Evaluation of the severity of organophosphous insecticide intoxication using poisoning severity scoring, laboratory and therapeutic parameters

ABSTRACT

Organophosphorus [OP] compounds are the most widely used insecticides that cause poisoning after accidental, occupational or suicidal exposure. Poisoning is particularly common in the developing countries where more potent agents are widely available for agricultural and household purposes. The aim of the study was to evaluate the role of poisoning severity score [PSS], different laboratory and therapeutic measures in assessment of severity of OP poisoning, and to determine the need for intensive care management in cases of OP intoxication. One hundred patients suffering from acute OP poisoning were interviewed and categorized clinically according to PSS into three grades. Routine laboratory tests were done including arterial blood gases, random blood sugar and serum potassium on admission. Specific tests were estimation of pseudo choline sterase activity on admission and serum amylase on admission and after six hours. The studied patients received different lines of treatment in the form of general measures plus atropine or atropine and pralidoxime with or without assisted mechanical ventilation.55% of patients had the mildest degree of OP intoxication [PSS1], 31% had PSS2 and 14% were graded as PSS3. Significant correlation was detected between the degree of poisoning assessed by PSS and different laboratory investigations as well as the lines of treatment used. Cases having the highest score of severity [PSS3] had the lowest psudocholinesterase activity with more pronounced hyperglycemia, hypoxia, metabolic acidosis and hypokalemia. Acute pancreatitis occurred specifically in them. They needed atropine and pralidoxime in addition to assisted mechanical ventilation with longer stay in hospital than other cases. Accordingly, all these parameters including clinical scoring[PSS], laboratory findings and lines of treatment needed can be used for determination of the severity of OP poisoning. They are recommended to be applied in all OP-intoxicated patients