Prevalence of Acute Pancreatitis and Hyperamylasemia in Acute Organophosphorus poisoning in Kashmir valley (North India)

Abstract

Organophosphorus poisoning is soaring due to easy availability in rural settings of developing countries. There are many reports of Acute Pancreatitis associated with OP poisoningand a casual relationship has been demonstrated in animal models. This study was therefore designed to determine the prevalence of hyperamylasemia and acute pancreatitis in organophospate poisoning in our setup and to reduce mortality and hospital stay by its early detection. This is a cross sectional hospital based study carried out in SKIMS Medical College, Srinagar, J&K which is tertiary care facility. All patients included were above 18 years of age with a recent history of organophosphate ingestion, cutaneous absorption or inhalation with clinical signs and symptoms of organophosphate poisoning. Confounding factors like drugs causing pancreatitis, ERCP within 24 hrs, previous history of pancreatitis, cholelithiasis and or any other local pathology were excluded. Serum Amylase and Lipase were measured. Imaging like ultrasonography and CT scan Abdomen was ordered. BISAP scoring was used to assess severity of acute pancreatitis. 50 patients with ingestion of organophosphates were evaluated. 23 patients developed abdominal pain, among which 11 patients had hyperamylasemia while 7 developed Clinical acute pancreatitis with high lipase and imaging findings. 2/3 of patients who developed pancreatitis had mild severity while other 1/3 had severe severity. Pancreatitis in Organophosphorus is not uncommon and needs high clinical suspicion for early diagnosis and management.