Correlation and prognostic significance of serum amylase, serum lipase, and plasma cholinesterase in acute organophosphorus poisoning

Abstract

Background: Organophosphorus (OP) are substances that are originally produced by the reaction of alcohols and phosphoric acid. These OP compounds are the main components of herbicides, pesticides, and insecticides. These are easily available in developing country like India; there is lack of awareness about these chemicals which results in high morbidity and mortality. Aims and Objectives: To estimate levels of amylase, lipase, plasma cholinesterase in acute OP poisoning. To assess severity of OP poisoning by using plasma cholinesterase levels and correlating it with other two markers. Predicting the severity of acute OP poisoning by using these biochemical markers. Materials and Methods: A hospital-based observational study was conducted on 100 subjects who were clinically diagnosed of acute OP poisoning. Subjects of either gender of all age-groups were included in the study. On admission, plasma cholinesterase, serum amylase, and serum lipase were measured. Based on plasma cholinesterase activity at the time of admission, subjects were divided into three groups. Group I-having 20-50% of plasma cholinesterase activity; Group II-10-20% of plasma cholinesterase activity; and Group III <10% of plasma cholinesterase activity. Results: Among 100 patients it was seen that serum amylase and serum lipase were negatively correlated with plasma cholinesterase levels and it was statistically significant. It was seen that serum amylase had the highest diagnostic accuracy for assessing severity of poisoning, 10 deaths were there in which 6 had <10% of plasma cholinesterase activity, 8 out of these 10 patients had elevated amylase level. Conclusion: OP poisoning is associated with elevated amylase level. Serum amylase, lipase can be used as an additional prognostic indicator along with plasma cholinesterase levels. Serum amylase could be considered as a better predictor of severity than lipase.

The relationship of serum amylase levels in acute organophosphorus poisoning with its clinical severity and outcome: a cross-sectional study

“…Our study demonstrated higher mean values of serum amylase level either within 12 h of exposure or 12 h postexposure in participants who became dead during the course of treatment. This shows the serum amylase levels dramatically rises in severe/life-threatening presentations with OP poisoning which is evident from multiple other studies 11 , 15 , 22 , 23 .…”

Biochemical and haematological abnormalities in severe acute organophosphorus poisoning

“…In our study, Hyperamylasaemia with serum amylase of more than 125 was reported in 9 patients (6.7%) and hyperlipasemia with serum lipase of more than 78 (Normal range 8 to 78) was found in 14 patients (9%). High lipase and Amylase levels has been reported as a bad prognostic marker in OP poisoning and predictor of mortality 19 . Leucocytosis with a WBC count of more than 11000/microlitre was seen in 20 patients (14.2%), again leucocytosis has been mentioned as a bad prognostic factor in OP poisoning in one of the studies 20 .…”

Acute pancreatitis, a significant mortality predictor in acute organophosphate poisoning: an observational study in a tertiary care centre in north India

“…Majority of the victims belonged to the age group 14-34 years and organophosphate compounds (OPC) are the most common agent used for suicide purpose. 1 As time advances, pesticides are now a days widely used for modern cultivation methods and therefor, they are readily available as over the counter drugs even in village shops and act as common agents for suicidal purposes. Most of these deaths occur in rural areas, where easy access to highly toxic pesticides turns many impulsive acts of self-poisoning into suicide.…”