Title: Creatine Phosphokinase: A Prognostic Marker in Organophosphorus Compound Poisoning

Authors: Subathra.C, S. Balasubramaniyan, I. Balaji, K. Haynes Raja

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i10.157

Abstract

Background: In developing countries like India, organophosphorus compounds (OPC) constitutes for 80% of pesticide poisoning. Creatine phosphokinase (CPK) is emerging recently as a prognostic marker in OPC poisnoning. This study is done to analyse the clinical utility of CPK in OPC poisoning patients.

Aim: To estimate Serum CPK levels in patients who have consumed Organophosphorous compound (OPC) poisoning and to assess the role of Serum CPK (CPK) as a marker of severity and correlate it withthe incidence of respiratory failure and final outcome in OPC poisoning.

Materials and Methods: 50 patients of acute OPC poisoning, aged 14 years and above, admitted in Rajah Muthiah medical college and hospital, within 6 hours of exposure irrespective of route of exposure and sex were selected and subjected for study. They were assessed clinically on admission by Peradeniya OPC Poisoning scales and categorized according to the severity. Then, they were also subjected to estimation of serum CPK at the time of admission and 48 hours after admission.

Results: CPK values were increased among 60% of study group at 0 hours and 68% at 48 hours. There was a significant increase in serum CPK levels from 0 to 48 hours which is of high statistical significance (p =0.001).

Conclusion: The correlations of serum CPK with outcomes such as ventilatory function and survival of the patient were statistically significant and positive at both periods of measurement. Therefore, serum CPK measurement is not only crucial at 0 hours, it is equally important to have serial monitoring of serum CPK levels, which ultimately tells the prognosis of the patients.

Keywords: organophosphorus compound poisoning, Creatine phosphokinase (CPK), Prognosis.

References

  1. Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: a nationally representative survey. The Lancet. 2012 Jun 23; 379(9834): 2343–51.
  2. Bhattacharyya K, Phaujdar S, Sarkar R, Mullick OS. Serum Creatine Phosphokinase: A Probable Marker of Severity in Organophosphorus Poisoning. Toxicol Int. 2011; 18(2): 117–23.
  3. Peter JV, Sudarsan TI, Moran JL. Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med. 2014 Nov;18(11):735–45.
  4. Lin T-J, Jiang D-D, Chan H-M, Hung D-Z, Li H-P. Prognostic Factors of Organophosphate Poisoning Between the Death and Survival Groups.The Kaohsiung Journal of Medical Sciences. 2007 Apr 1;23(4):176–82.
  5. S S. Neurological syndromes following organophosphate poisoning. Neurology India. 2000 Oct 1; 48(4): 308.
  6. Eddleston M, Mohamed F, Davies JO, Eyer P, Worek F, Sheriff MR, et al. Respiratory Failure in Acute Organoph-osphorus Pesticide Self-Poisoning. QJM. 2006 Aug; 99(8): 513–22.
  7. Vanneste Y, Lison D. Biochemical Changes Associated with Muscle Fibre Necrosis after Experimental Organophosphate Poisoning. Hum ExpToxicol. 1993 Sep 1; 12(5): 365–70.
  8. AbdelmonemGodaMadboly_Correlation between Serum Creatine Phosphokinase and Severity of Acute Organophosphorus Poisoning.pdf.
  9. M. Hassan N, Madboly A. Correlation between Serum Creatine Phosphokinase and Severity of Acute Organophosphorus Poisoning: A Prospective Clinical Study (2012-2013). IOSR Journal Of Environmental Science, Toxicology And Food Technology. 2013 Jan 1;4:18–29.
  10. Sen R, Nayak J, Khadanga S. Study of serum cholinesterase, CPK and LDH as prognostic biomarkers in organophosphorus poisoning. International Journal of Medical Research and Review [Internet]. 2014 Jun 30 [cited 2018 Oct 17];2(03). Available from: http://medresearch. in/index.php/IJMRR/article/view/101
  11. Kumar GC, Bhuvana K, Venkatarathnamma PN, Sarala N. Serum creatine phosphokinase as predictor of intermediate syndrome in organophosphorus poisoning. Indian Journal of Critical Care Medicine. 2015 Jul 1;19(7):384.
  12. Senanayake N, de Silva HJ, Karalliedde L. A Scale to Assess Severity in Organophosphorus Intoxication: POP Scale. Hum ExpToxicol. 1993 Jul 1;12(4):297–9.
  13. Counselman FL, McLaughlin EW, Kardon EM, Bhambhani-Bhavnani AS. Creatine phosphokinase elevation in patients presenting to the emergency department with cocaine-related complaints.The American Journal of Emergency Medicine. 1997 May 1;15(3):221–3.
  14. John M, Oommen A, Zachariah A. Muscle Injury in Organophosphorous Poisoning and Its Role in the Development of Intermediate Syndrome. NeuroToxicology. 2003 Jan 1;24(1):43–53.
  15. Calore EE, Sesso A, Puga FR, Cavaliere MJ, Calore NMP, Weg R. Sarcoplasmic lipase and non-specific esterase inhibition in myofibers of rats intoxicated with the organophosphate isofenphos. Experimental and Toxicologic Pathology. 1999 Jan 1;51(1):27–33.
  16. Sahjian M, Frakes M. Crush Injuries: Pathophysiology and Current Treatment. The Nurse Practitioner. 2007 Sep;32(9):13–8.

Corresponding Author

Dr S. Balasubramaniyan, M.D.

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