Study on some prognostic criteria in cases of organosphosphate insecticides poisoning

The most common insecticides used worldwide are the organophosphate. They are used in the industrial, commercial and household fields. They act as irreversible cholinesterase inhibitors [organophosphate cholinesterase bond is not spontaneously reversible without pharmacology intervention]. The aim of the present work was to study some prognostic criteria in cases of organophosphate insecticides admitted to the Poisoning Unit of Alexandria Main University Hospital in order to assess the validity of each criterion. This work was carried out on 50 cases of OP insecticide poisoning that were admitted during the period from February to August 2002, All patients were clinically assessed by a full clinical sheet including. Socio demographic data, time lapsed since intake of poisoning, clinical examination including vital signs investigations, ECU, blood gases, pseudo cholinesterase level that have been estimated on admission and before discharge. Antidotal therapy has also been reported. The present study showed that organophosphate poisoning is a serious health and social problem because of it's using as a suicidal tool especially by females, also the wide using in the agriculture aggravate this problem. History of short-term exposure plays a role in prognosis The characteristics of clinical signs and symptoms are important on the outcome. Improvement of signs and symptoms after treatment with atropine is a good prognostic sign. Results of the present work revealed also that decrease in serum cholinesterase activity per se is not reliable in prognosis but could be used to monitor the proper management of the cases. Other alarming signs, which could give an idea about the severity and prognosis of the case, are the decreased conscious level, blood gases changes, as well as the prolongation of QTc interval in the ECG

Effect of variation in site and time on the level of ethanol and methanol in postmortem blood samples

It is well recognized that postmortem [PM] drug levels in blood may be unstable as a consequence of redistribution artifact. Whereby drugs diffuse from their binding sites of high concentration in tissues and major organs, such as liver and lung, into blood. Also drugs can be expected to diffuse from gastric contents into blood. When measuring drug concentrations after death, it is important to consider the phenomenon of PM drug redistribution. PM drug concentrations may not be a true reflection of the antemortem one and as a result, wrong conclusions could be made about the cause of death. There is few published evidence for most drugs and poisons to show the important differences in their PM concentrations in blood and tissues according to choice of sampling site, sampling time, handling of samples including containers, preservation and documentation and type of laboratory investigation carried out on PM samples. The present work was carried out to evaluate experimentally in rabbits PM behavior of ethyl and methyl alcohol in relation to their concentration in different blood sampling sites at different time intervals. Furthermore to assess the effect of site of PM blood sampling on the level of ethyl alcohol and methyl alcohol at time of autopsy in human cadavers and compare it with the results from rabbit experiments. The study was conducted on ninety male rabbits as experimental animals, and the human cadavers that were positive on screening to ethanol [n = 4] and methanol [n = 3] during the period of the study. Rabbits were divided into three groups [30 rabbits each], two groups for each drug, which were given the LD50 of the drug. Blood samples [2ml] were drawn from right and left sides of the heart and femoral vein from each group of rabbits, immediately, twelve hours and twenty-four hours after death. As regards human cadavers, blood samples [5m1] were drawn from right and left sides of the beau and femoral vein at time of autopsy. Experimental and human blood sample extracts were analyzed by gas chromatography. The study showed that ethanol was detected in the control group after 12h PM. The highest mean value recorded was 681 g/ml in 24h PM Rt. cardiac. No significant changes could be detected in immediate PM blood concentration for ethanol and methanol from different sampling sites. The study also revealed that PM blood concentration for ethanol and methanol increased over time for different sampling sites. Where up to 24h PM femoral [peripheral] blood drug concentrations were the closest to the immediate PM values, followed by Rt. cardiac then Lt. cardiac blood. It was noticed also that up to 12h PM femoral [peripheral] blood methanol concentration could be used as a reliable indicator for the immediate PM values. Experimental animal studies, when interpreted carefully, are indicative of the PM drug changes observed in human, denoting that femoral [peripheral] blood is the best site for drug sampling

Changes in some essential elements in plasma and cerebrospinal fluid of heroin dependent patients

Heroin is a medical, social and legal problem. In this work, the clinical data obtained from addicts were evaluated and the effect of heroin dependence on some essential elements in their plasma and cerebrospinal fluid was determined. The patients who were examined and investigated during the 1st four hours after their last heroin dose, showed no apparent clinical manifestations except for constricted pupils, while those seen from 12-36 hours after their last dose showed withdrawal manifestations of various degrees of intensity. No changes were observed in the level of the chosed elements in their plasma or CSF up to four hours after the last dose, while in patients investigated after 12-36 hours after the last dose; a significant reduction in the mean CSF concentrations of both Ca [12.02%] and Mg [32.8%] as compared to the control group was present. The concentrations in the plasma did not change

Blood gases, acid base equilibrium and cholinesterase activity in dogs intoxicated with organophosphate insecticide EPN before and after treatment

The study was carried out on twenty-five mongrel dogs. These were divided into three groups: control group [10 dogs], intoxicated group [5 dogs], and treated group after intoxication [10 dogs]. Dogs were intoxicated with organophosphate insecticide [EPN] to investigate the changes that might be encountered in acid-base equilibrium, blood gases and cholinesterase activity, before and after treatment. It was found that dogs intoxicated with EPN developed metabolic acidosis manifested by significant lowering of the pH of the blood [academia] and bicarbonate level. Moreover a decrease in the PaCO[2] and to a lesser extent in the PaO[2] was encountered. A more significant diminution in plasma cholinestrase activity than red cell cholinesterase activity occurs. Treatment of the intoxicated dogs by sodium bicarbonate revealed a significant improvement in the pH of the blood and bicarbonate levels, while treatment by atropine and toxogonin slightly improved them. Again PaO[2] and PaCO[2] were corrected nearly to their original values after atropine and toxogonin and to a lesser extent after sodium bicarbonate therapy A significant improvement in the activity of plasma cholinesterase level and to a lesser extent the red cell cholinesterase following treatment with atropine and Toxogonin occured, while sodium bicarbonate slightly improved both. It is recommended that routine blood gases and acid base equilibrium tests should be carried out in cases of moderate or severe organo-phosphate insecticide poisoning in order to discover early metabolic acidosis. Early initiation of bicarbonate therapy, together with the ordinary therapeutic regimen [atropine and Toxogonin], or bicarbonate with atropine only whenever Toxogonin is not available, is helpful

correlative study between the clinical picture and circumstances of poisoning with organophosphorus insecticides and the serum cholinesterase level before and after treatment

Twenty patients with various degrees of organophosphorus poisoning were studied, 11 cases were accidental and 9 cases were suicidal. Ten medical students served as controls. The mean levels of serum cholinesterase enzyme in the mild, moderate and severe cases were 80%, 56.2% and 6.85%, of the mean control value, respectively. Treatment included atropine and obidoxime chloride [Toxogonin], and was successful in saving all the patients, with a significant elevation of serum cholinesterase level. The results stress the need for a health education programme for prevention and early treatment of organphosphorus insecticide poisoning