A study of the ECG changes associated with Organophosphorous compound poisoning

Introduction: Estimates from the World Health Organisation (WHO) indicate that 1 million accidental poisoning and 2 million suicide attempts involving pesticides occur the world over. Large proportion present to the ICU with an acute suicidal attempt with male predominance. The case mortality in the developing world is more than 20%. The cardiac manifestations are hypotension, bradycardia, and varied Electrocardiogram (ECG) changes manifested by prolonged QTc interval, inverted T waves, prolonged PR interval, and ST-segment elevation. There is also a high incidence of respiratory failure which has a high mortality. Aim of the study: ECG changes and systemic manifestations with organophosphorous compounds and its relationship to the nature of the compound and its outcome. Materials and methods: The study was conducted at Rajiv Gandhi Government General Hospital and Madras Medical College during a month period from June 2010 and October 2010. The study was conducted on a total of 102 patients admitted to the toxicology unit of Rajiv Gandhi Government General Hospital. A detailed history and physical examination and biochemical and ECG monitoring were done. Results: Most of the patients were in the age group 21-30. The mortality rate was 17%. The percentage of death was noted to be increased in the extremes of age groups less than 20 and more than 60 years. Of the patients who expired mortality was highest in monocrotophos consumption and a majority of them had ECG changes and renal (16%)/respiratory failures (58%). The ECG abnormality was seen in 64% of individuals. Conclusion: We concluded from this study that Electrocardiographic changes correlated independently with the prognosis of the OP poisoning cases and the identification of them, particularly QTc prolongation and timely shifting of cases to ICU and CCU where adequate resuscitative measures, ventricular pacing facilities available can prevent such sudden cardiac deaths. Blood transfusion is said to have a role in severe poisoning in rapidly replenishing acetylcholinesterase enzyme.