Organophosphate poisoning from inappropriate topical use of malathion pesticide: A case report

A 43-year-old male with no past medical history presented to our emergency department with vomiting, diarrhea, and abdominal pain of 3 h’ duration. Upon further questioning, he revealed that he had been applying malathion pesticide over his body for the past 3 days for self-diagnosed scabies. He was otherwise afebrile and hemodynamically stable, and the physical examination was unremarkable. The patient was diagnosed with organophosphate poisoning and treated symptomatically due to the lack of worrying cardiorespiratory or neurologic sequelae. He was subsequently admitted to the general ward, where his symptoms abated within 4 h. Serum and red blood cell cholinesterase tests sent on admission returned on day three and were significantly decreased (serum cholinesterase 2131 U/L, reference range 4700–12000 U/L; red blood cell cholinesterase 3365 U/L, reference range 7700–14600 U/L). He was discharged home well and stable on day 5 of admission, with outpatient psychiatric follow-up for likely delusional parasitosis.

Serum cholinesterase levels to predict all-cause mortality in a community-based study: The Takahata study

Introduction: Serum albumin (Alb) levels have been found to be independent predictors of all-cause mortality in a community-based population, but whether this is the case for serum cholinesterase (ChE) levels is uncertain. This study aimed to determine whether serum ChE levels are independent predictors of all-cause mortality in a community-based population. Methods: A total of 3,504 subjects (mean age 62.5 years) from Takahata, Japan participated and were followed up for 13.5 years (median 13.2 years). Based on baseline serum Alb and ChE levels, subjects were stratified by interquartile range as low, middle, and high. The correlation between serum Alb and ChE levels was examined by calculating correlation coefficients. The association between each group and all-cause mortality was examined by Kaplan-Meier and Cox proportional hazards analysis. Results: During follow-up, 568 subjects died. There was a positive correlation between serum Alb and ChE levels (r=0.30). Kaplan-Meier analysis showed that all-cause mortality in the low group was significantly higher for both serum Alb and ChE levels (log-rank P<0.01). Adjusted Cox proportional hazards analysis showed that the serum Alb level was not an independent predictor of all-cause mortality (hazard ratio (HR) 1.18, 95% confidence interval (CI) 0.95-1.46 for all-cause mortality in the low group compared to the middle group), whereas the serum ChE level was an independent predictor of all-cause mortality (HR 1.30, 95% CI 1.06-1.59 for all-cause mortality in the low group compared to the middle group). Conclusion: The serum ChE level is an independent predictor of all-cause mortality in the general community-based population.

Clinical Significance of Serum Cholinesterase Determination in Cardiovascular Diseases

The activity of serum cholinesterase was determined by the method of T.V. Pravdich-Neminskaya in 115 people with various diseases of the cardiovascular system (of which 72 - with various manifestations of rheumatism).

Prepregnancy Assessment of Liver Function to Predict Perinatal and Postpregnancy Outcomes in Biliary Atresia Patients with Native Liver

Considering that some biliary atresia (BA) survivors with native liver have reached reproductive age and face long-lasting complications, specific attention needs to be paid to pregnant cases. This study aimed to investigate the relationship between liver function, perinatal outcomes, and prognosis. A database review was conducted to identify pregnant BA cases with native liver and perinatal data, and clinical information on BA-related complications was analyzed. Perinatal serum cholinesterase (ChE) levels, model for end-stage liver-disease (MELD) score, and platelet trends were analyzed, and the association between these indicators and perinatal outcomes was investigated. Patients were categorized into three groups according to the perinatal clinical outcomes: favorable (term babies with or without several episodes of cholangitis; n = 3), borderline (term baby and following liver dysfunction; n = 1), and unfavorable (premature delivery with subsequent liver failure; n = 1). Lower serum ChE levels, lower platelet counts, and higher MELD scores were observed in the unfavorable category. Borderline and unfavorable patients displayed a continuous increase in MELD score, with one eventually needing a liver transplantation. Pregnancy in patients with BA requires special attention. Serum ChE levels, platelet counts, and MELD scores are all important markers for predicting perinatal prognosis.

Cholinesterase activity in serum during general anesthesia in patients with or without vascular disease

Maintaining hemodynamic stability during the induction and maintenance of anesthesia is one of the challenges of the anesthesiologist. Patients with vascular disease are at increased risk of instability due to imbalance between the sympathetic and parasympathetic parts of the autonomic nervous system, a balance accessible by serum cholinesterase activity. We aim to characterize the dynamics of cholinesterase activity in patients undergoing general anesthesia (GA) and surgery. This was a prospective study of 57 patients undergoing ambulatory or vascular surgery under GA. Cholinesterase activity was measured before the induction of anesthesia, after 15 min and at the end of surgery by calculating the capacity of serum acetylcholinesterase (AChE) and butyrylcholinesterase to hydrolyze AcetylThioCholine. Data on atherosclerotic disease, anesthesia management were analyzed. Both AChE and total cholinergic status (CS) decreased significantly after GA induction at 15 min and even more so by the end of surgery. Vascular surgery patients had lower baseline cholinesterase activity compared to ambulatory surgery patients. Patients requiring intraoperative administration of phenylephrine for hemodynamic support (21.1%) had a significantly lower level of AChE and CS compared to untreated patients. Our findings serve as a mirror to the sympathetic/parasympathetic imbalance during GA, with a marked decrease in the parasympathetic tone. The data of a subgroup analysis show a correlation between low cholinesterase activity and an increase in the need for hemodynamic support.

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