Prognostic Significance of Estimation of Pseudocholinesterase Activity and Role of Pralidoxime Therapy in Organophosphorous Poisoning

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Atropine, insecticides, organophosphorous, pralidoxime, pseudocholinesterase


Background: Organophosphorous (OP) poisoning is one of the most common poisonings seen in India. OP compounds act through inhibition of enzyme acetylcholinesterase and estimation of pseudocholinesterase (PCE) activity strengthens the diagnosis in clinically uncertain cases of OP poisoning. The role of pralidoxime (PAM) therapy in OP poisoning has been controversial. Study Objectives: This study was aimed to determine the prognostic significance of estimation of PCE activity and also to assess the role of PAM therapy in OP poisoning. Materials and Methods: Patients of suspected OP poisoning of age >12 years admitted to emergency unit at a tertiary healthcare center of north India were enrolled. Patients were categorized into two groups; group A who were given intravenous atropine and group B who were given injectable PAM along with atropine. Serum PCE level was estimated at the time of admission in all patients and severity of OP poisoning was assessed according to PCE level. Requirement of atropine, oxygen inhalation, intubation and ventilatory support, total hospital stay, and mortality were compared between different classes of severity and also between Groups A and B. Results: This study included a total of 70 subjects, 35 in each group with mean age of 24.99 ± 8.7 years. Out of 70 subjects 49 (70%) were male and 21 (30%) were female. Forty nine patients (70%) of OP poisoning were with suicidal intent while 21 (30%) cases were accidentally poisoned. In all suicidal cases route of poisoning was ingestion whereas in all the accidental cases route of exposure was inhalational. PCE levels were reduced in all the cases and the mean level was 3,154.16 ± 2,562.40 IU/L. The total dose of atropine required, need for oxygen inhalation and need for intubation and ventilatory support, mean duration of hospital stay and mortality rate (P = 0.003) were higher in moderate to severe cases and did not have significant difference between Groups A and B. Conclusion: The study recommends estimation of PCE level at admission to classify severity of OP poisoning and to estimate prognosis. This study did not find any beneficial role of PAM therapy in reducing morbidity as well as mortality.


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Chaudhary, S. C., Singh, K., Sawlani, K. K., Jain, N., Vaish, A. K., Atam, V., Patel, M. L., & Agarwal, A. (2018). Prognostic Significance of Estimation of Pseudocholinesterase Activity and Role of Pralidoxime Therapy in Organophosphorous Poisoning. Toxicology International, 20(3), 214–217. Retrieved from



Original Research
Received 2018-08-10
Accepted 2018-08-10
Published 2018-08-10



Thundiyil JG, Stober J, Besbelli N, Pronczuk J. Acute pesticide poisoning: A proposed classification tool. Bull World Health Organ 2008;86:205"‘9.

Jesslin J, Adepu R, Churi S. Assessment of prevalence and mortality incidences due to poisoning in a South Indian tertiary care teaching hospital. Indian J Pharm Sci 2010;72:587"‘91.

Goswamy R, Chaudhuri A, Mahashur AA. Study of respiratory failure in organophosphate and carbamate poisoning. Heart Lung 1994;23:466"‘72.

Aygun D, Dognnay Z, Altintop L, Guven H, Onar M, Deniz T, et al. Serum acetylcholinesterase and prognosis of acute organophosphate poisoning. J Toxicol Clin Toxicol 2002;40:903"‘10.

Kumar SV, Fareedullah MD, Sudhakar Y, Venkateswarlu B, Kumar EA. Current review on organophosphorus poisoning.Arch Appl Sci Res 2010;2:199"‘215.

Areekul S, Srichairat S, Kirdudom P. Serum and red cell cholinesterase activity in people exposed to organophosphate insecticides. Southeast Asian J Trop Med Public Health 1981;12:94"‘8.

Mehta AB, Shah AC, Joshi LG, Kale AK, Vora DD. Clinical features and plasma acetylcholinesterase activity in poisoning with insecticidal organophosphorus compounds. J Assoc Physicians India 1971;19:181"‘4.

Nouira S, Abroug F, Elatrous S, Boujdaria R, Bouchoucha S.Prognostic value of serum cholinesterase in organophosphate poisoning. Chest 1994;106:1811"‘4.

Ram JS, Kumar SS, Jayarajan A, Kuppuswamy G. Continuous infusion of high doses of atropine in the management of organophosphorus compound poisoning. J Assoc Physicians India 1991;39:190"‘3.

Peter JV, Moran JL, Graham P. Oxime therapy and outcomes in human organophosphate poisoning: An evaluation using meta"‘analytic techniques. Crit Care Med 2006;34:502"‘10.

Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticides poisoning. Lancet 2008;371:597"‘607.

Chugh SN, Aggarwal N, Dabla S, Chhabra B. Comparative evaluation of atropine alone and atropine with pralidoxime in the management of organophosphorus poisoning. J Indian Aca Clin Med 2005;6:33"‘7.

Avasthi G, Singh G. Serial Neuro"‘electrophysiological studies in acute organophosphate poisoning"‘correlation with clinical findings, serum cholinesterase levels and atropine dosage.J Assoc Physicians India 2000;48:794"‘9.

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