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Background: Organophosphorus (OP) compounds are one of the most common agents used for suicidal poisoning. People in the middle socioeconomic status are mainly affected. The most important determinant of death in OP poisoning is the severity. The ideal treatment of OP poisoning, this study was undertaken to compare the efficacy of fresh frozen plasma (FFP) along with the standard regimen of atropine and oximes.Methods: 80 patients were taken in this study (40 cases and 40 controls) with history and biochemical pictures suggestive of acute OP poisoning. Normality assumption and equality of variance were satisfied for most of quantitative variables. As a comparison of the baseline data of the study groups did not reveal any significant difference (p>0.05), the result at a given point of time between two groups were also compared with the same methods of assess the comparative changes.Results: Total 80 patients >15 years of age were taken for the study. Out of the total 63.7% are female and 36.3% are males. OP compounds are commonly used as suicidal agent. Salivation is the most common presenting symptoms in both cases and controls. The mean value of serum cholinesterase on day -1 in cases and controls are nearly same but the subsequent mean values as the days progresses are higher in cases than that controls.Conclusions: FFP showed its positive effect in reducing the development of intermediate syndrome/ fatality/ ventilatory support.
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Background: Organophosphates (OP) are a diverse group of insecticides used for pest control. Due to easy availability of these compounds over the counter, organophosphate poisoning continues to be a major cause of deliberate self-harm. Although choline esterase inhibition plays a key role in OP poisoning, other metabolic factors like dysglycemia contribute to the severity of poisoning. The present study attempts to assess glycaemic variability as a probable prognostic factor in acute OP poisoning. Aim of the study was to correlate the blood glucose levels with the severity and treatment outcome of acute organophosphate poisoning.Methods: 100 patients of acute organophosphate poisoning admitted in the hospitals affiliated to Bangalore Medical College and Research Institute during the study period from August 2018 to July 2019, were enrolled into the study as per the inclusion criteria and graded into mild, moderate & severe, based on Peradeniya organophosphorus poisoning (POP) scale. Random blood sugar (RBS) was estimated at the time of admission and patients were followed up till recovery/death.Results: The patients in this study were categorized into hypoglycemics (10%), euglycemics (75%) and hyperglycemic (15%). 16% of euglycemics, 30% of hypoglycemics and 60% of hyperglycemics had severe grade of poisoning. The ventilator requirements in hypoglycaemics, euglycemics and hyperglycemics were 40%,48% and 80% respectively. The outcome in terms of mortality was 8% in euglycemics group and 20% in hyperglycemics group. Hence hyperglycemia was found to be a poor prognostic marker in acute organophosphate poisoning.Conclusions: RBS at admission in acute organophosphate poisoning patients is a simple, inexpensive tool that may help to predict the clinical outcome. Early identification of the poor prognostic indicators may help in timely intervention, to reduce morbidity and mortality, especially in a resource limited country like India.
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Introduction: Organophosphate compounds are often usedfor homicidal and suicidal purposes. It accounts for about80% of pesticide related hospital admissions. Study aimed toassess the severity of OP poisoning by POP scale, PSS andGCS and to compare POP scale, PSS and GCS in predictingthe treatment outcome in OP poisoning.Material and Methods: 100 patients of OP compoundpoisoning were included in the study. POP score, PSS andGCS were assessed at the time of presentation and weregrouped based on the severity. These scores were individuallyevaluated in predicting the ventilator requirement andmortality in OP compound poisoning and the scores werecompared with each other, as to asses which score was betterin predicting the severity of OP poisoning.Results: Ventilator requirement and mortality was found tobe in 43% and 16% of patients respectively. Intubation ratesand mortality rates were higher in patients with severe gradesof POP score, PSS and GCS with a significant p value (0.00),than in patients with mild to moderate grades. All three scorescorrelated well in predicting the requirement of ventilatorysupport and mortality in OP compound poisoning cases.Conclusion- The three scoring systems are simple andeffective tool that can be assessed based on the clinicalexamination. For a resource limited country, like India, any ofthe three scoring systems can be applied at the primary caresetting level which helps in making timely decision regardingneed for ventilatory support and timely shifting of patient tothe ICU care setting.
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Background: India has shown a sharp rise in the number of suicidal poisoning in the past few years and organo-phosphorus compounds are the most commonly implicated. This is a prospective study done to assess if troponins can be used as a prognostic marker in patients with organophosphate poisoning.Methods: Author conducted a prospective study on 50 patients to measure the level of troponin T and CK-MB on admission and Day 3 in patients with OP poisoning. This was then correlated to the severity of poisoning and also studied for its association with outcomes like respiratory failure or death. The primary endpoints were death and respiratory failure while secondary endpoint was the length of ICU stay.Results: With 0.1 ng/ml taken as the cut off for Troponin- T, and 40 U/L for CK-MB, positive cardiac enzymes were seen only in 10% of the patients, but all the patients in this group developed res-piratory failure. The mean Troponin T and CK-MB levels (0.1142±0.06 ng/ml and 39.14±8.23 U/L) were higher for patients who died when compared to the survivors. A similar picture was seen in patients with respiratory failure (Troponin T 0.0895±0.01 ng/ml and 34.65±11.66 U/L) as compared to those without respiratory failure.Conclusions: The level of cardiac enzymes correlated well with the severity of poisoning, days of ICU stay and outcome, thus suggesting its use as a prognostic indicator of organophosphorus poisoning.
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Objective To observe the clinical effect of hemoperfusion in the treatment of patients with critical severe organophosphorus poisoning. Methods Sixty-two patients with critical severe organophosphorus poisoning admitted to the Department of Critical Care Medicine of Jincheng People's Hospital from August 2016 to August 2018 were enrolled, and they were divided into a routine treatment group and a hemoperfusion group according to whether hemoperfusion or not, 31 cases in each group. The routine treatment group was treated with western drugs combined with continuous gastric lavage, while the hemoperfusion group was additionally treated with hemoperfusion for consecutive 3 days on the basis of the routine emergency regimen. The changes of the dosage of penehyclidine hydrochloride used, recovery time of consciousness, recovery time of cholinesterase (ChE) activity, off-line time of mechanical ventilation, hospitalization time, poisoning rebound and mortality were observed in the two groups after treatment; Glasgow coma scale (GCS) was used to assess the prognosis of patients. Results The dosage of penehyclidine hydrochloride used in hemoperfusion group was less than that in the routine treatment group (mg: 3.1±1.2 vs. 5.8±1.3), and the time of consciousness recovery (hours: 3.3±1.7 vs. 13.4±2.4), recovery time of ChE activity (days: 7.7±1.5 vs. 17.9±3.3), off-line time (days: 2.1±0.9 vs. 7.5±2.6), hospitalization time (days: 12.3±1.5 vs. 19.8±3.6) in hemoperfusion group were shorter than those in the routine treatment group (all P < 0.05); poisoning rebound [3.23% (1/31) vs. 16.13% (5/31)] and mortality [9.68% (3/31) vs. 25.81% (8/31)] in hemoperfusion group were lower than those in the routine treatment group (both P < 0.05). The Glasgow coma score (GCS) of the hemoperfusion group on 3, 4 and 5 days after treatment were all higher than those of the routine treatment group (9.9±2.9 vs. 5.7±2.6, 13.3±2.7 vs.7.8±3.2, 13.3±1.5 vs.9.3±2.6, all P < 0.05). Conclusion The conventional treatment, western drug and gastric lavage, combined with hemoperfusion in patients with critical severe organophosphorus poisoning can further reduce the hospital stay, improve the quality of life and reduce the mortality of such patients, therefore.
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Introduction: Estimates from the World Health Organisation (WHO) indicate that 1 million accidental poisoning and 2 million suicide attempts involving pesticides occur the world over. Large proportion present to the ICU with an acute suicidal attempt with male predominance. The case mortality in the developing world is more than 20%. The cardiac manifestations are hypotension, bradycardia, and varied Electrocardiogram (ECG) changes manifested by prolonged QTc interval, inverted T waves, prolonged PR interval, and ST-segment elevation. There is also a high incidence of respiratory failure which has a high mortality. Aim of the study: ECG changes and systemic manifestations with organophosphorous compounds and its relationship to the nature of the compound and its outcome. Materials and methods: The study was conducted at Rajiv Gandhi Government General Hospital and Madras Medical College during a month period from June 2010 and October 2010. The study was conducted on a total of 102 patients admitted to the toxicology unit of Rajiv Gandhi Government General Hospital. A detailed history and physical examination and biochemical and ECG monitoring were done. Results: Most of the patients were in the age group 21-30. The mortality rate was 17%. The percentage of death was noted to be increased in the extremes of age groups less than 20 and more than 60 years. Of the patients who expired mortality was highest in monocrotophos consumption and a majority of them had ECG changes and renal (16%)/respiratory failures (58%). The ECG abnormality was seen in 64% of individuals. Conclusion: We concluded from this study that Electrocardiographic changes correlated independently with the prognosis of the OP poisoning cases and the identification of them, particularly QTc prolongation and timely shifting of cases to ICU and CCU where adequate N. Jayaprakash, S. Geetha. A study of the ECG changes associated with Organophosphorous compound poisoning. IAIM, 2019; 6(2): 69-73. Page 70 resuscitative measures, ventricular pacing facilities available can prevent such sudden cardiac deaths. Blood transfusion is said to have a role in severe poisoning in rapidly replenishing acetylcholinesterase enzyme.
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Aim of the study:Effect of atropinization with different methods.Outcomes in terms of duration of hospital stay and patients recovery. Methodology: An open-label randomized clinical trial was conducted in, Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka. 108 individuals with OPC poisoning .We compared two groups that used a titrated dosing protocol based on a structured monitoring sheet for atropine infusion with anoth-er group using an ‘ad hoc’ regime. The aim was to compare the efficacy and safety of conventional bolus doses with individualized incremental doses of atropine for atropinization followed by continuous atropine infusion for manage-ment of OPC poisoning.Result: Out of 108 patients, 54 patients received conventional bolus dose atropine (group A) and 54 patient received rapidly incremental doses of atropine followed by infusion (group B).36 subjects analyzed in group A and 32 in group B for moderate to severe poisoning. The mortality in group A was 11.1%(4/36) and in group B was 6.3%(2/32).The mean duration of atropinization in group A was 5.8hrs (348) in minutes compared to time 26.9minutes for group B. Conclusion: Administration of atropine using a fixed algorithm is easy and effective in providing the atropine requirement in management of early phase of acute OPC poisoning. Rapid incremental dose atropinization followed by atropine infusion reduces mortality and morbidity from OPC poisoning and shortens the length of hospital stay and early recovery .Incremental atropine and infusion should become the treatent of choice for OPC poisoning.
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OBJECTIVE:To evaluate the economics of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus poisoning (AOPP).METHODS:The information of 118 AOPP patients were collected and divided into group A (59 cases) and B (59 cases) according to therapy plan.There were 22 cases of mild poisoning,20 cases of moderate poisoning and 17 cases of severe poisoning in group A.There were 21 mild cases,21 moderate cases and 17 severe cases in group B.Based on routine treatment,group A was given Penehyclidine hydrochloride injection intramuscularly with initial dose of 1 mg (mild),2 mg (moderate) and 4 mg (severe).Group B was given Atropine sulfate injection intravenously,with initial dose of 2 mg (mild),5 mg (moderate) and 10 mg (severe).Both received maintenance treatment according to patients condition and stopped taking medicine after symptoms disappeared.Clinical efficacies,the time of acetylcholinesterase recovery and ADR were observed in 2 groups.The economics of therapy plans for mild,moderate and severe poisoning were evaluated in 2 groups by cost-effectiveness analysis.RESULTS:There was no statistical significance in total response rate of mild poisoning or the time of acetylcholinesterase recovery between 2 groups (P＞0.05).Total effective rates of moderate and severe poisoning in group A were significantly higher than group B,and the time of acetylcholinesterase recovery was significantly shorter than group B,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR in mild,moderate and severe poisoning patients (P＞0.05).Cost-effectiveness ratio of penehyclidine hydrochloride was similar to that of atropine in mild poisoning patients;that of penehyclidine hydrochloride were significantly lower than that of atropine in moderate and severe patients.It was inline with the results of sensitivity analysis.CONCLUSIONS:Based on routine treatment,penehyclidine hydrochloride is similar to atropine in therapeutic efficacy of AOPP and the time of acetylcholinesterase recovery.For moderate and severe AOPP patients,penehyclidine hydrochloride is significantly better than atropine in improving therapeutic efficacy and the time of acetylcholinesterase recovery.The safety of 2 drugs are satisfactory;penehyclidine hydrochloride possesses cost-effectiveness advantage.
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Objective To investigate theprognostic factors and prognostic value of acute organophosphorus pesticide poisoning. Methods Patients with acute organophosphorus pesticide from January 2009 to January 2017 in Cangzhou city emergency center from poisoning, describing the demographic characteristics, and clinical characteristics and prognosis of poisoning, using Logistic regression model analysis of admission when white blood cell count (WBC) , cholinesterase (ChE), lactic acid (Lac), blood glucose (GLU), serum myocardial enzymes (CK) and acute physiology and chronic health score (APACHE score) effects on the prognosis of patients, using Logistic regression probability prediction model and ROC curve analysis of the value of the index prediction on the prognosis of the patients. Results A total of 519 patients with acute organophosphorus pesticide poisoning were treated, the ratio of male to female was 1 :1.21 (235/284), the age was 20-50 years old (73.41%), mainly for farmers (64.74%), and the cause of poisoning was suicide (73.99%) . 87.09% patients were cured or improved, healed or dead patients accounted for 12.52%, accounting for 0.39% of the other. WBC (OR=5.056, 95% CI:1.714~14.915) , ChE (OR=5.190, 95% CI:1.396 ~ 19.298) , Lac (OR=5.124, 95% CI:1.347 ~ 19.497) , APACHE score (OR=10.098, 95% CI:1.311 ~ 77.767) is a risk factor for the prognosis of patients with organophosphorus poisoning. Logistic regression probability prediction results P=0.52, AUC:0.717 (95%CI:0.677~0.901), sensitivity: 0.70, specificity: 0.91, Kappa value: 0.460. The ROC curve was established by the APACHE II score alone, and the APACHE II score was 17.5 points, and AUC: 0.987 (95%CI:0.977~0.998), sensitivity: 0.99, specificity: 0.88, Kappa value: 0.543. Conclusion The scores of WBC, ChE, Lac and APACHE II were the prognostic factors of organophosphate poisoning. The predictive effect of the APACHE II score alone was better than that of WBC, ChE, Lac and APACHE II scoring.
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Introduction: In India, OP compounds cause more self-poisoning deaths in southern and central India. In Northern India, aluminum phosphide causes most deaths with a fatality ratio. Poisoning due to occupational exposure, accounted for about one fifth of the incidents, with a fatality ratio of less than 1%. More than 90% of the non-occupational incidents were suicidal, with a fatality rate more than 10% and the majority of the subjects are young males. Accidental exposures accounted for 8- 10% of the incidents and homicidal use (less than 1%) were other forms of poisoning. The reported overall mortality following OP insecticide poisoning varies from 4-30% in different countries and institutions. Aim: To estimate serum Amylase levels in acute organophosphorus compound poisoning and the find out the clinical outcomes. Materials and methods: The study was conducted in Government Dharmapuri Medical College Hospital, Dharmapuri. Study duration was from January 2017 to June 2017. Of a total of 145 patients with organophosphorus compound poisoning admitted to the hospital during the study period, 40 were included in the study. 10 healthy (age matched) individuals were kept as a control. Biochemical evaluation which includes Serum Amylase Blood glucose, urea, creatinine, and Liver function tests were analyzed and matched among the two groups. Results: The biochemical results have not shown much variation from the normal levels in our study. P. Elango, G. Indumathi. A study of serum amylase levels in acute organophosphorous poisoning at Government Dharmapuri Medical College Hospital, Dharmapuri. IAIM, 2017; 4(9): 6-11. Page 7 In the study, the Amylase levels were significantly elevated at the time of admission (185.2 U/L) and have shown a gradual remission with proper treatment. The mean Amylase level in severely poisoned patients was 297.7 U/L which was significantly (P < 0.01) higher than the healthy control group. On comparing the Amylase levels in first 24 hours against control, the variations were considered to be significant (P < 0.01). Conclusion: From the observation we made, it could be suggested that OP pesticide poisoning is a serious condition that needs rapid diagnosis and treatment. The mean Amylase level in first 24 hours of OP poisoning was 154 U/L which is significantly higher than the control groups.
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Introduction: Organophosphorus compound (OPC) poisoning has assumed alarming proportions and it is primarily a problem of the developing countries. Serum cholinesterase levels are easier to estimate and usually depressed after OP poisoning. Peradeniya OP poisoning scale has not been studied much in Indian scenario. So, we decided to have first hand information and hence conducted this study. Aim and objectives: To find out severity of patients with OP poisoning by calculating Peradeniya OP Poisoning score, level of plasma and RBC cholinesterase level of patients of OP poisoning on admission before any treatment, and correlate the level with severity and outcome of patients and requirement of ventilator support with OP poisoning. Material and methods: All patients who presented to emergency department with history of poisoning with known compound were taken as study subjects. A detailed history, clinical examination and relevant biochemical investigations were performed. Peradeniya OP poisoning scale Patel P, Patel VP, Patel H, Rathod GB. Study of prognostic value of serum and RBC acetyle cholinesterase level in organophosphorus poisoning and its correlation with the outcome. IAIM, 2016; 3(3): 147-157. Page 148 was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. In all study subjects, 3 ml of plain blood was collected on admission before administration of atropine and plasma cholinesterase and RBC cholinesterase was estimated. Results: Most of the patients consumed poison with a suicidal intent. Majority had consumed poison orally. Most patients had consumed 50 – 100 ml of poison. Quantity of poison consumed did not correlate with severity of poisoning. In this study, requirement of ventilatory support was seen in 16% of patients. Mortality in our study was 9%. Pseudo cholinesterase levels were significantly depressed in patients who required ventilatory support and correlated with mortality. Miosis, Bradycardia, increased respiratory rate, impaired level of consciousness, all correlated well with need for ventilatory support and increased mortality. Peradeniya OP poisoning score of more than 8 correlated in predicting the need for ventilatory support and mortality. RBC and Plasma cholinesterase levels estimation in conjunction with Peradeniya OP poisoning score is a useful parameter for grading severity of OP poisoning and in predicting the need for ventilatory support and mortality. Conclusion: The POP scale and RBC Che and plasma cholinesterase levels both showed a significant association in predicting the need for ventilatory support and outcome. Lower grade of poisoning had a better outcome whereas higher severity of poisoning had a poorer outcome.
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Objective To study the expression of hypoxia-inducible factor-1 (HIF-1) in the brain tissue after the brain injury caused by acute organophosphate poisoning,and the interventional effect and mechanism of hyperbaric oxygen (HBO) therapy.Methods Sixty healthy male Sprague-Dawley rats randomly divided into a control group (n=6),a poisoning group (n=18),a routine group (n=18) and an HBO group (n=18) according to a random number table.Acute organophosphate poisoning was induced into all rats except those in the control group.The routine group was given penehyclidine hydrochloride and pralidoxime chloride for once,while the HBO group was provided with HBO therapy immediately on the basis of routine treatment.At 1,3 and 7 hours after acute organophosphate poisoning was induced,six rats were sacrificed at each time point and the blood samples were taken from inferior caval vein to measure the content of Malondialdehyde (MDA).The expression of HIF-1α mRNA in the brain tissue was detected by the quantitative real-time PCR,and that of HIF-1 protein was evaluated by immunohistochemical method.Meanwhile,pathologic changes of the brain tissues were observed using hematoxylin-eosin (HE) staining.Results Compared with the poisoning group,the pathological damage to cerebral tissues lessened in the HBO group.The expression of HIF-1 protein and HIF-1 mRNA of the poisoning and the HBO groups was significantly higher than the control group at 3 different time points.After the HBO treatment,the protein expression of HIF-1 lowered from 226.57 ± 57.49,to 205.91 ± 30.36 and further to 187.67 ± 29.25,while the MDA content decreased from 7.74 ± 0.14,to 7.40 ± 0.13 and later to 6.10 ±0.08,both were significantly lower than those of the poisoning group at all time points,with HIF-1 being 1305.67 ± 167.17,2667.83 ± 367.79 and 1709.24 ± 199.07,along with MDA content being 9.48 ± 0.05,11.56 ± 0.13 and 12.26 ± 0.14,and those in the routine group at the time points of 1 and 3 hour later (P ＜ 0.05).A positive correlation was found between the expression level of HIF-1 mRNA and level of MDA in the serum (r =0.909,P=0.000).Conclusion HIF-1 plays an important role in the development of brain injury caused by acute organophosphate poisoning.The efficacy of hyperbaric oxygen intervention against AOPP-induced brain injury is better than that of the routine treatment and its mechanism may be its antioxidation and inhibition of HIF-1 expression.
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Background: Acute organophosphorus (OP) poisoning is one of the most common poisonings in India contributing to significant morbidity and mortality. Irreversible inhibition of cholinesterase enzymes is attributed to the serious clinical outcomes in these patients, which is assessed by the estimation of serum cholinesterase (SChE) levels. The present study was undertaken to evaluate the utility of serial estimation of SChE levels in patients of OP poisoning in predicting the clinical outcome. Methods: Medical records of 31 patients from January 2013 to December 2013 admitted in our institute with acute OP poisoning were analyzed for SChE at admission, 48 hrs, 72 hrs and 120 hrs after admission. Data regarding clinical findings at admission and outcomes were recorded. Results: Monocrotophos (55%) was the most commonly used OP compound. Mean serial SChE levels (in KU/L) at admission, 48, 72, and 120 hrs in patients who survived are 0.18±0.10, 0.28±0.14, 0.41±0.21, 0.46±0.16 and in patients who expired are 0.02±0.01, 0.05±0.02, 0.03±0.02, 0.03±0.02, respectively. SChE levels at admission in survived group, compared to those in expired group were statistically significant (p<0.001). About 92% patients in moderate to severe grade of poisoning (SChE levels <0.2 KU/L) were mechanically ventilated. The relationship between serial SChE levels in survival group and was found to be statistically significant (p<0.01). Conclusion: In the present study, significant increase in serial SChE levels were correlating with better clinical outcome as evidenced by an improvement with mechanical ventilation and survival rates in acute OP poisoning.
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Objective To explore the prognostic value of APACHE Ⅱscore in patients with Severe acute organophosphorus poi-soning .Methods 42 patients with Severe acute organophosphorus poisoning ,in which 34 cases survived ,8 cases dead ,were select-ed .The APACHE Ⅱscores of patients in first 24 h of admission were collected ,and receiver operating characteristic curves (ROC curve) were drawn .Results APACHE Ⅱ score of the 42 patients with Severe acute organophosphorus poisoning was 18 ~30 (20 .11 ± 6 .32) ,in which the survival group was(16 .10 ± 3 .12) ,the dead group was(28 .01 ± 4 .46) (P<0 .01) .With the increase of APACHE Ⅱ score ,the fatality rate gradually increased .The total area under the ROC curves of APACHE Ⅱ score for death judgment was 0 .922 ,APACHE Ⅱ score of 21 .2 was the best diagnostic point ,the sensitivity was 95% ,and specificity was 89% . Conclusion The APACHE Ⅱscore could predict severity of patients with Severe acute organophosphorus poisoning ,and APACHEⅡscore ≥21 .2 could be used as the prognosis for death of the patients .
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Objective To explore the associated risk factors on patients with organophosphorus poisoning combine with respiratory failure secondary pulmonary infection.Methods Two hundred and twenty-four clinical data of organophosphorus poisoning combine with respiratory failure were collected from January 2009 to May 2013.Retrospectively analyzed the situation of pulmonary infection and Logistic regression model were used to analyzed the relative risk of organophosphorus poisoning combine with respiratory failure secondary pulmonary infection.Results The secondary pulmonary infection rate of organophosphorus poisoning combine with respiratory failure was 68.75％ (154/224).Logistic regression analysis showed that combined with aspiration,hand hygiene,breathing machine,the decrease of cholinesterase activity were the relative risk factors (P ＜ 0.05).Conclusions The secondary pulmonary infection rate of organophosphorus poisoning combine with respiratory failure is higher.Combined with aspiration,hand hygiene,breathing machine,the decrease of cholinesterase activity may be the relative risk factors.
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Objective To investigate the changes in ATPase activity of diaphragm in rats with acute organophosphorus poisoning (AOPP) and to explore the effect of Xuebijing injection on the ATPase activity. Methods 24 clean healthy Spraue-Dawley(SD)rats were divided into control group,model group and Xuebijing treatment group by means of random number table,with 8 rats in each group. AOPP model was established by intra-gastrical administration of 50 mg/kg oxide dimethoate. In Xuebijing treatment group,after oxide dimethoate administration,intraperitoneal injection of Xuebijing(10 mL/kg)was given at the same time,while in control group and model group,equal amount of normal saline(NS)was injected via the same route. The rats were sacrificed at 6 hours after model formation,and their diaphragms were taken sterilely. The activities of Na+-K+-ATPase and Ca2+-ATPsae of diaphragms were detected by enzyme linked immunosorbent assay(ELISA). The histopathological changes in diaphragms of rats were observed with light microscopy. Results 6 hours after intoxication,the diaphragm Na+-K+-ATPase activity of rats in model group was markedly lower than that in control group(mmol?h-1?g-1:5.22±0.74 vs. 9.98±0.37,P<0.01),while the Na+-K+-ATPase activity in Xuebijing treatment group(6.93±1.14) was markedly higher than that in model group(P<0.05). The diaphragm Ca2+-ATPase activity of rats in model group was markedly lower than that in control group(mmol?h-1?g-1:7.45±0.74 vs. 12.08±0.74,P<0.01),while the Ca2+-ATPase activity in Xuebijing treatment group(9.35±1.67)was obviously higher than that in model group(P<0.05)after intoxication for 6 hours. Light microscope observation indicated that there were swelling and necrosis in diaphragm in model group,while in Xuebijing treatment group no necrosis was found. Conclusion The diaphragm was degenerated and necrotic in AOPP rats,Xuebijing injection can lessen the injury in such rats,and the curative effect may be related to the improvement of the Na+-K+-ATPase and Ca2+-ATPsae activities of diaphragm.
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Objective To discuss the correlations between hemoperfusion(HP) times and therapeutic effects/prognosis in patients with severe acute organophosphorus poisoning(AOPP). Methods According to the frequency of HP,82 patients with severe AOPP were divided into three groups:non HP(25 cases),HP1(27 cases) and HP2(30 cases)groups. The non HP group received only routine treatment,on the basis of routine treatment,the HP1 group accepted once HP within 12 hours after poisoning and the HP2 group underwent twice or more times of HP,the interval between each time being 24 hours. The comparisions of clinical indexes,incidences of complications and rates of mortality among the three groups were performed. Results With the increase of HP times,the dosages of atropine and pralidoxime chloride were significantly reduced,the times of serum cholinesterase(ChE)activity recovery,consciousness recovery,hospitalization and mechanical ventilation were significantly shortened,the score of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score in 48 hours after admission,incidence of complications and mortality were evidently decreased(all P<0.05). Compared with those in HP1 group,the dosages of atropine(mg:164.57±68.82 vs. 256.81±97.06)and pralidoxime chloride(mg:6.95±1.40 vs. 8.76±1.64) in HP2 group were significantly reduced,the times of ChE activity recovery(day:9.03±2.46 vs. 10.96±3.44), consciousness recovery(hour:23.83±6.29 vs. 39.93±8.24),hospitalization(hour:9.57±2.39 vs. 11.52±3.02) and mechanical ventilation(hour:40.50±16.55 vs. 65.74±18.88)in HP2 group were significantly shortened;APACHEⅡscore during 48 hours after admission(11.97±3.47 vs. 14.26±2.88)was obviously decreased,and the incidences of complications,such as intermediate syndrome(10.0% vs. 18.5%),rebound phenomenon(3.3% vs. 25.9%),arrhythmia(13.3%vs. 44.4%),multiple organ dysfunction syndrome(MODS,6.7%vs. 29.6%)and mortality rate(6.7% vs. 18.5%)in HP2 group were markedly decreased(all P<0.05). Conclusion It is recommendable that combined with routine treatment,early and multiple HP application would enhance the therapeutic effect and decrease the mortality in patients with severe AOPP.
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Objective To explore the therapeutic effect of lipid emulsion on acute organophosphorus poisoning and its consequence of acute lung injury. Methods A total of 48 sealant - grade Sprague-Dawley (SD) rats were randomly divided into four groups A,B,C,D,namely saline control group,lipid emulsion control group,the conventional therapy group and lipid emulsion administration group. After dichlorvos (DDVP) 11 mg/kg was given by intra-peritoneal injection,if there was no loss of DDVP during the injection process,the model of poisoning was considered to be made successfully.Then the rat models in four groups were respectively treated:with normal saline (5 ml/kg) intravenous injection in group A,lipid emulsion (5ml/kg) intravenous injection in group B,atropine (5 mg/kg) and pralidoxime chloride (40 mg/kg) intramuscular injection in group C,and combined use of lipid emulsion (5 ml/kg) with atropine and pralidoxime chloride in group D after administration of DDVP by intra-peritoneal injection.The activity of cholinesterase (CHE) in blood was detected before and 0.5 h,2 h and 4 h after DDVP poisoning. The clinical manifestations,the survival of rats,the wet weight of rat' s lung and the pathological changes of the lung tissue were observed within following 24 h. The rates of survival and symptoms of rats were compared between paired groups by using the x2 test,and the mean values of biomarkers were compared paired groups by using t test. Results In groups A and B,the intensity of muscular fasciculation and salivation were more severe and appeared sooner after DDVP exposure in comparison with groups C and D leading to lower survival rates in group A and B. Compared with group C,the rate of 24 h survival was higher and the intensity of muscular fasciculation was weaker in group D ( P ＜ 0.05 ).In group A and group B,the 24-hour survival rates were 1/12 and 2/12,respectively ( P ＜ 0.05 ).The levels of CHE in blood significantly decreased after DDVP poisoning ( P ＜ 0.05 ).There was no significant difference in activity of CHE between group B and group A,and in groups C and D,the levels of CHE in blood were not significantly higher than that in the group B 0.5 h after DDVP poisoning ( P ＜ O.05 ).In groups C and D,the activity of CHE in blood was significantly higher compared with group A and B,and that in group D was higher compared with C,and that in group B was higher compared with A 2 and 4 hours after DDVP poisoning ( P ＜ 0.05 ).In groups C and D,the wet weight of rat lung was significantly lighter compared with groups A and B,and that in group D was lighter compared with C,and that in group B was lighter compared with A 24 h after DDVP poisoning P ＜ 0.05 ).The electron microscopic findings showed the combined use of lipid emulsion with atropine and pralidoxime chloride obviously lessened the lung histopathologic changes after DDVP poisoning.Conclusions The lipid emulsion combined with atropine and pralidoxime chloride can be beneficial to controlling the toxic symptoms,reduce the death rate,accelerate the resume of the activity of CHE in blood,and relieve the lung injury induced by acute organophosphorus poisoning.
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@#Objective To explore the features and rehabilitation for organophosphate-induced delayed polyneuropathy. Methods 2 patients with serious organophosphorus-induced delayed neuropathy due to drinking tamaron and dichlorvos were reported. Results and Conclusion The patient partially recovered after physiotherapy. Long leg orthosis is beneficial to the functional recovery of lower limb.
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[Objective]To understand non-trauma mechanic ventilation treating acute respiratory failure of organophosphorus pesticide poisoning and observe the effect.[Method]16 cases of organophosphorus poisoning together with respiratory failure were treated with non-trauma mechanic ventilation,then observed clinical effect and blood-gas changes.[Result]15 cases got safe and went out of hospital;1 was opened thachea and died from multi-organic failure.Average machine time was 7.8 hours,before going machine:PaO243.92?7.95mmHg,SaO280.6?5.9%;after ventilation,the disease was stable,the artery blood-gas:PaO283.65?4.72mmHg,SaO296.6?4.1%.There's marked difference between them,no complications happened in treatment.[Conclusion]Mechanic ventilation is a key link in saving severe respiratory failure caused by organophosphorus poisoning.Success or not is closely related with going-machine time,meanwhile,the energy-recovery agent must be used enough and reasonably to quickly reach atropine function,as well as to strengthen trachea nursing,by these can death rate be reduced effectively for severe organophosphorus poisoning.