DOI: http://dx.doi.org/10.18203/2349-3933.ijam20183140

A study on serum cholinesterase level in organophosphorus poisoning and its correlation with severity of organophosphorus poisoning

Vilas Honnakatti, Naren Nimbal, Prakash Doddapattar

Abstract


Background: There has been a steady increase in the use of organophosphates (OPs) as pesticides in most of the developing countries including India for more than 50 years. OPs tend to be the commonest cause of poisoning worldwide and are persistently and deliberately used in suicides in Agrarian areas. As stated by WHO, 3 million cases of pesticide poisoning occur every year, of these about 1 million are accidental and 2 million are suicidal poisonings, resulting in more than 0.25 million deaths per year. As there is limited availability of facilities and resources in developing countries, all OP poisoning patients are not managed in intensive care units. Hence it is important to understand the clinical features and other factors that indicate severity of poisoning which should be identified in the initial examination.

Methods: It was a hospital based prospective study of 100 OP poisoning patients that were attending to casualty of BIMS Hospital and Medical College Belagavi, India. Over a period, patients fulfilling inclusion criteria were included and patients were categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum cholinesterase level measured at the time of admission.

Results: The patients were in the age group of 18 to 70 years. Majority of the patients were in the age group of 21-30 years (51%). Sixty nine percent of the patients were from rural areas and 38% of them were farmers. Sixty nine percent of patients were from low socioeconomic stratum. Major route of intake of poison was ingestion. Eighty four percent of patients consumed poison with a suicidal intent. In this study, authors observed that there is a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase at the time of initial presentation of the patients (P<0.001).

Conclusions: Present study concluded that significant correlation between the degree of derangement in serum cholinesterase level and severity of poisoning at the initial presentation. Higher the score on the POP scale, the greater was the degree of derangement in the serum cholinesterase level.


Keywords


Cholinesterase level, Organophosphorus poison, POP scale

Full Text:

PDF

References


Reddy KS. The essentials of forensic medicine and toxicology. Journal of Punjab Academy of Forensic Medicine & Toxicology. 2005;5(5):53.

World Health Organization. The impact of pesticides on health. Available at: http://www.who.int/mental_ health/prevention/suicide/en/PesticidesHealth2.pdf

Banerjee I, Tripathi SK, Roy AS. Efficacy of pralidoxime in organophosphorus poisoning: Revisiting the controversy in Indian setting. J Postgrad Med. 2014;60:27-30.

Jokanović M, Kosanović M. Neurotoxic effects in patients poisoned with organophosphorus pesticides. Environ Toxicol Pharmacol. 2010 May 1;29(3):195-201.

Tripathi KD. Essentials of medical pharmacology. JP Medical Ltd; 2013 Sep 30:6th edition:93-100.

Costa LG, Giordano G, Cole TB, Marsillach J, Furlong CE. Paraoxonase1 (PON1) as a genetic determinant of susceptibility to organophosphate toxicity. Toxicol. May 2013;307:115-22.

Mackness M, Mackness B. Current aspects of paraoxonase-1 research. In Komoda T, ed. The HDL handbook: biological functions and clinical implications .2nd ed. Amsterdam: Academic Press; 2014.

Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger J. Ellenhorn's medical toxicology: diagnosis and treatment of human poisoning. Baltimore: Williams & Wilkins. 1997:1614-30.

King M. Cholinesterase. Kaplan A et al. Clin Chem The CV Mosby Co. St Louis. Toronto. Princeton. 1984:1108-11.

Senanayake N, de Silva HJ, Karalliedde L. A scale to assess severity in organophosphorus intoxication: POP scale. Hum Exp Toxicol. 1993;12:297-9.

Nouira S, Abroug F, Elatrous S, Boujdaria R, Bouchoucha S. Prognostic value of serum cholinesterase in organophosphate poisoning. Chest. 1994 Dec 1;106(6):1811-4.

Rehiman S, Lohani SP, Bhattarai MP. Correlation of serum cholinesterase level, clinical score at presentation and severity of OP poisoning. J Nepal Med Assoc. 2008;47(170);47-52.

Bhattacharyya K, Phaujdar S, Sarkar R, Mullick OS. Serum creatine phosphokinase: A probable marker of severity in organophosphorus poisoning. Toxicology Int. 2011 Jul;18(2):117.

Kavya ST, Srinivas V, Chandana MR. Clinical profile of patients with organophosphorus poisoning in an intensive care unit in a tertiary hospital. Int J Clinical Cases Investig. 2012 Oct;4(3):24-31.

Proudfoot A. Organophosphate and carbamate insecticides in diagnosis and management of Acute poisoning 1. Edition Oxford Blackwell Scientific. 1982:153-7.