Title: Measurement of Serum Amylase in Correlation with Plasma Cholinesterase Level for Assessing the Severity of Organophosphorus Poisoning
Authors: Dr M. Ramesh MD, Dr Thenmozhi MD
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.212
Abstract
Background and Objectives: Organophosphate (OP) compound poisoning is the most commonly encountered poisoning in tertiary care hospital. Previously plasma cholinesterase level was used for predicting the severity of poisoning. It was also used to determine the clinical course. Recently serum amylase is being recommended as a better predictor of severity of poisoning. Hence in this study measurement of serum amylase in correlation with plasma cholinesterase level is being studied for assessing the severity of Organophosphate compound poisoning.
Methods: A prospective study was conducted on 100 patients admitted to emergency ward and Intensive care unit in tertiary care hospital. Serum amylase and Plasma cholinesterase levels were measured at the time of admission and at 48 hours.
Results: This Study revealed that there is significant elevation of amylase and inhibition of cholinesterase at admission and at 48 hours in OPC poisoning patients . The overall mean value for amylase was 712.66 U/L at admission (660 U/L in survivors Vs 835.13 U/L in non-survivors, p<0.001). The overall mean value for plasma cholinesterase was 1958.78 U/L at admission (2236.54 U/L in survivors Vs 1310.67 U/L in non-survivors, p<0.05). The overall mean value for amylase was 401.62 U/L at 48 hours (248.71 U in survivors Vs 758.40 U in non-survivors, p<0.001). The overall mean value for plasma cholinesterase was 3524.06 U/L at 48 hours. (4358.70 U/L in survivors Vs 1576.57 U/L in non-survivors, p<0.05).
Interpretation: The elevation of serum amylase in OP intoxicated patients can provide a high degree of prediction for subsequent respiratory failure and mortality. In such cases quick transfer of the patient to a intensive care unit will reduce the degree of mortality associated with OP poisoning.
Keywords: Organophosphate poisoning, serum amylase, plasma cholinesterase.
References
- Davies JE. Changing profile of pesticide New England Journal of Medicine 1987;316:806-808.
- Jeyaratnam J. Pesticide poisoning: as a major global health problem. World Health Stat Q 1990;43:139-144.
- Gossel, Thomas A. Principles of clinical toxicology 3rd ed., Raven Press New York
- Orfila MJB Traite des poisons tines mineral, vegetal et animal on toxicology generale sous le rapports de la medicine legale Paris: Crochard;1815
- Palmer Taylor. Anticholinesterase agents, Goodman-Gilman’s The pharmacological basis of therapeutics 9th ed, McGraw Hill, New York 1996;160.
- Stedman E. Chemical constitution and miotic action, Am. J. Physiol. 1929;90:528- 529.
- McCombie H and Saunders BC Alkyl fluoro phosphanates preparation and physiological properties, Nature 1946;157(4):287-289.
- Schrader G. Die entwickling rever insektizide auf Grindlange von organischem fluoro und phosphor verbindingen. Monographic No.62 Verlag Chemie, Winheim 1952.