A Study of Clinical Profile of Acute Organophosphorus Poisoining in Correlation With Serial Serum Pseudocholinestrase Levels

Background and Introduction:Acute Organophosphorus poisoning (OP) is important cause of morbidity and mortality in India. In medical emergency 10% of admissions are due to poisoning and organophosphorus poisoning contributes to nearly 50% ofcases1,2,3.The objective of the study is to study the levels of pseudocholinesterase in serum as a diagnostic aid in patients with suspected organophosphorus poisoning and to predict the prognosis based on pseudocholinesterase activity. Materials and Methods:Informed consent was taken from 50 patients suspected of organophosphorus poisoning and admitted to Medical Emergency Ward.Pseudocholinesterase levels were estimated by S-butyrylthiocholine iodide method using dibucaine as inhibitor. Serum levels of pseudocholinesteraselevels of patients were examined on Day 1, Day 2, Day 3 and Day 6 of admission.Result:Patients who survived had increasing levels of pseudocholinesterase activity of 3.56% on 2nd day and further rise of 4.48% on 3rd day and a rise of 6.88% on 6th day. In patients who expired,the enzyme activity had reduced by 4.6%on Day 2 and a raise of 11% on Day 3 and a fall of 5.5% on Day 6. It was observed that the enzyme activity in patients those survived has increased on successive days indicating a better prognosis whereas the enzyme activity in patients those expired was falling except for the Day 3 where a raise of 11% was noticed. This may be probably due to the treatment given to the patients,which has caused a transient raise in enzyme levels. Conclusion:In early stages of poisoning,determining pseudocholinesterase activity is reliable diagnostic test. Mean pseudocholinesterase activity in patients who survived was above 4300 U/L and the levels had increased in the successive days above 5400 U/L, which indicated better prognosis. In the patients who expired the pseudocholinesterase activity was around 4300 U/L and was falling except for the Day 3. This point out that raise in enzyme levels is directly proportional to better prognosis.