RESUMO
Background:POP scale andserum cholinesterase estimation are purported to be meaningful indicators for mortality prediction in the cases of organophosphorus poisoning. The present study was undertaken to substantiate the correlation ofPOP scale score and serum cholinesterase levels in acute OP poisoning with mechanical ventilation requirement and mortality in our setting. Methods:Data of 150 eligible participants was collected, with POP scale andserum cholinesterase levels being assessed during initial presentation in each of them. Clinical course of the cases was monitored anddocumented. Results:The observed case fatality rate was 32.7%. POP scale scoring revealed 30out of 75 patients to be from moderate group and 19 out of 22 patients to be from severe group. Forty nine outof 75 in moderate group & all patients in severe group required ventilator support. With respect to Serum Cholinesterase level; 20 out of 23 and 29 out of 77 patients died in the severe & moderate poisoning categories respectively. Forty eight out of 77 in moderate poisoning andall patients in severe poisoning required ventilator support. Conclusions: POP scale scoring and serum Cholinesterase level assessments are clinically relevant indicators in acute OP poisoning cases and are of great utility towards assessment ofmechanical ventilation requirement and mortality prediction.
RESUMO
Background: Organophosphorus insecticides are one of the most common causes of poisoning in India. It has a high mortality rate and accounts for a third of suicidal deaths in south-east Asia.Methods: The objectives were to estimate serum pseudocholinesterase and creatine phosphokinase (CPK) levels in organophosphorus poisoning and correlate them with theseverity and prognosis described by the Peradeniya organophosphorus poisoning (POP) scale at initial presentation.This was a cross-sectional study conducted over 18 months. A total of 180 organophosphorus-poisoning subjects were divided into mild, moderate and severe grades based on POP scale at admission. Serum pseudocholinesterase and CPK levels were estimated at admission. The outcome was noted, and the results were statistically analysed.Results:It was found that 112 (62.2%), 51 (28.3%) and 17 (9.4%) patients had mild, moderate and severe poisoning, respectively, according to POP scale. Mean pseudocholinesterase level (units/litre) was 2393.29, 1104.37 and 638.18 and mean serum CPK level (units/litre) was 153.41,344.94 and 280.53 in mild, moderate and severe poisoning, respectively. ICU and ventilator were required for 84 (46.75%) and 72 (40%) patients, respectively. Mortality was 17.8%. Negative, weak and significant correlation was seen between POP score and pseudocholinesterase (r=-0.265, p=0.00). Positive, moderate and significant correlation was seen between POP score and CPK levels (r=0.449, p=0.00).Conclusions: POP scale applied at admission along with serum pseudocholinesterase and CPK levels serve as a simple and effective system to determine early need for ventilation and mortality in rural, peripheral centres in developing nations.
RESUMO
Background: There has been a steady increase in the use of organophosphates (OPs) as pesticides in most of the developing countries including India for more than 50 years. OPs tend to be the commonest cause of poisoning worldwide and are persistently and deliberately used in suicides in Agrarian areas. As stated by WHO, 3 million cases of pesticide poisoning occur every year, of these about 1 million are accidental and 2 million are suicidal poisonings, resulting in more than 0.25 million deaths per year. As there is limited availability of facilities and resources in developing countries, all OP poisoning patients are not managed in intensive care units. Hence it is important to understand the clinical features and other factors that indicate severity of poisoning which should be identified in the initial examination.Methods: It was a hospital based prospective study of 100 OP poisoning patients that were attending to casualty of BIMS Hospital and Medical College Belagavi, India. Over a period, patients fulfilling inclusion criteria were included and patients were categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum cholinesterase level measured at the time of admission.Results: The patients were in the age group of 18 to 70 years. Majority of the patients were in the age group of 21-30 years (51%). Sixty nine percent of the patients were from rural areas and 38% of them were farmers. Sixty nine percent of patients were from low socioeconomic stratum. Major route of intake of poison was ingestion. Eighty four percent of patients consumed poison with a suicidal intent. In this study, authors observed that there is a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase at the time of initial presentation of the patients (P<0.001).Conclusions: Present study concluded that significant correlation between the degree of derangement in serum cholinesterase level and severity of poisoning at the initial presentation. Higher the score on the POP scale, the greater was the degree of derangement in the serum cholinesterase level.