Mild Poisoning Research Articles

Correlation of Pseudocholinesterase Level with Clinical, Biochemical Parameters Including Cardiac Profile and the Outcome in Organophosphorus Poisoning.

Poisoning is a significant health hazard and a leading cause of morbidity and mortality worldwide. India, being a predominantly agrarian country, routinely employs organophosphate (OP) pesticides in farming, and they are readily available "over the counter." OPs exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous systems. Due to the limited availability of facilities and resources in health-care systems, and economically restraining patients, it is necessary to rely more on clinical features to assess the severity of poisoning and manage the condition properly. It was a hospital-based prospective observational study that included patients aged >13 years in a tertiary care hospital. All patients were clinically evaluated based on their history and examination. The diagnosis was made based on characteristic clinical manifestations or evidence of exposure to organophosphorus compounds (corroborative evidence such as empty containers and the odor of gastric aspirates). Clinical severity was assessed and categorized according to the Peradeniya Organophosphorus Poisoning Scale (POP scale). A score of 0-3 is considered mild poisoning, 4-7 as moderate poisoning, and 8-11 as severe poisoning. Out of the 50 patients enrolled in the study, 17 (34.00%) were aged <20 years, 19 (38%) were in the 20-30 years age group, and 14 (28%) were aged >30 years. Ingestion is the only mode of exposure to poisoning. None of the patients had history of contact or inhalational exposure. Of the 50 cases, 12 (24.0%) were in the mild category, 26 (52.0%) in the moderate category, and 12 (24%) in the severe category on the POP grading. A comparison of the mean serum pseudocholinesterase, troponin-T, and pro-BNP levels with severity was performed. In mild OP poisoning, the mean serum PChE level was 2766.58 ± 1120.44; in moderate, it was 1969.35 ± 1330.07, and in severe, it was 701.83 ± 961.17. Pseudocholinesterase levels decreased progressively with increasing clinical severity from mild-to-severe cases, and this association was statistically significant (P < 0.001). Two-dimensional echocardiography screening done in all patients did not show any significant abnormalities. This study shows that serum PCE is reduced in OP poisoning and correlates with the clinical severity grading done by the POP scale and is also associated with an increase in the duration of intensive care unit stay. No significant evidence of direct cardiac injury was observed in this study. A low Glasgow Coma Scale score and an increased respiratory rate at presentation are associated with poor outcomes.

Serum Potassium Level in Acute Organophosphorus Poisoning and its Correlation with Severity in Patients Presenting to Emergency Room in a Tertiary Hospital

Background: Organophosphorus compounds (OPCs) are common causes of accidental and suicidal poisoning in agricultural countries like Nepal. Serum cholinesterase, used to diagnose organophosphorus poisoning (OP), is not reliable for predicting its severity. This study aimed to assess serum potassium as an alternative prognostic indicator for OP poisoning severity. Methodology: This single-centric cross-sectional study included patients presenting with OP poisoning at a tertiary care center over six months. Total 86 cases met the inclusion criteria. The Peradeniya organophosphorus poisoning (POP) scale categorized patients by severity. The association between OP poisoning severity and serum potassium level at presentation was studied. Results: Of the 86 cases, 47 (55%) were females. The mean age was 26.96 years (SD: 8.73), ranging from 18 to 65 years. Most cases, 53% (n=46), were aged 20-29 years. Chlorpyriphos (50%) + cypermethrin (5%) was the most common OP compound, used in 29% cases. Malathion (50%) was the least used, in 7% (n=6) of cases. At presentation, 36% (n=31) had hypokalemia, among which 6 had mild poisoning (POP score: 0-3), while 25 had moderate to severe case of poisoning (POP score: 4-11). The association between OP poisoning severity and hypokalemia was statistically significant (p-value &lt;0.001, OR: 23.958, 95% CI). Conclusion: Serum potassium levels in patients presenting within 12 hours of OP poisoning significantly correlate with severity, as determined by the POP scale. Hypokalemia is prevalent in moderate to severe OP poisoning cases, with higher POP scores linked to lower serum potassium levels.

Evaluation of Lac and NGAL on the Condition and Prognosis of Patients with Diquat Poisoning.

This study aims to explore the evaluation of lactic acid (Lac) and neutrophil gelatinase-associated lipocalin (NGAL) on the condition and prognosis of patients with diquat (DQ) poisoning. A total of 79 cases of DQ poisoning treated in one hospital from January 2019 through February 2023 were included: 10 cases of mild poisoning, 49 cases of moderate to severe poisoning, and 20 cases of fulminant poisoning. According to the Kidney Disease: Improving Global Outcomes-acute kidney injury (KDIGO-AKI) criteria, the patients were divided into 60 cases in the AKI group and 19 cases in the non-acute kidney injury (NAKI) group. According to the AKI diagnostic indicators, AKI patients were divided into Grade I, Grade II, and Grade III. According to prognosis, the patients were divided into survivor group and non-survivor group. During the same period, 30 healthy subjects were selected as the healthy group. The changes of blood Lac, NGAL, cystatin C (CysC), and serum creatinine (Scr) levels of patients were detected, the 28-day survival of patients was recorded, and the correlation between blood Lac, NGAL levels, and renal injury grade in patients with AKI caused by DQ poisoning was analyzed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value and prognostic value of Lac, NGAL, and their combination in patients with AKI caused by DQ poisoning. There were significant differences in AKI grade, Lac, NGAL, CysC, and Scr levels among different degrees of poisoning groups (P < .05). There were significant differences in the levels of Lac, NGAL, CysC, and Scr among patients with different AKI grades (P < .05). The levels of Lac, NGAL, CysC, and Scr in the survivor group were significantly lower than those in the non-survivor group (P < .05). The blood Lac and NGAL levels were positively correlated with AKI grades in patients with DQ poisoning (r = 0.752, 0.836; P = .000, .000). The combined detection of blood Lac and NGAL had higher predictive value for AKI and assessed value for death in DQ poisoning than either of them alone. The combined detection of Lac and NGAL have a certain clinical value in AKI grading and evaluating AKI prognosis caused by DQ poisoning.

Rise of Pregabalin Poisoning and Abuse Cases in Serbia: A Ten-Year Retrospective Study.

The aim of this study was to analyze data on gabapentinoid-related attendances to the National Poison Control Center of Serbia (NPCC), particularly abuse cases; to estimate its changes and to compare it with trends in national consumption rates of these drugs. We also aimed to analyze the main characteristics of the study population and to investigate the major clinical effects in poisoned patients. This is a retrospective study of patients admitted to the NPCC for acute poisoning involving gabapentinoids from 1 May 2012 to 1 October 2022. There were 357 (95.5%) pregabalin-related and 17 (4.5%) gabapentin-related poisoning cases in 302 patients. Abuse of pregabalin was detected in 27.8% (84/302), while gabapentin abuse occurred in 0.7% (2/302) of all patients. A steady increase in rates of pregabalin poisoning and abuse cases strongly correlated with the increase in overall consumption of this drug, while there were no significant changes in rates of gabapentin consumption, poisoning and abuse rate during the study period. Most patients who abused pregabalin pregabalin were males (84.5%) and the median age was 26 years (range: 15-45 years). Almost 60% of patients who abused pregabalin (48/84) belonged to the migrant population. Co-ingestions occurred in 89.4% of pregabalin-related cases (319/357), resulting in more severe poisoning. The most often co-ingested drugs were benzodiazepines and among them clonazepam was detected in the largest number of cases. The poisoning and abuse cases involving pregabalin are on the rise in Serbia, which coincided with an increase in its overall consumption during the study period. Isolated pregabalin ingestions resulted in mild poisoning, although severe symptoms such as coma and bradycardia were recorded. When prescribing pregabalin to patients at risk of abuse caution is needed. Strengthening the measures for dispensing of pregabalin may reduce the risks associated with its abuse.

A CROSS SECTIONAL STUDY TO ASSESS THE SEVERITY OF ORGANOPHOSPHORUS POISONING AND ITS CORRELATION WITH PSEUDOCHOLINESTERASE ESTIMATION

Background &amp; objectives Organophosphorus (OP) compounds is the most common poisoning. Serum pseudocholinesterase enzymes levels are routinely measured in OP compound poisoning. The Peradeniya Organophosphorus Poisoning (POP) scale is used to assess the severity of the poisoning. So this study was conducted to assess the severity using POP scoring system and to estimate serum pseudocholinesterase values in OP compound poisoning patient. Methods A cross sectional study was conducted on 100 patients admitted under Department of General medicine , Adichuchunchanagiri hospital and research centre, B.G. Nagara. Results Among the patients, 47% had mild poisoning, 48% had moderate poisoning and 5% had severe poisoning according to POP Scale. Patients who had lower level of serum pseudocholinesterase had increased mortality. ConclusionThere was good association between POPScale and serum pseudocholinesterase levels and severity of poisoning. Our study shows that the severity of poisoning had a direct relation with the pseudocholinesterase levels.

Evaluation Of Cholinesterase Levels In Vegetable Farmers In Pekanbaru

Pesticides are chemical substances to control and eradicate pests. However, pesticide residues hurt farmers indirectly. The level of pesticide poisoning in the body can be known by examining cholinesterase levels. This study aims to determine cholinesterase levels in the blood of vegetable farmers on Jalan Kartama, Pekanbaru City. The sampling technique used in this research is purposive sampling. The method used in this research is. The results of the examination showed that from 20 serum samples from farmers, 11 people (55%) had cholinesterase levels according to reference values ??(not poisoned) and 9 people (45%) had mild poisoning. Other factors that can cause a decrease in cholinesterase levels in the body are working period ? 5 years, spraying pesticides against the wind and using incomplete Personal Protective Equipment (PPE). Therefore, vegetable farmers are expected to wear complete Personal Protective Equipment (PPE) when spraying pesticides and spraying in the direction of the wind.

Parameters of the Blood Oxidant/Antioxidant System in Elderly Patients with Acute Poisoning

The aim of the study was to assess the oxidant/antioxidant status in elderly patients in the early period of acute poisoning by psychotropic drugs or corrosive substances.Material and methods. An open prospective observational study with retrospective control was conducted in 80 patients (age ≥ 60 years) with acute poisoning, of which 49 patients aged 72.1±9.55 years had psychotropic drug poisoning (PDP) and 31 subjects aged 73.0±10.3 years had corrosive substance poisoning (CSP). Patients with mild poisoning were excluded from the study. The control group consisted of 39 volunteers aged 68.3±6.3 years. Total antioxidant status (TAS), blood levels of malondialdehyde (MDA), stable nitric oxide metabolites (nitrite/nitrate, NOx), and oxidative stress index (MDA/TAS) were measured on days 1, 3 and 5 after hospital admission.Results. When analyzing the changes in the parameters of the oxidant/antioxidant system, we observed lower values of the studied parameters in patients with both PDP and CSP compared to the control group. In patients with PDP, several parameters were reduced: MDA by 1.2 times on days 1 and 3 (P=0.002; P=0.008, respectively), NOx by 1.7 times (P&lt;0.001) at all stages of the study, MDA/TAS by 2.4–2.9 times (P&lt;0.001). In patients with CSP, MDA level decreased by 1.1–1.2 times at all study timepoints (P=0.003; P=0.010; P=0.046, respectively), NOx dropped 1.4–1.6-fold (P=0.012; P=0.004; P=0.023, respectively), and MDA/TAS decreased by 2.3–2.4 times (P&lt;0.001). While comparing patients with favorable and fatal outcome, we found that in survived patients an increase of MDA/TAS along with growing NOx level was seen by day 5 with no significant changes of MDA and TAS, while in non-survivors MDA/TAS dropped continuously due to progressive fall of NOx level, reaching values 2.8–2.9 times (P&lt;0.001) lower than those of the controls.Conclusion. In elderly patients with acute poisonings due to psychotropic drugs or corrosive substances, an inadequate response of the oxidant/antioxidant system occurs manifesting as a reduced blood level of peroxidation products with simultaneous normal or slightly decreased concentration of antioxidant protection system components. Thus, the oxidative stress develops, which contributes to the death of the patients.

Emergency psychological intervention of acute ammonia leakage event

Objective: To analyze the situation of emergency psychological intervention in an acute ammonia leakage event, and to provide reference for emergency response. Methods: In August 2020, the emergency treatment of 65 patients admitted by Zhangqiu District People's Hospital Affiliated to Jining Medical College of Shandong Province in June 2019 in the ammonia tank car leakage incident was analyzed, the psychological intervention in emergency after the incident was collected, the anxiety and depression were evaluated by symptom checklist 90 (SCL-90) , and targeted psychological intervention was implemented according to the psychological evaluation results, And analyze the intervention efficiency. Results: Among the 65 patients, there were 52 cases of ammonia stimulation reaction, 11 cases of mild poisoning and 2 cases of moderate poisoning. There were 60 cases of chest tightness and dyspnea, 11 cases of bloody sputum, 58 cases of sore throat, 43 cases of hoarseness, 28 cases of photophobia and tears, 13 cases of blurred vision, 18 cases of nausea and vomiting, and 2 cases of dry and wet rales in the lungs. The scores of somatization, depression, anxiety, hostility, phobia, paranoia and negative coping in patients with mild and moderate poisoning were higher than those in patients with stimulus response (P<0.05) . The effective rate of intervention was 98.7%. Conclusion: Emergency psychological evaluation and intervention in mass public health events are helpful to the treatment of patients.

CT Imaging in the Diagnosis of Lung Injury of Organophosphorus Poisoning and Analysis of Its Correlation with Procalcitonin and C-Reactive Protein Levels

This study focused on the application value of CT images of patients with organophosphorus poisoning lung injury. Specifically, 50 patients diagnosed with organophosphorus pesticide poisoning lung injury in the hospital were selected as research subjects. They all had chest CT examinations. Patients were classified according to different degrees of poisoning, and different groups were compared for the levels of C-reactive protein (CRP) and procalcitonin (PCT) in the serum. The results showed that, of the 50 patients, 25 patients had mild organophosphorus poisoning, accounting for 50%, 14 patients had moderate poisoning, accounting for 28%, and 11 patients suffered from severe organophosphorus poisoning. It was found that, in AOPP patients, cascade effect was exerted by stimulating the secretion of inflammatory mediators such as CRP, causing systemic inflammatory response syndrome, and multiorgan failure appeared in the early stage of the disease. After the histogram equalization treatment, the image was clearer than that processed by the other three methods. In terms of CT image smoothing, the effect of the Gaussian filtering was better than the mean filtering effect, and the effect of the median filtering was better than that of the Gaussian filtering. Therefore, the structure of the lungs became clearer, and the lung texture was also clearly displayed, and CT images after histogram equalization have an important value in the diagnosis of lung injury caused by organophosphorus poisoning.

Pregabalin poisoning: Evaluation of dose-toxicity relationship.

ContextPregabalin poisoning is mostly benign, although coma and convulsions occasionally occur.AimTo determine the dose‐toxicity relationship of pregabalin.MethodsDose‐toxicity data of isolated pregabalin poisonings were collected from (1) a prospective study performed by the Dutch Poisons Information Centre (4 April 2014 to 4 October 2016) and from (2) case reports and case series reported in literature. Poisonings were graded using the Poisoning Severity Score (PSS) and the relationship between dose (mg kg−1) and PSS was evaluated.ResultsIn our study (n = 21 patients), the most commonly observed symptoms were drowsiness (62%), confusion (29%) and apathy (24%). PSS was none in three (14%), minor in 15 (71%), and moderate in three patients (14%). Most case series also reported a PSS of none to minor in the majority of poisonings (69‐100%). For 34 individual patients (21 from our study and 13 from literature), detailed data on dose and clinical course were available to examine the dose‐toxicity relationship.The median dose was significantly lower in the PSS none‐minor group (“benign”) (8.6 mg kg−1, interquartile range (IQ25‐75) 5.0‐17.6 mg kg−1) than in the PSS moderate‐severe group (“significant toxicity”) (46.7 mg kg−1, IQ25‐75 21.3‐64.3 mg kg−1); estimate of the median difference = 27.3 mg kg−1 (95% confidence interval (CI): 10‐48.6).ConclusionsIn general, higher pregabalin doses result in more severe poisonings. Below 20 mg kg−1 the majority of patients (83%) only suffer from mild poisoning. However, large interindividual differences exist in pregabalin‐induced toxicity. Therefore, pre‐hospital triage should not only include pregabalin dose, but also underlying illnesses, co‐exposures and reported symptoms.

Investigation and analysis of a mass ammonia gas poisoning accident

Objective: To investigation and analysis of ammonia gas leakage in a meat factory. Methods: In April 2013, Enterprise managers and workers were investigated, and clinical data of 24 patients were analyzed. Results: The company caused a leak in the ammonia pipeline maintenance operation, Among the patients, 20 had stimulus response and 4 had mild poisoning. Conclusion: To prevent group occupational ammonia poisoning, it is necessary to strengthen the awareness of occupational disease prevention of enterprise owners and the awareness of self-protection of workers.

Analysis of incidence characteristics of occupational chronic benzene poisoning under two diagnostic criteria

Objective: To analyze the incidence characteristics of occupational chronic benzene poisoning under two diagnostic criteria. Methods: In March 2020, 126 patients who were divided into the old criteria group (74 cases) and the new criteria group (52 cases) were retrospectively analyzed. These patients were diagnosed with occupational chronic benzene poisoning, and were diagnosed in our hospital during the period of January 2009 to December 2019. The gender composition, age of onset, years of benzene exposure, industry distribution, work type, benzene concentration in working environment and diagnostic grade of the two groups of patients were analyzed and compared. The follow-up of 22 benzene poisoning observation subjects under the old criteria were retrospectively analyzed. Results: There were no statistically significant differences in gender composition, age of onset, years of benzene exposure, industry distribution and work type between the old criteria group and the new criteria group (P>0.05) . In the old criteria group and the new criteria group, 41.9% (31/74) and 17.3% (9/52) of the patients' workplace benzene concentration exceeded the maximum allowable concentration, respectively. The composition of different benzene concentration in the workplace between the two groups showed statistically significant (P<0.05) . In the old criteria group, the proportion of mild poisoning (79.7%, 59/74) was the majority, while in the new criteria group, the proportion of moderate and severe poisoning (51.9%, 27/52) were the majority, and there was statistically significance in the composition ratio of diagnostic grade between the two groups (P<0.05) . Under the old criteria, after folow-up of 22 cases of benzene poisoning observation subjects, we observed that 8 cases (36.4%) progressed to the level of chronic benzene poisoning. Conclusion: The revision of diagnostic criteria for benzene poisoning may affect the composition of diagnosis classification. Based on the rights and interests of workers, formulating more complete diagnostic criteria and system policies will be more conducive to the development of occupational benzene poisoning prevention and control.

Akut Karbon Monoksit Zehirlenmesiyle Başvuran Hastaların Laktat Düzeyinin Karboksihemoglobin ve Klinik Bulgularla İlişkisi

Aim: Acute carbon monoxide (CO) poisoning is a potentially mortal, though preventable, condition. Mild poisoning presents with non-specific symptoms, such as fatigue, headache, nausea and vomiting, whereas severe exposure to CO can result in loss of consciousness, coma, and death. The aim of this study was to investigate the utility of lactate and carboxyhemoglobin (COHb) levels in the clinical presentation and treatment of patients with acute CO poisoning. Material and Methods: Data were obtained from the hospital information system and patient files with ICD-10 code “T58: Toxic effects of CO”. The blood parameters and vital signs of patients at admission, causes of poisoning, time to hospital, and Glasgow coma scores during admission were recorded. Within related and relevant complications of CO intoxication and data concerning treatment plans and hospitalization status were recorded. Results: A statistically significant difference was found between COHb and lactate levels of patients who did and did not develop neurological and cardiac complications (p&amp;lt;0.001). Moreover, a statistically significant difference was found in COHb and lactate levels among patients who did or did not receive hyperbaric oxygen therapy, and who were hospitalized or not (p&amp;lt;0.001). As looking for biochemical profile, significant correlations was found between COHb and pH, base excess, and bicarbonate and lactate levels. Conclusion: This study shows that COHb and lactate levels at admission to the emergency department are significant for prognosis, follow-up, and treatment of patients with CO poisoning. Elevated lactate and COHb levels may also found to be associated with neurological and cardiac complications.

The Biochemical Outcome of two Treatment Protocols in Patients With Opium-associated Lead Poisoning: A Cross-sectional Study in North of Iran

Background: Lead is a potent toxin that targets heme synthesis and some antioxidant enzymes that induce oxidative stress. Lead exposure remains one of the significant health concerns all over the world. Chelating agents have been used as antidotes for acute and chronic lead poisoning. The present study was conducted to evaluate the biochemical outcome of two different chelating therapies. Methods: This descriptive cross-sectional study was performed in the Razi University Hospital, Rasht, Guilan. Fifty-six patients with a history of opium use were enrolled in the study who were treated symptomatically. Blood lead Llevels (BLL), Hemoglobin (Hb), Red Blood Cell (RBC), White Blood Cell (WBC), urea, creatinine, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and Alkaline Phosphatase (ALP) were evaluated before and after treatment. The BLL more than 100μg/dl with clinical symptoms was considered as severe lead poisoning (n=34) who received 4 days of DMPS (2,3-dimercaptopropane-1-sulfonate) injection. Other cases with BLL of 20-100μg/dl were considered as those with mild poisoning (n=22) that were treated with oral D-Penicillamine for 14 days. Results: The mean age of patients was 49.73±14.11 years. Data analysis indicated no significant differences between the groups at baseline regarding the demographic variables. A significant reduction was observed in BLL before and after the intervention using the D-Penicillamine from 75.88±26.22 to 44.3±17.51 μg/dl (P=0.0001). The BLL reduced from 105.5±34.04 to 24.51±24.08 μg/dl after treatment with DMSP (P=0.0001). The levels of ALT, AST, and WBC significantly decreased post-treatment following using D-penicillamine and DMPS (P&lt;0.05). The D-Penicillamine-treated group showed an increase in Hb and RBC (P&lt;0.05). Conclusion: According to the results, penicillamine improves low to moderate lead toxicity. Although DMSP decreases BLL significantly and reverses liver enzymes, further investigations on Hb and RBC, are needed.

The Biochemical Outcome of two Treatment Protocols in Patients with Opium-Associated Lead Poisoning: A Cross-Sectional Study in North of Iran

Background: Lead is a potent toxin that targets heme synthesis and some antioxidant enzymes that induce oxidative stress. Lead exposure remains one of the significant health concerns all over the world. Chelating agents have been used as antidotes for acute and chronic lead poisoning. The present study was conducted to evaluate the biochemical outcome of two different chelating therapies. Methods: This descriptive cross-sectional study was performed in the Razi University Hospital, Rasht, Guilan. Fifty-six patients with a history of opium use were enrolled in the study who were treated symptomatically. Blood lead levels (BLL), hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC), urea, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were evaluated before and after treatment. The BLL more than 100μg/dl with clinical symptoms was considered as severe lead poisoning (n=34) who received 4 days of DMPS (2,3-dimercaptopropane-1-sulfonate) injection. Other cases with BLL of 20-100μg/dl were considered as those with mild poisoning (n=22) that were treated with oral D-Penicillamine for 14 days. Results: The mean age of patients was 49.73±14.11 years. Data analysis indicated no significant differences between the groups at baseline regarding the demographic variables. A significant reduction was observed in BLL before and after the intervention using the D-Penicillamine from 75.88 ± 26.22 to 44.3 ± 17.51 μg/dl (P = 0.0001). The BLL reduced from 105.5 ± 34.04 to 24.51 ± 24.08 μg/dl after treatment with DMSP (P = 0.0001). The levels of ALT, AST, and WBC significantly decreased post-treatment following using D-penicillamine and DMPS (P <0.05). The D-Penicillamine-treated group showed an increase in Hb and RBC (P <0.05). Conclusion: According to the results, penicillamine improves low to moderate lead toxicity. Although DMSP decreases BLL significantly and reverses liver enzymes, further investigations on Hb and RBC, are needed.

Correlation of Serum Amylase, Lipase and Creatine Kinase with Severity of Organophosphate Poisoning- A Cohort Study

Introduction: Organophosphate Compounds (OP) are widely used pesticides in agriculture. It is easily available and OP poisoning is most common cause of poisoning and hospital admissions. Severe poisoning is associated with high mortality. Severity of poisoning can be assessed by Peradeniya Organophosphorus Poisoning (POP) scale, Acute Physiology and chronic Health Evaluation (APACHE) II, Glasgow Coma Scale (GCS) or serum Cholinesterase Level (ChE). Serum amylase, lipase, and creatine kinase are important biomarkers raised in OP poisoning. Aim: To correlate serum amylase, lipase, and creatine kinase with severity of OP poisoning. Materials and Methods: This was a hospital based observational cohort study conducted on 130 patients of organophosphate poisoning admitted in General Medicine wards of SCB Medical College, Cuttack, Odisha from June 2019 to December 2020. Serum Acetylcholine Esterase (AChE), amylase, lipase and creatinine kinase were estimated at admission, day 2, and at discharge. Other routine investigations were done. Acetylcholine Esterase (AChE) was used to confirm the diagnosis. The severity of poisoning was assessed using POP scale and graded as mild, moderate and severe. The severity of poisoning and the level of enzymes were correlated. The parameters were tabulated and mean values and Standard Deviation (SD) were analysed using Statistical Package For The Social Sciences (SPSS) software version 22.0. Results: Out of 130 patients 91 were males and 39 were females, mostly from rural areas, both farming and non-farming community. Age ranged from 14 years to 79 years, with majority in 19 to 39 years. AChE decreased in all cases depending on severity confirming OP poisoning. Severity as assessed by POP score were mild (52 patients), moderate (46 patients) and severe (32 patients). At admission, the Amylase (U/L), Lipase (U/L), and Creatine kinase (U/L) level (mean±SD) in mild poisoning were 83.7±41.9 U, 70.9±18.6, 72.5±34.9, in moderate poisoning 153.6±109.7, 91.9±47.4, 92.6±81.5, and in severe poisoning 243.9±113.8, 195.3±147.7, 298.8±207.4, respectively. Measurements on second day also remained elevated. Among the severe cases 24 patients developed Intermediate Syndrome (IMS), and 26 patients died. There was positive correlation between increase of enzyme levels and the severity of OP poisoning as per POP score. Conclusion: Serum amylase, lipase, and creatine kinase level correlated well with the severity of organophosphorus poisoning and scan be used additionally as an indicator to assess the severity. Serum amylase is a better indicator of severity than lipase and Creatine Kinase (CPK).

Study of organophosphorus compound poisoning in a tertiary care hospital and the role of Peradeniya Organophosphorus Poisoning scale as a prognostic marker of the outcome

Introduction:Organophosphate compounds (OPC) cause most self-poisoning deaths in India due to their easy availability and lack of stringent laws.Aim:To evaluate the clinical profile and outcome of the patients presenting with OPC poisoning and to study the prognostic value of Peradeniya Organophosphorus Poisoning Scale (POPS) in predicting the clinical outcomes.Methods and Materials:This was a prospective study involving 100 patients of OPC poisoning admitted to Tata Main Hospital from June 2018 to May 2020 based on the inclusion criteria. Demographic profile, clinical features, treatment details, and need for ventilatory support were noted. POPS was applied on admission, and the patients were followed up for the outcome in terms of morbidity and mortality.Observations:Of the 100 patients, most patients were between 20 and 29 years with male to female ratio being 1.2:1. Vomiting (94%), followed by excessive secretions (84%) were the most common symptoms. Overall mortality was 22%. On grading of severity as per the POP scale, 27% of the patients had mild poisoning, 37% patients had moderate, whereas 36% had severe poisoning. Only 11.11% of the patients with POPS 0–3 required ventilator support, whereas 16.2% of the patients with POPS 4–7, and 100% of patients with POPS 8–11 required ventilator assistance (P < 0.0001). Similarly, the total dose of atropine required (P < 0.0001), length of intensive care unit (ICU) stay, complications, and mortality (P < 0.0001) were significantly associated with higher POPS.Conclusion:POPS at admission, correlated well with the need for ventilator support, the total dose of atropine required, length of stay in the ICU, complications, and mortality. It can thus be used for prognostication and risk stratification of patients with OPC poisoning.

The Possibilities of Working Capacity Maintenance at Organophosphorous Compounds Intoxication

Th e experience of modern local armed confl icts and the monitoring of terrorist activity in the world indicate the possibility of the aff ection of people by organophosphorus compounds (OPs) in combat and as a result of industrial accidents and terrorist acts. It can be predicted that in case of timely use of PPE by the personnel, in addition to lethal and severe aff ections, up to 30 ± 5% of them will be mild forms of intoxication. It is shown in the article, that the actoprotectors with diff erent mechanism of action (hypoxene, octodrine and meldonium) increase the endurance of experimental animals with mild poisoning of OPs in case of single oral administration. Moreover, the degree of inhibition of peripheral blood acetylcholinesterase of all animals treated with model OPs did not diff er between groups and ranged from 8 to 24%. As a result of the experiments on animals, the preparations were distributed in the following order: meldonium &lt;octodrine &lt;hypoxene. Joint oral administration of the test substances was not accompanied by a potentiation of the actoprotective eff ect. It is established, that the combined use of the studied actoprotectors is comparable with the isolated administration of meldonium, has no advantages over the use of octodrine and surpasses hypoxene in rate of onset of the eff ect, but is inferior to it in severity and duration. Th ese facts indicate the viability of use of the studied actoprotectors to prevent a decrease in combat readiness in case of the threat of the aff ection by OPs (hypoxene), for its urgent increase in case of mild aff ection (octodrine) and for the complex treatment of poisoning due to organophosphates (OPs) (meldonium, hypoxene)

Clinical significance of serum amylase and glucose level in organophosphorus poisoning

Background: Organophosphorous (OP) poisoning is a common problem in country like Nepal where agriculture is the backbone of the economy. The primary mechanism of action is inhibition of acetylcholinesterase (ACHE). Organophosphorus poisoning is a possible cause of acute pancreatitis along with alternation of glucose metabolism.&#x0D; Materials and Method: This was a hospital based cross-sectional comparative study. The level of serum amylase and glucose were measured in thirty-eight OP poisoned patients at the time of admission, before discharge and were compared.&#x0D; Results: Amongst 38 patients, Majority had mild OP poisoning 27(71.1%) as per Peradeniya Organophosphorus Poisoning (POP) score whereas 9(23.7%) had moderate and 2(5.2%) had severe poisoning. The mean initial serum amylase level in patients with mild poisoning was 152±73.92 (IU/L)(p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22(IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (Mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (Mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (Mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis.&#x0D; Conclusion: Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.

Letter to Editor Hemodialysis for the Treatment of Isoniazid Intoxication

Hemodialysis for the Treatment of Isoniazid Intoxication To the Editor, We recently read with great interest the manuscript entitled “Secondary shoulder dislocation and fracture due to acute isoniazid intoxication”. The authors presented the treatment of a life-threatening condition, intractable seizures, metabolic acidosis with high anion gap related to Isoniazid (INH) intoxication (1). High doses of INH are associated with metabolic acidosis, intractable convulsions, rhabdomyolysis, lactic acidosis, shock, decreased level of consciousness, coma, and even may cause death if not appropriately treated (1). Thus, its early and proper treatment is very important (2). In this case report, it was stated that the authors have performed a very successful treatment of isoniasid induced loss of consciousness and metabolic acidosis. It has been seen that the patient has ingested a dose of 1200 mg of INH before admission. It has been seen from the case that; the authors has treated the patient succesfully with midazolam and they have stopped the seizure in this way. It is well known that; pyridoxine is the one of the best treatment options in the treatment of INH intoxication. And this case is a perfect sample of this treatment method. But, because of the little molecular weight and hydophilic structre INH has a low distribution volume (0.6L/kg) (2). And INH reduces the levels of NAD that has a role in the transformation of lactate to piruvate. Lactate accumulates in the blood and acidosis and anion gap of the patient increases. Additionally INH decreases the activity of glutamic acid decarboxylase activity and due to the blockage of gamma amino butyric acid (GABA), convulsion can develop easily (2,3). This situation may cause drug resistant convulsions and coma (1,4). It could result with a life-threatening condition. Although in this patient, hemodialysis was not needed, hemodialysis is the alternative and effective treatment option in patients with refractory convulsions and comatose. Hemodialysis is not necessary in mild poisoning of INH but well effective in severe intoxication and it provides rapid clinical improvement in this situation. It removes INH which did not adhere to the activated charcoal and toxic metabolites of it from circulation (2,5). It should be kept in mind as an effective treatment option in severe INH intoxication by Emergency physicians.