Abstract

Background: It is apparent that although inhibition of cholinesterase plays an important role in organophosphate (OP) toxicity, other factors are also important. One of the contributing factors for its severity is electrolyte imbalances esp. hypokalemia. This study was aimed at evaluating the levels of hypokalemia along with plasma cholinesterase (PChE) levels in predicting morbidity and mortality of acute OP poisoning in patients presenting in our hospital.

Methods: In this cross sectional study, patients with definitive diagnosis of OPC poisoning were enrolled. Pre-interventional history and clinical features were noted with severity assessment done according to Proudfoot classification, along with measurement of serum potassium ([K+]) and PChE levels.

Results: Thirty OP poisoned patients (22 men, 8 women) were enrolled. A total of 30 cases who presented with clinical features of opc poisoning were classified according to Proud foot classification. Among them, 68.4% of cases (13 out of 17) developed hypokalemia. Muscle weakness and fasciculations developed with mean serum [K+] levels of 2.90 ± 0.11. Ventilatory support was required at the mean serum [K+] levels of  ± 0.10 mmol/L. Mortality was noted when the mean serum [K+] reduced to 2.7 ± 0.06 mmol/L. Correlation of the ventilator support and mortality with serum [K+] was significant (P < 0.001). Death was mostly observed among patients who had respiratory distress associated with hypokalemia and severly reduced PChE.

Conclusion: With severe clinical features of OP poisoning, there was severe reduction in serum [K+] and PChE levels. Hence, these biochemical findings can be encouraged as predictive markers of severity of op poisoning. Clinicians and medical toxicologists should consider hypokalemia as an alarming sign of poor prognosis in OPC poisoned patients.

Keywords: Hypokalemia ; Organophosphate Poisoning; Prognosis.