Significance of Serum Potassium Level at Admission in Organophosphorus Poisoning and Impact on Outcome - A Hospital Based Study from North East India

BACKGROUND Organophosphorus (OP) pesticides are one of the most common cause of morbidity and mortality due to poisoning worldwide especially in agrarian countries like India. Hence it is prudent to undertake a detailed study of clinico-pathological evaluation of OP poisoning and assess the role of serum potassium as an alternative, easy and convenient prognostic indicator in estimating the severity of OP poisoning. This study was undertaken to assess serum potassium levels in patients of acute organophosphorus poisoning and determine association between serum potassium level and outcome in cases of acute organophosphorus poisoning. METHODS This was a prospective observational study conducted in Department of General Medicine, Silchar Medical College & Hospital for one year from 1st June 2019 to 31st May 2020 with a sample size of 100 after satisfying the inclusion and exclusion criteria. Peradeniya organophosphorus poisoning (POP) scale was used for categorizing study population according to severity. RESULTS Among patients who were admitted with organophosphorus poisoning, 72 % of the patients discharged were having normal serum potassium levels on admission, whereas 22 % (n = 22) patients who died had hypokalaemia at the time of admission. The chi-square value for the association between serum potassium and outcome is statistically significant [P value is 0.001 (P < 0.05)]. CONCLUSIONS The serum potassium level on the day of admission was significantly correlated with the severity of the acute organophosphate poisoning as determined by Peradeniya OP poisoning scale. The cases that had lower serum potassium levels on admission had poor outcome. Reduced serum potassium levels also had significant association with the need for ventilator support. Therefore, serum potassium can be used as a predictive marker of severity in organophosphorus poisoning. This can help in early triage of patients and will be helpful in reducing mortality and morbidity. KEYWORDS Organophosphorus Compound Poisoning, Serum Potassium, POP Scale

Study of Serum Amylase for Predicting the Severity of Organophosphorus Poisoning and Correlation with Respiratory Failure - A Cross Sectional Study at KIMS, Hubballi, Karnataka

BACKGROUND Organophosphorus (OP) compounds are insecticides which are widely used in agriculture. Acute organophosphorus poisoning is one of the important causes of morbidity and mortality in developing countries like India. Considering financial burden / availability of tests, we need cheap and easily measurable biomarkers for predicting prognosis / complications in a limited resource country, like India. We intend to correlate the levels of serum amylase in patients admitted with acute organophosphorus poisoning for predicting the severity of acute OP poisoning and also to correlate serum amylase association with respiratory failure. METHODS This was a prospective observational study. Total of 94 patients of OP poisoning admitted to KIMS Hospital, Hubballi between January 1st 2017 and December 31th 2017 were studied. Detailed history, clinical examination, and lab investigations like pseudocholinesterase, serum amylase and other relevant investigations were carried out. Peradeniya OP poisoning scale was applied to all the study subjects and the severity of OP poisoning was graded as mild, moderate, severe. Data obtained was analysed by different statistical methods. RESULTS OP poisoning was more common in adults of age group between 20 – 30 years, Incidence was more in male patients and mortality rate was 12.8 %. Mean values of serum amylase negatively correlate with pseudocholinesterase levels and it was statistically significant. Correlation between the severity of OP poisoning (based on Peradeniya score) and biochemical parameters like pseudocholinesterase, serum amylase was statistically significant. CONCLUSIONS The correlation between the severity of OP poisoning and biochemical parameter– serum amylase, was statistically significant and it was useful in predicting the development of respiratory failure. Pseudocholinesterase and serum amylase were also useful to predict the outcome of the patient. KEYWORDS Amylase, Organophosphorus Poisoning, Pseudocholinesterase, Peradeniya Score

LDH LEVEL IN ACUTE ORGANOPHOSPHORUS POISONING AND ITS RELATION WITH SEVERITY AND MORTALITY: A TERTIARY CARE HOSPITAL EXPERIENCE

Background: Organophosphorus compounds have been widely used for a few decades in agriculture for crop protection and pest control. In India Organophosphorus poisoning is the most common. The objective of our study was to measure the LDH Level in acute organophosphorus poisoning Methods: This study was conducted among minimum 100 patients acute organophosphorus poisoning admitted in Casualty ward, MICU and attending medical ward of JLN hospital, Ajmer during Aug 2018 to July 2020. Serum lactate dehydrogenase estimation by spectrophotometric analysis using Beckman Coalter AU 680 Results: These were significantly higher among deaths on day 1 and 3(810±372.99 and 1027.09±458.26, respectively) in comparison to survivors on day 1 and 3 (538.18±300.42 and 365.19±175.49, respectively). Significant difference was found between mean values of different levels of severity of LDH on day 1 and 3. Conclusion: In conclusion, this study found that Serum LDH can be used as biomarker in diagnosis or stratifying severity of acute OP poisoning, as it is cheap and easily available, especially in developing countries. Serial measurements of serum LDH levels in acute OP poisoning can predict the prognosis. Keywords: LDH, OP poisoning, Severity

Butyrylcholinesterase nanodepots with enhanced prophylactic and therapeutic performance for acute organophosphorus poisoning management

Poly(4-acryloylmorpholine)-modified butyrylcholinesterase shows outstanding prophylactic and therapeutic efficacy against organophosphorus poisoning. Poly(4-acryloylmorpholine) holds promise as a PEG substitute in drug delivery.

Study of serum creatinine phosphokinase and serum lactate dehydrgenase as prognostic markers in organophosphorus poisoning

Background: Organophosphorus (OP) compounds are insecticides which are widely used in agriculture. Acute organophosphorus poisoning is an important cause of morbidity and mortality in developing countries like India. In a limited resourced country like India, we need cheap and easily measurable biomarkers for predicting prognosis.Objective was to estimate creatinine phosphokinase and serum lactate dehydrgenase as prognostic markers in acute organophosphorus poisoning.Methods: Total 94 cases of OP poisoning admitted to KIMS Hospital, Hubbali between January 1st 2017 to December 31th 2017 were studied. Detailed history, clinical examination and lab investigations like pseudo cholinesterase, serum LDH and serum CPK were carried out. Peradeniya OP poisoning scale was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. Data obtained was analysed by different statistical methods.Results: OP poisoning is more common in adults of age group between 20 - 30 years, Incidence is was more in male patients, Mortality rate is 12.8%. Mean values of serum LDH, serum CPK were negatively correlated with pseudcholinesterase levels and it was statistically significant. Correlation between the severity of OP poisoning (based on Peradenyia score) and biochemical parameters like serum CPK, serum LDH, was statistically significant.Conclusions: The correlation between the severity of OP poisoning and biochemical parameters was statistically significant and they are usefull in predicting development of respiratory failure.