Study to evaluate the correlation of serum cholinesterase levels, peradeniya clinical score at presentation and severity of organophosphorus poisoning
Author(s): Dr. Gulshan R Thakare, Dr. Chandrashekhar S Dhurve and Dr. Baba S Yelke
Background: The incidence of OP poisoning in India is among the highest in the world. The Peradeniya Organophosphorus Poisoning scale assesses the severity of poisoning based on the symptoms at presentation and is simple to use. We planned this study to evaluate the correlation of serum cholinesterase levels, Peradeniya clinical score at presentation and severity of organophosphorus poisoning.
Methodology: A prospective observational study was conducted on 140 adult patients with history of acute OP poisoning. The diagnosis was made based on history or evidence of exposure to OP compound within 24 hours, assessment was also done based on the POP scaling system. A score of 0 to 3 is considered as mild poisoning, 4 to 7 as moderate poisoning and 8 to 11 as severe poisoning. Pseudocholinesterase were measure to assess the severity of poisoning as per Proud foot classification. Correlation between serum cholinesterase level and POP was assessed.
Results: Majority of the patients (32.14%) belongs to age group between 31-40. Mean age of patients were 40.41±9.55 years. Male (69.28%) and rural (91.42%) patients were more common. Most of the patients had suicidal poisoning (87.85%). More than 50% of the poisoning cases were caused by Monocrotofos, Chlorpyrifos and Profenophos. Nausea, vomiting and sweating were more common symptoms and present in more than 60% of the patients. The most frequent sign was miosis (55.71%) patients, tachypnea (42.14% patients) and fasciculation (34.28% patients). 32.85% patients had moderate and 7.85% patients had severe poisoning according to their POP score. All the patients with severe POP score needed the ventilator support, positive correlation between the POP score and the need for ventilator support. Overall mortality was (8.57%). Patients with low Pseudocholinesterase level had higher incidence of need for ventilator support. The relation between POP score and the Sr. Pseudocholinesterase levels was statistically significant. As the severity of poisoning increases the average dose of Atropine needed to treat the patients also increases. As the severity of the poisoning increases, the dose of Pralidoxime needed to treat patients also increases.
Conclusion: Patients with low POP score and high level of Sr, Pseudocholinesterase level needed less ventilator support as compared to patients with high POP score and low Sr, Pseudocholinesterase level. Mortality is more in patients with high POP score and low Sr, Pseudocholinesterase. There is significant correlation between POP score, Sr, Pseudocholinesterase level and need of mechanical ventilation and final prognosis in patients with acute organo-phosphorous poisoning and can be can be used as a prognostic marker indicating severity of the poisoning.
Dr. Gulshan R Thakare, Dr. Chandrashekhar S Dhurve, Dr. Baba S Yelke. Study to evaluate the correlation of serum cholinesterase levels, peradeniya clinical score at presentation and severity of organophosphorus poisoning. Int J Adv Res Med 2023;5(2):78-84. DOI: 10.22271/27069567.2023.v5.i2b.481