Severity Of Organophosphorus Poisoning Research Articles

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 <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 the effectiveness of fresh frozen plasma transfusion as adjuvant treatment in acute organophosphate-poisoned patients: A randomized clinical trial.

Organophosphorus (OP) poisoning is a significant cause of morbidity and mortality worldwide. Recent research has explored new approaches to improving treatment options, which present several challenges. This study aimed to evaluate the role of fresh frozen plasma (FFP) as an adjunctive therapy for acute OP intoxication. A prospective single-blinded randomized clinical trial was conducted on patients of both sexes admitted to the Intensive Care Unit (ICU) of the Poison Control Center at Ain Shams University Hospital (PCC-ASUH) with acute OP toxicity during the period from the beginning of August 2022 to the end of July 2023. According to the Peradeniya score, Group I consisted of 48 patients (52%) with moderate OP poisoning, and Group II consisted of 44 patients (48%) with severe OP poisoning. Patients in the moderate group were assigned to receive either standard treatment (Group Ia, n = 24) or standard treatment plus FFP (Group Ib, n = 24). In addition, patients in the severe group were assigned to receive either standard treatment (Group IIa, n = 22) or standard treatment plus FFP (Group IIb, n = 22). A total of 46 patients received FFP transfusion. The authors demonstrated that the early use of a total of nine packs of FFP (250mL each) over three consecutive days significantly reduced the total doses of atropine and oximes, the total hospitalization period, and the requirement for mechanical ventilation in patients with OP poisoning, both in the moderate and severe groups.

Study to evaluate the correlation of serum cholinesterase levels, peradeniya clinical score at presentation and severity of organophosphorus poisoning

Study to evaluate the correlation of serum cholinesterase levels, peradeniya clinical score at presentation and severity of organophosphorus poisoning

A study of serum creatine phosphokinase and severity of organophosphorus poisoning

Organophosphorus (OP) poisoning is an important global health problem especially in developing countries. Estimation of erythrocyte cholinesterase (EChE) and plasma cholinesterase (BChE) as an evidence of OP poisoning is costly, not regularly performed and shows wide inter-individual variability. To study the feasibility of using serum creatine phosphokinase (CPK) as a predictor for severity of OP poisoning. Thirty four patients were included in this study who were admitted to tertiary care centre with history of OP poisoning less than 24hrs. The clinical severity of patients categorized according to Peradeniya organophosphorus poisoning (POP) scale. In our study 53.0% were male, 47.0% were female. Incidence of OP poisoning was more common among age group 21-30 years. Farmers (38.2%) were more common among occupation. Monocrotophos (46.0%) was commonly used compound for poisoning. 38.2% patients were severe. There was significant reduction in plasma cholinesterase and significant increase in CPK levels. There was a highly significant correlation between initial serum CPK levels and severity of acute OP poisoning. This study recommends CPK as an alternative biomarker for acute OP poisoning.

Assessment of Serum cholinesterase and Serum Creatinine Phosphokinase Levels in Organophosphorus Poisoning Patients at a Tertiary Care Centre of Northern India

Introduction: Poisoning with Organophosphorus compounds is an important global health problem, possibly the most common acute poisoning in developing countries. This study was done to correlate the severity of acute organophosphorus poisoning with serum cholinesterase and serum creatine phosphokinase level.Materials and Methods: A Prospective observational clinical study was done on 42 patients suspected of Organophosphorus poisoning of age >15 years admitted to the emergency unit at a tertiary healthcare center in northern India. Serum cholinesterase levels and serum Creatinine phosphokinase levels were estimated at the time of admission in all patients and the severity of Organophosphorus poisoning was assessed according to Peradeniya Organophosphorous Poisoning (POP) Scale.Results: In this study, among 42 patients of acute organophosphorus poisoning 32(76.2%)were males and 10(23.8%) were females. Our study authors observed a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase and Serum CPK level at the time of the patients’ initial presentation. Also found that there was a significant correlation between serum cholinesterase and serum CPK with the outcome of the patients.Conclusion: In our study severity as well as outcomes of OP poisoning was directly correlated with serum cholinesterase level and serum Creatinine phosphokinase.

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.

English

BACKGROUND Organophosphorus (OP) pesticides are one of the most common cause of morbidity and mortality due to poisoning worldwide especially in agrarian countries like India. Hence it is prudent to undertake a detailed study of clinico-pathological evaluation of OP poisoning and assess the role of serum potassium as an alternative, easy and convenient prognostic indicator in estimating the severity of OP poisoning. This study was undertaken to assess serum potassium levels in patients of acute organophosphorus poisoning and determine association between serum potassium level and outcome in cases of acute organophosphorus poisoning. METHODS This was a prospective observational study conducted in Department of General Medicine, Silchar Medical College & Hospital for one year from 1st June 2019 to 31st May 2020 with a sample size of 100 after satisfying the inclusion and exclusion criteria. Peradeniya organophosphorus poisoning (POP) scale was used for categorizing study population according to severity. RESULTS Among patients who were admitted with organophosphorus poisoning, 72 % of the patients discharged were having normal serum potassium levels on admission, whereas 22 % (n = 22) patients who died had hypokalaemia at the time of admission. The chi-square value for the association between serum potassium and outcome is statistically significant [P value is 0.001 (P < 0.05)]. CONCLUSIONS The serum potassium level on the day of admission was significantly correlated with the severity of the acute organophosphate poisoning as determined by Peradeniya OP poisoning scale. The cases that had lower serum potassium levels on admission had poor outcome. Reduced serum potassium levels also had significant association with the need for ventilator support. Therefore, serum potassium can be used as a predictive marker of severity in organophosphorus poisoning. This can help in early triage of patients and will be helpful in reducing mortality and morbidity. KEYWORDS Organophosphorus Compound Poisoning, Serum Potassium, POP Scale

English

BACKGROUND Organophosphorus (OP) compounds are insecticides which are widely used in agriculture. Acute organophosphorus poisoning is one of the important causes of morbidity and mortality in developing countries like India. Considering financial burden / availability of tests, we need cheap and easily measurable biomarkers for predicting prognosis / complications in a limited resource country, like India. We intend to correlate the levels of serum amylase in patients admitted with acute organophosphorus poisoning for predicting the severity of acute OP poisoning and also to correlate serum amylase association with respiratory failure. METHODS This was a prospective observational study. Total of 94 patients of OP poisoning admitted to KIMS Hospital, Hubballi between January 1st 2017 and December 31th 2017 were studied. Detailed history, clinical examination, and lab investigations like pseudocholinesterase, serum amylase and other relevant investigations were carried out. Peradeniya OP poisoning scale was applied to all the study subjects and the severity of OP poisoning was graded as mild, moderate, severe. Data obtained was analysed by different statistical methods. RESULTS OP poisoning was more common in adults of age group between 20 – 30 years, Incidence was more in male patients and mortality rate was 12.8 %. Mean values of serum amylase negatively correlate with pseudocholinesterase levels and it was statistically significant. Correlation between the severity of OP poisoning (based on Peradeniya score) and biochemical parameters like pseudocholinesterase, serum amylase was statistically significant. CONCLUSIONS The correlation between the severity of OP poisoning and biochemical parameter– serum amylase, was statistically significant and it was useful in predicting the development of respiratory failure. Pseudocholinesterase and serum amylase were also useful to predict the outcome of the patient. KEYWORDS Amylase, Organophosphorus Poisoning, Pseudocholinesterase, Peradeniya Score

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 serum creatinine phosphokinase and serum lactate dehydrgenase as prognostic markers in organophosphorus poisoning

Background: Organophosphorus (OP) compounds are insecticides which are widely used in agriculture. Acute organophosphorus poisoning is an important cause of morbidity and mortality in developing countries like India. In a limited resourced country like India, we need cheap and easily measurable biomarkers for predicting prognosis.Objective was to estimate creatinine phosphokinase and serum lactate dehydrgenase as prognostic markers in acute organophosphorus poisoning.Methods: Total 94 cases of OP poisoning admitted to KIMS Hospital, Hubbali between January 1st 2017 to December 31th 2017 were studied. Detailed history, clinical examination and lab investigations like pseudo cholinesterase, serum LDH and serum CPK were carried out. Peradeniya OP poisoning scale was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. Data obtained was analysed by different statistical methods.Results: OP poisoning is more common in adults of age group between 20 - 30 years, Incidence is was more in male patients, Mortality rate is 12.8%. Mean values of serum LDH, serum CPK were negatively correlated with pseudcholinesterase levels and it was statistically significant. Correlation between the severity of OP poisoning (based on Peradenyia score) and biochemical parameters like serum CPK, serum LDH, was statistically significant.Conclusions: The correlation between the severity of OP poisoning and biochemical parameters was statistically significant and they are usefull in predicting development of respiratory failure.

A prospective evaluation of correlation between cholinesterase level and severity of organophosphorus poisoning

Background: Organophosphorus compounds are anticholinesterases by inhibiting cholinesterase it protects acetyl chorine from hydrolysis. So, acetylcholine accumulates at the synapses, and all the clinical manifestation are due to that. So, this study has been designed to establish the reactive between level of serum and prognosis of op poisoning patients.Methods: Patient with history of organophosphorus poisoning admitted into the emergency department with following exclusion and inclusion criteria were included in this study. All patients were managed as per standard treatment protocol of op poisoning. Various parameters like demography of the patients, sign and symptoms, severity of intoxication, clinical and lab parameter manoring, Serum cholinesterase was measured every alternate day.Results: 22(47.84%) patients have mild symptom out of that 20 patient’s serum cholinesterase was more than 2000 IU/L, and 2(4.3%) patients serum cholinesterase was between 1000-2000 IU/L. In eighteen patient’s severity as per POP scale was moderate, out of that 2(4.3%) patients have serum cholinesterase was below 1000 IU/L, 8 having serum cholinesterase between 1000 to 2000 IU/L, and remaining eight having serum cholinesterase above 2000 IU/L.Conclusions: Serum cholinesterase was less in patient with high severity score or low serum concentration of cholinesterase was associated with high severity score. Serum cholinesterase was improved as days passes.

A study on serum cholinesterase level in organophosphorus poisoning and its correlation with severity of organophosphorus poisoning

Background: There has been a steady increase in the use of organophosphates (OPs) as pesticides in most of the developing countries including India for more than 50 years. OPs tend to be the commonest cause of poisoning worldwide and are persistently and deliberately used in suicides in Agrarian areas. As stated by WHO, 3 million cases of pesticide poisoning occur every year, of these about 1 million are accidental and 2 million are suicidal poisonings, resulting in more than 0.25 million deaths per year. As there is limited availability of facilities and resources in developing countries, all OP poisoning patients are not managed in intensive care units. Hence it is important to understand the clinical features and other factors that indicate severity of poisoning which should be identified in the initial examination.Methods: It was a hospital based prospective study of 100 OP poisoning patients that were attending to casualty of BIMS Hospital and Medical College Belagavi, India. Over a period, patients fulfilling inclusion criteria were included and patients were categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum cholinesterase level measured at the time of admission.Results: The patients were in the age group of 18 to 70 years. Majority of the patients were in the age group of 21-30 years (51%). Sixty nine percent of the patients were from rural areas and 38% of them were farmers. Sixty nine percent of patients were from low socioeconomic stratum. Major route of intake of poison was ingestion. Eighty four percent of patients consumed poison with a suicidal intent. In this study, authors observed that there is a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase at the time of initial presentation of the patients (P<0.001).Conclusions: Present study concluded that significant correlation between the degree of derangement in serum cholinesterase level and severity of poisoning at the initial presentation. Higher the score on the POP scale, the greater was the degree of derangement in the serum cholinesterase level.

Leukocyte count: A reliable marker for the severity of organophosphate intoxication?

INTRODUCTION:Organophosphorus poisoning (OPP) is a major public health problem in developing countries like India. Leukocyte count is a simple and inexpensive test, and elevated count is associated with acute inflammation and increased oxidative stress-like OPP. This study was done to correlate the severity of acute OPP with leukocyte count and also to assess the prognosis.MATERIALS AND METHODS:A prospective, observational clinical study was done on 80 patients suspected of OPP of age >15 years admitted to emergency unit at a tertiary rural teaching health-care center of Central India. Serum cholinesterase level and leukocyte count were estimated at the time of admission in all patients and severity of OPP was assessed according to Peradeniya organophosphorus poisoning (POP) scale.RESULTS:The mean age of the patients was 33.52 years (standard deviation [SD] 11.62) in males and 27.30 years (SD 7.33) in females. Among them, 57 (71.25%) were males and 23 (28.75%) were females. The severity of poisoning was directly correlated with serum cholinesterase level (P = 0.0001). Leukocyte count had a sensitivity of 60%, specificity of 76%, and negative predictive value of 85% if counts were more than 12,000 and 30% sensitivity, 95% specificity, and 80% negative predictive value if counts were more than 15,000 in predicting mortality in patients with OPP.CONCLUSION:Leukocyte count levels on admission can be used a prognostic marker in patients with OP poisoning.

Clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning and prognosis analysis after rescue.

This study reports the clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning, and analyzes the prognosis after rescue.The general data of 68 patients with severe organophosphorus poisoning treated in our hospital were retrospectively analyzed. These patients were divided into 2 groups: treatment group, and control group. Patients in the control group received routine emergency treatment, while patients in the treatment group additionally received hemoperfusion plus hemodialysis on the basis of routine emergency treatment. The curative effects in these 2 groups and the prognosis after rescue were compared.Compared with the control group, atropinization time, recovery time of cholinesterase activity, recovery time of consciousness, extubation time, and length of hospital stay were shorter (P < .05); the total usage of atropine was significantly lower (P < .05); Glasgow Coma Score was significantly higher (P < .05); acute physiology and chronic health score (APACHE II) was significantly lower (P < .05); and mortality and poisoning rebound rate was significantly lower (P < .05) in the treatment group.Hemoperfusion and hemodialysis on the basis of routine emergency treatment for critical patients with organophosphorus poisoning can improve rescue outcomes and improve the prognosis of patients, which should be popularized.

Curative effect observation of Depmas dual blood purification for severe acute organic phosphorus poisoning

Objective To observe the clinical curative effect of Depmas double blood purification system for acute severe organophosphorus pesticide poisoning.Methods Retrospectively study was carried out on 147 patients of acute severe organophosphorus pesticide poisoning.Patients were divided into four groups,the conventional treatment group treated with drug therapy,hemoperfusion group given HA230 hemoperfusion in addition to conventional treatment,plasma exchange combined with hemoperfusion group given HA230 hemoperfusion and plasma exchange therapy in addition to conventional treatment,and Depmas group treated with plasma separation by Baxter blood fiber and then given series HA230 and BS330 hemoperfusion treatment on the separated plasma in addition to conventional treatment.Survival rate,mean survival time of death patients,the concentration changes of cholinesterase and bilirubin in peripheral blood were observed.Results Compared to the conventional treatment group,survival rates of hemoperfusion group,hemoperfusion combined with plasma exchange group and Depmas group were higher,the mean survival time was longer,the cholinesterase concentration in peripheral blood was higher and the elevated bilirubin concentration was decreased with the differences statistically significant (P＜0.01).Compared to hemoperfusion group,the survival rates of hemoperfusion combined with plasma exchange group and Depmas group were higher,the mean survival time was longer,the cholinesterase concentration in peripheral blood were higher and the elevated bilirubin concentration was decreased with the differences statistically significant (P＜0.05).Besides,there were no significant differences between the survival rate,mean survival time,peripheral blood cholinesterase and bilirubin concentration of hemoperfusion combined with plasma exchange group and that of Depmas group (P＞0.05).Conclusions Depmas dual blood purification system has remarkable curative effect for the treatment of acute severe organophosphorus poisoning. Key words: Hemoperfusion; Plasma exchange; Depmas double blood purification; Severe organophosphorus pesticide poisoning

Xanthine Oxidase and Paraoxonase – 1 as a new markers in the diagnosis and prognosis of organophosphorus pesticide poisoning

Background: Acetylcholinesterase is already well known marker for organophosphorus poisoning in human beings. But, our interest was to known for another new markers. There is high limited study on xanthine oxidase and paraoxonase 1 in human beings having organophosphorus poisoning. Thus, aim of our this research was to estimate and correlate activities of xanthine oxidase and paraoxonase 1 in different stages of organophosphorus poisoning in a way to find out potential of these enzymes as marker of organophosphorus poisoning in human beings. Method: Xanthine oxidase (XO) activity was determined by Roussos method while paraoxonase (PON1) activity was determined by spectrophotometric method. Result: As compared to healthy controls, the activities of paraoxonase 1 were continuously and significantly decreased (p < 0.01) from group I to group V, while, the activities of xanthine oxidase were continuously and significantly increased (p < 0.01) from group I to group V in organophosphorus poisoned patients. Conclusion: We found a proportional increase in xanthine oxidase (XO) and a proportional decrease in paraoxonase 1 activity with severity of organophosphorus poisoning. Increase in xanthine oxidase activity is less significant compared to decrease in activity of paraoxonase 1. However, xanthine oxidase activity is a marker of oxidative stress developed in organophosphorus poisoning. Thus, paraoxonase 1 (PON1) can be used as a potent biochemical marker in the diagnosis and prognosis of organophosphorus poisoning along with xanthine oxidase (XO).

Acute organo-phosphorus pesticide poisoning in North Karnataka, India: oxidative damage, haemoglobin level and total leukocyte.

Pesticide poisoning is an important cause of morbidity and mortality in India. To assess the oxidative damage, hemoglobin level and leukocyte count in acute organophosphorus pesticide poisoning. Plasma cholinesterase was assessed as a toxicity marker. Oxidative damage was assessed by estimating serum malondialdehyde (MDA) levels, plasma total antioxidant capacity (TAC), erythrocyte superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) levels. Progressive and significant decline (p< 0.001) in plasma cholinesterase in correlation with the severity of organophosphorus poisoning was observed. Serum MDA levels significantly increased (p< 0.001) in all grades of organophosphorus poisoning cases as compared to controls. Erythrocyte SOD, CAT and GPx were significantly increased (p< 0.05) in earlier grade and (p< 0.001) in later grades of organophosphorus poisoning cases as compared to controls. While plasma TAC (p<0.001) was significantly decreased in all grades of organophosphorus poisoning cases as compared to controls. Leucocytosis observed in these cases signifies the activation of defense mechanism which could be a positive response for survival. Organophosphorus compounds inhibit cholinesterase action leading to cholinergic hyperactivity. Increased MDA level may lead to peroxidative damages deteriorating the structural and functional integrity of neuronal membrane. Increased erythrocyte SOD, CAT and GPx activities suggest an adaptive measure to tackle the pesticide accumulation. Hence it is concluded that cholinesterase inhibition may initiate cellular dysfunction leading to acetylcholine induced oxidative damage.

ß-Glucuronidase as a new potent biomarker in the diagnosis and prognosis of organophosphorus toxicity

Background: Organophosphorus poisoning occurs as a result of accidental exposure, suicidal and homicidal attempts. Organophosphorus compounds are known to cause selective release of liver microsomal s-glucuronidase (BG) into serum. Dissociation of the egasyn – s-glucuronidase complex in the liver by organophosphorus compounds was followed by a massive release of s-glucuronidase from liver into the serum. Objectives: There are few papers suggesting increase in activity of s-glucuronidase (BG) in serum of experimental animals subjected to organophosphorus poisoning. But, still there is less or no such study in human beings having organophosphorus poisoning. Thus, aim of our this research was to estimate and correlate activity of s-glucuronidase (BG) in different stages of organophosphorus poisoning. Methods: s-glucuronidase (BG) activity was determined by Goldstein method. Results and Conclusions: We found that the serum activity of β – glucuronidase (BG) proportionally increases (p < 0.01) and correlates with severity of organophosphorus poisoning. Further, there was found a significant increase in β – glucuronidase (BG) activity in low dose (mild) poisoning also. Thus, β – glucuronidase (BG) can be used as a potent biochemical marker in the diagnosis and prognosis of organophosphorus poisoning along with acetylcholinesterase or may also without acetylcholinesterase.

Blood β-glucuronidase as a suitable biomarker at acute exposure of severe organophosphorus poisoning in human

Organophosphorus compounds are known to cause the selective release of liver microsomal beta-glucuronidase into plasma. Organophophoruses may induce nitrosative stress leading to the generation of nitrogen free radicals and alterations in scavengers of free radicals in many biological systems. In this study, we investigate how acute human organophosphorus intoxication is associated with changes of blood nitric oxide, total thiol molecules, and activities of the acetylcholinesterase and beta-glucuronidase. A total of 21 acute organophosphorus-poisoned patients were recruited into study and were divided into two groups of mildly (13) and severely affected (9); 26 age-matched healthy volunteers were recruited as control group. Results indicated that both mildly and severely affected patients had lower acetylcholinesterase activities as compared to controls. The extent of acetylcholinesterase reduction in the severely affected patients was higher than that of mildly affected patients. A significant increase in serum beta-glucuronidase was observed only in severely affected patients as compared to controls. Both mildly and severely affected patients had lower plasma total thiol molecules as compared to controls. The extent of reduction of total thiol molecules in the severely affected patients was higher than that of mildly affected patients. No significant difference was observed in plasma total nitric oxide of controls and patients. It is concluded that nitrosative stress has a minor role in toxicity of organophosphorus, whereas blood beta-glucuronidase is very sensitive biomarker at high exposure of severe organophosphorus poisoning.

A clinico-epidemiological study of organophosphorus poisoning at a rural-based teaching hospital in eastern Nepal.

Thirty-seven patients with severe organophosphorus poisoning (OPP) presented to the emergency ward of BP Koirala Institute of Health Sciences between January 1995 and December 1996. The mean age of patients was 26.9 years. There were 17 (46%) males and 20 (54%) females, with male:female ratio being 1:1.2.Twenty-three (62%) patients were unmarried with 16 (46%) of them students. The most common reason for poisoning was suicide--32 patients (86.5%). The most commonly involved compound was Metacid (methyl-parathion)--23 (62%) patients. Ninety per cent of the patients presented within 2 h of ingestion. All patients were managed with intravenous atropine. Pralidoxime was given to patients with nicotinic symptoms and mechanical ventilation initiated in patients with respiratory distress. The mean dose of atropine used in the first 24 h and during the hospital stay was 30.6 mg and 136.7 mg, respectively. The mean duration of treatment was 5.5 days (range 2-20 days). Two patients developed intermediate syndrome and the overall mortality among hospitalized patients was 8%.