Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

ABSTRACT

Background: Organophosphorus Compounds (OPC) are main cause of accidental and suicidal poisoning in agrarian countries like India. Aim was to study the clinical profile of OPC-Poisoning and correlate it with the electrocardiographic (ECG) changes and electrolyte abnormalities.Methods: Hundred consecutive cases admitted to Medicine Department underwent clinical examination, ECG, electrolytes, Acetyl Choline Esterase (AChE) estimation from time to time and Paradeniya Organophosphorus Poisoning (POP) score at the time of admission. All these parameter with duration of hospital stay and outcome were statistically analysed using X2 test, Fisher exact test, and inference was drawn.Results: In hundred OPC-Poisoning patients [Male (n=48), Female (n=52), M F ratio 0.921] with mean age of 37.78�.95 years, commonest poison was cholropyrifos+cypermethrin and was mostly suicidal (96%). Common symptoms were sweating (48%), salivation, blurring of vision, breathlessness and signs were smell of poison (90%), tachypnea, altered sensorium, miosis and fasciculation. POP scoring found 41% of patients in mild, 26% in moderate and 33% in sever grade of poisoning. Hospital stay ranged from 4-18 days. Complications were pulmonary Edema (PE) in 28%, Respiratory Failure (RF) 18%, Aspiration Pneumonia (AP) 15% and Intermediate Syndrome (IS) 4%. 10 died out of 42 patients who had complications and the cause of death was RF in 4, Ventricular Fibrillation (VF) 2 and IS in 2. ECG finding showed sinus tachycardia (31%), prolonged corrected QT (QTc) interval (28%), sinus bradycardia (25%), ST-T changes (17%) and Premature Ventricular Contraction (PVC) in 4% which degenerated to VF in 2%. 24 patients were Hypokalemic from which 16 developed complications.Conclusions: Similar to earlier studies we observed poisoning which was suicidal. QTc prolongation and Hypokalemia are associated with high morbidity and mortality in OPC-Poisoning.