Prognostic Significance of Various Biochemical Parameters in Acute Organophosphorus Poisoning
Keywords:Amylase, CPK, lipase, organophosphorus poisoning, plasma cholinesterase
AbstractBackground: 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.
Vijaya Kumar S, Fareedullah Md, Sudhakar Y, Venkateswarlu B, Ashok Kumar E. Current review on organophosphorus poisoning. Arch Appl Sci Res 2010;2:199"‘215.
Pore NE, Pujari KN, Jadkar SP. Organophosphorus poisoning. J Pharma Biosci 2011;2:604"‘12.
Amanvermez R, Baydın A, Yardan T, Başol N, Günay M. Emergency laboratory abnormalities in suicidal patients with acute organophosphate poisoning. Turkish J Biochem 2010;35:29"‘34.
Matsumiya N, Tanaka M, Iwai M, Kondo T, Takahashi S, Sato S. Elevated amylase is related to the development of respiratory failure in organophosphate poisoning. Hum Exp Toxicol 1996;15:250"‘3.
Lee HS. Acute pancreatitis and organophosphate poisoning. A case report and review. Singapore Med J 1989;30:599"‘601.
Lee WC, Yang CC, Deng JF, Wu ML, Ger J, Lin HC, et al. The clinical significance of hyperamylasemia in organophosphate poisoning. J Toxicol Clin Toxicol 1998;36:673"‘81.
Bhattacharya K, Phaujdar S, Sarkar R, Mullick OS. Serum creatine phosphokinase: A probable marker of severity in organophosphorus poisoning. Toxicol Int 2011;18:117"‘23.
Panteghini M, Bais R, Van Soling WW. Enzymes. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz Text Book of Clinical Chemistry. 4th ed. Philadelphia: Saunders Elsevier; 2006. p. 616"‘7.
Balali"‘Mood M, Balali"‘Mood K, Moodi M, Balali"‘Mood B. Health aspects of organophosphorus pesticides in asian countries. Iran J Public Health 2012;41:1"‘14.
Hundekari IA, Suryakar AN, Rathi DB. Acute organo"‘phosphorus pesticide poisoning in North Karnataka, India: Oxidative damage, haemoglobin level and total leukocyte. Afr Health Sci 2013;13:129"‘36.
Manu MS, Prashant V, Akila P, Suma MN, Basavanagowdappa H. A retrospective analysis of serial measurement of serum cholinesterase in acute poisoning with organophosphate compounds. Toxicol Int 2012;19:255"‘9.
Yun HW, Lee DH, Lee JH Cheon VJ, Choi YH. Serial serum Cholinesterase activities as a prognostic factor in organophosphate poisoned patients. Hong Kong J Emerg Med 2012;19:92"‘7.
Tietz NW, Huang WY, Rauh DF, Shuey DF. Laboratory tests in differential diagnosis of hyperamylesemia. Clin Chem 1986;32:301"‘7
Ahmed A, Begum I, Aquil N, Atif S, Hussain T, Vohra E. Hyperamylasemia and acute pancreatitis following organophosphate poisoning. Pak J Med Sci 2009;25:957"‘61.
Lin CL, Yang CT, Pan KY, Huang CC. Most common intoxication in nephrology ward organophosphate poisoning. Ren Fail 2004;26:349"‘54.
Aslan S, Cakirz Z, Emet M, Serinken M, Karcioglu O, Kandis H, et al. Acute abdomen associated with organophosphorus poisoning. J Emerg Med 2011;41:507"‘12.
Singh S, Bhardwaj U, Verma SK, Bhalla A, Gill K. Hyperamylasemia and acute pancreatitis following anticholinesterase poisoning. Hum Exp Toxicol 2007;26:467"‘71.
Hassan NA, Madboly AG. Correlation between serum creatine phosphokinase and severity of acute organophosphorus poisoning: A prospective clinical study (2012"‘2013) J Environ Sci Toxicol Food Technol 2013;4:18"‘29.