Title: Pancreatic Involvement in Different Agricultural Poisoning
Authors: Dr Anil Kumar Patra, Dr Ayaskanta Kar, Dr Sagnika Tripathy
Introduction: Acute pancreatitis as a complication in agricultural poisoning like organophasphorous and other non OPs has been reported time to time but large scale studies are still lacking as a whole in agricultural poisoning group and especially in non OPs.
Objective: To find out prevalence of pancreatitis in agricultural poisonings and correlate the serum amylase and lipase level with clinical severity in terms of outcome.
Study Design: Hospital based observational study.
Study Setting: The study was done in the Department Of General Medicine, VIMSAR, Burla, Odisha.
Study Duration: Study duration was from November 2016 to October 2018(24 month)
Subjects and Methods: 200 patients of age >14 years who have ingested any agriculturally used substance were included in the study. Past medical history of pancreatic, hepatic or kidney disease or any other causes of hyperamylasemia were kept as exclusion criteria. Serum amylase and lipase was measured on day 1, day 3 and day 5 after ingestion. Clinical features were noted and more than three times of upper normal limit were taken diagnostic and USG abdomen was done for radiological evaluation in biochemically diagnosed cases of pancreatitis.
Results: Organophosphorus compound were the largest group of poison with 121 patients followed by herbicide with 40 patients. Serum amylase was raised in 33% of the patients and 19.5% patients were having amylase more than 3 times UNL.19% of OP and 20% of herbicide poisoning cases were having amylase >330 U/L. Mean level of amylase was 160.5U/L in agricultural poisoning, 262.2U/L in death group,139.94U/L among survivor.15% of cases were having lipase raised more than 3 times of UNL. Mean lipase value was 130.91U/L.10(5%) of patients were having pancreatitis in ultrasonography. 15(7.5%) cases both pain abdomen and raised amylase >3 times was found and in 10 (5%) cases pain abdomen and raised lipase >3 times was found fulfilling the diagnostic criteria. Mortality was 17.55%. Mortality in poisoning complicated with pancreatitis was 50%.
Conclusion: Pancreatitis in agricultural poisoning is common. Not only the OPs but non-OPs like herbicide, pyrethroid, carbamate leads to pancreatitis as a complication. Serum amylase and lipase significantly correlate with disease severity in terms of mortality and can be useful as a prognostic indicator.
Keywords: Agricultural poisoning, OP-organophosphorous, UNL-upper normal limit.