Creatinephosphokinase in organophosphorus poisoning

Background: Organophosphorus Poisoning has been found to be a major cause of death or morbidity in our country as it freely available without need of prescription unlike in developed countries where prescription is required to purchase insecticides, the various organophosphorus compounds available are Malathion, parathion, diazinon, fenthion, dichlorvos, chlorpyrifos, ethion. Erythrocyte cholinesterase (EchE) and pseudocholinesterase (Butyryl cholinesterase-BchE) are markers used for assessing the severity in OP poisoning, but estimation of these are costly, has variable values for different individuals and is not available at all centers. This study was done to estimate levels of serum Creatine Phosphokinase (CPK)serially in acute OP poisoning patients and to correlate with prognosis.Methods: 50 patients of organophosphorus poisoning admitted to Mcgann hospital attached to Shimoga institute of medical sciences Shimoga over a period of 6 months from 1st July 2016 to 31st December 2016 were taken up for the study. A comprehensive history and detailed clinical examination was performed and patients were clinically evaluated for severity. Level of serum cholinesterase and serum CPK were estimated at admission and CPK level was measured on day 3 and day 5. The outcome of these patients was evaluated.Results: Out of 50 patients, 78% (n=39) were males and 22% (n=11) were females. Majority of patients were in the age group 21 – 40 years. Chlorpyrifos was the most common compound used. 72% had mild, 20% had moderate and 8% had severe poisoning. Serial measurements of serum CPK levels showed significant correlation with the severity of acute OP poisoning patients. The CPK levels showed a sensitivity of 74% and a specificity of 81% with a positive predictive value of 92%.Conclusions: Severe organo phosphorus poisoning is correlated with CPK levels. This study recommends CPK level estimation in assessment of severity and prognosticate patients with organophosphorus compound as alternate marker to choline esterase.

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Study of POP score, serum cholinesterase and serum creatine phosphokinase in organo phosphorus poisoning

Medpusle International Journal of Medicine ◽

10.26611/1021915 ◽

2019 ◽

Vol 9 (1) ◽

pp. 17-21

Author(s):

Jignesh F Vasava ◽

◽

Mahesh M Rathod ◽

Poma Shah ◽

Ajay S. Dabhi ◽

...

Keyword(s):

Creatine Phosphokinase ◽

Serum Cholinesterase ◽

Phosphorus Poisoning ◽

Serum Creatine Phosphokinase

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Evaluation of Serum Creatine Phosphokinase as a Marker of Severity in Organophosphorus Poisoning

International Journal of Biomedical Research ◽

10.7439/ijbr.v9i5.4767 ◽

2018 ◽

Vol 9 (5) ◽

pp. 179

Author(s):

Yogendra V. Bansod ◽

Swapnil G. Bhedodkar

Keyword(s):

Creatine Phosphokinase ◽

Prognostic Significance ◽

Clinical Severity ◽

Serum Cholinesterase ◽

Serum Creatine Phosphokinase ◽

Organophosphorus Poisoning ◽

Severe Clinical Picture ◽

Scale Category ◽

Global Health Problem

Background & Objectives: Organophosphorus (OP) poisoning is an important global health problem. Estimation of erythrocyte cholinesterase (EChE) and butyrylcholinesterase (BChE) as an evidence of OP poisoning is costly and not regularly performed. There are emerging options for new cheaper biochemical markers in relation to OP poisoning like creatine phosphokinase (CPK). The objectives of this study were to measure serum CPK level and correlate it with severity of poisoning, to evaluate clinical and prognostic significance of CPK in OP poisoning, to assess if serum CPK level can be used as an alternative of BChE level to stratify OP poisoning severity.Method: Total 100 patients of OP poisoning without any prior treatment, presenting within 12 hours, were selected and their clinical severity was categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Level of serum CPK, blood BChE and pH were measured and total dose of atropine required (mg) until final clinical outcome was calculated.Results: Out of 100, 43% patients had mild, 36% moderate and 21% severe clinical picture. There was a significant positive correlation between serum CPK value and requirement of atropine dose in patient with severe POP scale category and negative correlation with pH and serum cholinesterase levels, indicating that more severe the poisoning more will be serum CPK and requirement of atropine doses while less will be pH and serum cholinesterase, (p<0.0001).Conclusions: This study suggests role of serum creatine kinase as surrogate, relatively cheap and easily quantifiable markers of severe OPC exposure and their association.

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A prospective evaluation of correlation between cholinesterase level and severity of organophosphorus poisoning

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20200079 ◽

2020 ◽

Vol 7 (2) ◽

pp. 276

Author(s):

M. Deepak Phanindra ◽

P. V. V. Satyanarayana ◽

Anand Acharya

Keyword(s):

Severity Score ◽

Standard Treatment ◽

Organophosphorus Compounds ◽

Treatment Protocol ◽

Serum Cholinesterase ◽

Inclusion Criteria ◽

High Severity ◽

Organophosphorus Poisoning ◽

History Of ◽

High Severity Score

Background: Organophosphorus compounds are anticholinesterases by inhibiting cholinesterase it protects acetyl chorine from hydrolysis. So, acetylcholine accumulates at the synapses, and all the clinical manifestation are due to that. So, this study has been designed to establish the reactive between level of serum and prognosis of op poisoning patients.Methods: Patient with history of organophosphorus poisoning admitted into the emergency department with following exclusion and inclusion criteria were included in this study. All patients were managed as per standard treatment protocol of op poisoning. Various parameters like demography of the patients, sign and symptoms, severity of intoxication, clinical and lab parameter manoring, Serum cholinesterase was measured every alternate day.Results: 22(47.84%) patients have mild symptom out of that 20 patient’s serum cholinesterase was more than 2000 IU/L, and 2(4.3%) patients serum cholinesterase was between 1000-2000 IU/L. In eighteen patient’s severity as per POP scale was moderate, out of that 2(4.3%) patients have serum cholinesterase was below 1000 IU/L, 8 having serum cholinesterase between 1000 to 2000 IU/L, and remaining eight having serum cholinesterase above 2000 IU/L.Conclusions: Serum cholinesterase was less in patient with high severity score or low serum concentration of cholinesterase was associated with high severity score. Serum cholinesterase was improved as days passes.

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Analysis of Organophosphorus compound poisoning patients attending CMS-TH, Bharatpur, Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v7i4.6736 ◽

2012 ◽

Vol 7 (4) ◽

pp. 9-19

Author(s):

S Laudari ◽

BS Patowary

Keyword(s):

Clinical Presentation ◽

Statistical Significance ◽

Medical Emergency ◽

Precipitating Factors ◽

Medical Sciences ◽

Treatment And Prevention ◽

Female Predominance ◽

Organophosphorus Poisoning ◽

Planning Treatment ◽

Psychiatric Problems

Organophosphorus (OP) compound poisoning is a medical emergency. It is important to know its nature, clinical presentation, severity and outcome in order to take up appropriate measures including proper planning, treatment and prevention. This study was aimed to assess the clinical profile of organophosphorus poisoning. This is a prospective hospital based study conducted at CMS-T.H., Bharatpur, Nepal. The study included 111 patients of organophosphorus poisoning during the period November 2008 to July 2011. The incidence was commoner in females than males with female:male ratio being 1.47:1. Majority of the patients(58.56%) belonged to the age group 16 to 30 years with female predominance(2.25:1). Modes of poisoning were suicidal in the majority (94.59%), accidental in 4.50%. and homicidal in 0.90%. Psychiatric problems were the major precipitating factors. Majority of patients(62.16%) had moderate poisoning (POP scale: 4-7).On admission, dyselectrolytemia and respiratory failure were found in 74.77% and 21.62% respectively.8 patients expired (7.69%). Large amount of OP poison ingestion (>40ml) and increased severity of poisoning (POP scale) were found to have statistical significance with the rate of mortality. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 9-19 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6736

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

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i4.1854 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

Suresh Kumar Nagar ◽

Maniram Kumhar ◽

V. B. Singh ◽

Mayank Srivastav

Keyword(s):

Organophosphorus Compounds ◽

Tertiary Care ◽

Crop Protection ◽

Serum Lactate ◽

Spectrophotometric Analysis ◽

Serum Lactate Dehydrogenase ◽

Care Hospital ◽

Significant Difference ◽

Organophosphorus Poisoning ◽

Acute Organophosphorus Poisoning

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

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A Study on Correlation Between Serum Cholinesterase Level and Clinical Severity Based on Pop Scale in Organophosphorus Poisoning

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i2.38903 ◽

2021 ◽

Vol 18 (2) ◽

pp. 55-58

Author(s):

Anil Shrestha ◽

Aasim Kidwai ◽

Richa Shrestha ◽

Suman KC

Keyword(s):

Organophosphorus Pesticides ◽

Case Fatality ◽

Public Health Problem ◽

Initial Presentation ◽

Clinical Severity ◽

Serum Cholinesterase ◽

Major Public Health Problem ◽

Age Group ◽

Suicidal Intention ◽

Organophosphorus Poisoning

Introduction: Organophosphorus (OP) compounds are the most commonly used pesticides worldwide and Organophosphorus poisoning has become the major public health problem especially in developing countries.The case fatality rate following ingestion of Organophosphorus pesticides in developing countries in Asia is 5-20%.Due to limited availability of facilities and resources in Nepal, it is important to prioritize treatment based on severity of poisoning as all patients can’t be managed in Intensive Care Unit. Aims: To study the correlation between serum cholinesterase level and clinical severity based on Peradenya organophosphorus poisoning scale in Organophosphorus poisoning. Methods: The study was conducted in the department of Medicine, Nepalgunj Medical College, Kohalpur, Banke from November 2019 to November 2020. It is based on the descriptive study of 66 patients with Organophosphorus poisoning attending to the emergency department. All patients with history of exposure to Organophosphorus poisoning were included in the study. Peradenya Organophosphorus Poisoning scale was used to assess the clinical severity as mild, moderate and severe. At the same time venous blood samples were collected for serum cholinesterase level. Results: Age group ranged from 16-60 years and majority of patients were in the age group of 20-29 years (34.85%). 53% were females. 74.2% of the patients were from lower socioeconomic status. 83.3% of the patients consumed poison with suicidal intention. Majority of the patients were from tharu ethinicity (40.9%) and were farmers (30.3%). It was observed that there is significant correlation between serum cholinesterase level and severity of poisoning based on Peradenya Organophosphorus Poisoning scale at initial presentation (p value <0.001). Conclusion: There is significant correlation between severity of poisoning and degree of derangement of serum cholinesterase level at the initial presentation. As the facility for the estimation of serum cholinesterase level is not available in all regions of Nepal.

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Multiomic Analysis of Zebrafish Models of Acute Organophosphorus Poisoning With Different Severity

Toxicological Sciences ◽

10.1093/toxsci/kfz133 ◽

2019 ◽

Vol 171 (1) ◽

pp. 211-220

Author(s):

Benjamin Piña ◽

Tamar Ziv ◽

Melissa Faria ◽

Shani Ben-Lulu ◽

Eva Prats ◽

...

Keyword(s):

Endoplasmic Reticulum ◽

Endoplasmic Reticulum Stress ◽

Organophosphorus Compounds ◽

Cholinergic Neurons ◽

Acetylcholinesterase Inhibitors ◽

Chemical Models ◽

Organophosphorus Poisoning ◽

Important Therapeutic Target ◽

Acute Organophosphorus Poisoning ◽

Integrative Omics

Abstract Organophosphorus compounds are acetylcholinesterase inhibitors used as pesticides and chemical warfare nerve agents. Acute organophosphorus poisoning (acute OPP) affects 3 million people, with 300 000 deaths annually worldwide. Severe acute OPP effects include overstimulation of cholinergic neurons, seizures, status epilepticus, and finally, brain damage. In a previous study, we developed 3 different chemical models of acute OPP in zebrafish larvae. To elucidate the complex pathophysiological pathways related to acute OPP, we used integrative omics (proteomic, transcriptomics, and metabolomics) on these 3 animal models. Our results show that these stochastic, apparently disparate morphological phenotypes can result from almost linear concentration-response variations in molecular levels. Results from the multiomics analysis strongly suggest that endoplasmic reticulum stress might play a central role in the pathophysiology of severe acute OPP, emphasizing the urgent need of further research on this molecular pathway. Endoplasmic reticulum stress could be an important therapeutic target to be included in the treatment of patients with severe acute OPP.

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Study of role of prognostic markers in the management of organophosphorus poisoning patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20182276 ◽

2018 ◽

Vol 6 (6) ◽

pp. 1996

Author(s):

Sameer Chaudhary ◽

Rohan Kalmegh

Keyword(s):

Scale Score ◽

Prognostic Markers ◽

Initial Presentation ◽

Serum Cholinesterase ◽

Ventilator Support ◽

Organophosphorus Poisoning ◽

Severe Group

Background: POP scale and serum cholinesterase levels may be effective indicators for mortality in organophosphorus poisoning. The objective of this study was to assess the POP scale score and serum cholinesterase levels at initial presentation in OP poisoning and its correlation with need for ventilator support and mortality.Methods: One hundred and fifty eligible participants were recruited, and POP scale and serum cholinesterase levels were assessed.Results: Total 32.7% patients died; of which 30 out of 75 belonged to moderate and 19 out of 22 patients belonged to severe group; as per POP scale score. 49 out of 75 in moderate poisoning and all patients in severe poisoning required ventilator support. With respect to serum cholinesterase level; 20 out of 23 and 29 out of 77 patients died in the severe and moderate poisoning categories respectively. Forty eight out of 77 in moderate poisoning and all patients in severe poisoning required ventilator support.Conclusions: Assessment by POP scale and serum cholinesterase levels is useful in assessing the need for ventilator support and are indicators of mortality in OP poisoning cases.

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