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Early Markers in Severe Organophosphorus Poisoning and Their Association with Mortality
Ashaq Hussain Parrey1, Manzoor Koka1, Mohd Ismail1
1Department of Internal Medicine, Government Medical College, Srinagar, India.
Background:
Organophosphorus (OP) poisoning, in addition to its cholinergic manifestations, shows metabolic derangements leading to acidosis, hypokalemia, hyperlactemia, and hyperglycemia. In addition to low acetylcholinesterase, these markers could serve as early predictors of severity of poisoning and mortality.
Objective:
The objective of this study was to assess the metabolic parameters at presentation in OP poisoning and their association with mortality.
Methods:
This was a prospective study that recruited 152 patients older than 14 years with a history of OP ingestion within 6 h of presentation.
Results:
In this study, 11 (6 male and 5 female) of 152 patients died (mortality rate 7.2%).. Mean age of the patients who died was 47 years and mean age of those who survived was 29 years. Ten of 11 patients (90%) who died had fasciculations at presentation. Metabolic parameters that were abnormal at presentation with significant correlation with mortality were acidosis (pH < 7.35) in 8 of 11 patients who died (72.7%) compared with 27.7% in those who survived. Hyperlactemia with serum lactate > 2 mmol/L was seen in 10 of 11 patients (90.1%) who died during hospital stay compared with 39% of patients who survived. Hypokalemia with potassium < 3.5 mmol/L was seen in 8 of 11 patients who died (72.7%) compared with 34.7% of those who survived.
Conclusions:
Hypokalemia, hyperlactemia, hyperglycemia, fasciculations, and advanced age are early markers predicting poor outcomes in OP poisoning.
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