2000).…”

“…Acute pancreatitis is frequent in OP poisoning and increased serum amylase is less specific and sensitive. Hence, serum lipase measurement may be useful in patients with increased amylase levels for early diagnosis of pancreatitis (Lee et al, 1998;Sumathi et al, 2014). As patients with hyperamylasemia had normal serum lipase, thus hyperamylasemia was contributed to be of salivary origin and not of pancreatic origin, this finding agreed with (Clark, 2002).A previous report by Lee et al (1998) explained that hyperamylesemia in OP poisoned patients may be due to excessive muscarinic stimulation, severe acidosis, or shock with subsequent hypersecretion of salivary glands.…”

“…OP poisoning is associated with various biochemical abnormalities among which hyperamylasemia is well documented. Serum amylase could be considered as a better predictor of severity followed by lipase (Sumathi et al, 2014).…”