Prognostic Significance of Various Biochemical Parameters in Acute Organophosphorus Poisoning

BACKGROUND: Organophosphorus (OP) compounds are a heterogeneous group of insecticides widely used in agricultural industry. These OP compounds are likely to have more adverse effects in developing countries like India due to its easy availability and less awareness which results in high morbidity and mortality. AIMS AND OBJECTIVES: 1. To estimate plasma cholinesterase, amylase, lipase and, creatine phosphokinase (CPK) in acute OP poisoning. 2. To correlate these biochemical parameters with plasma cholinesterase levels in OP poisoning. 3. To determine the use of a biochemical marker in predicting the severity of acute OP poisoning. MATERIALS AND METHODS: A hospital based observational study was conducted on 53 subjects who have clinically diagnosed of acute OP poisoning and admitted in emergency unit of a tertiary care rural hospital. Subjects of either gender of all age-groups were included in the study. On admission, plasma cholinesterase, serum amylase, lipase and CPK were measured. Based on plasma cholinesterase activity at the time of admission, subjects were divided into three groups. Group I-having 20-50% of plasma cholinesterase activity; Group II-10-20% of plasma cholinesterase activity; and group III-<10% of plasma cholinesterase activity. RESULTS: Serum amylase, lipase and CPK were negatively correlated with plasma cholinesterase levels. Serum amylase showed statistically significant negative correlation with plasma cholinesterase. Serum amylase showed the highest diagnostic accuracy for assessing severity of poisoning followed by CPK and Lipase. CONCLUSION: OP poisoning is associated with hyperamylasemia. Serum amylase, lipase and CPK can be used as an additional prognostic indicator with plasma cholinesterase levels. Serum amylase could be considered as a better predictor of severity followed by CPK and lipase.