Pancreatitis as a Complication of Anticholinesterase Insecticide Intoxication

Abstract

Severe pancreatitis and a pseudocyst occurred in a patient following accidental ingestion of an anticholinesterase insecticide, a substance not previously known to produce pancreatitis. Experiments were done to elucidate the mechanism. In one group of dogs the pancreatic duct was perfused and intraductal pressures were measured. The cholinesterase inhibitor 0,0-diethyl-0-(2-isopropyl-6-methyl-4-pyrimidinyl)phosphorothioate (25 mg/kg) caused a significant increase in the mean intraductal pressure from 12 +/- 2.4 to 27.8 +/- 5.9 cm saline. In a second group of dogs pancreatic secretory rates were measured. Anticholinesterase (75 mg/kg) in combination with secretin infusion (1 U/kg/hr) caused a significant increase in the secretin stimulated flow rate from 0.13 to 0.56 cc/min. Atropine (75 microgram/kg) abolished the anticholinesterase induced pressure and secretory rate increases. In a third group of dogs administration of cholinesterase inhibitor 75 mg/kg and secretin infusion 2 U/kg/hr resulted in acute pancreatic interstitial edema, acinar cell vacuolization, hyperamylasemia and hyperlipasemia. These results suggest that occurrence of pancreatitis as a complication of anticholinesterase insecticide intoxication is the result of hypersecretion and pharmacologic ductal obstruction.

Organophosphorus Insecticides and Glucose Homeostasis

“…These results are in accordance with the study of Hagar et al, (2002) who had earlier reported increased blood glucose levels and hyerinsulinemia with concomitant histochemical and ultramicrostructural changes in pancreas of rats following chronic exposure to dimethoate. Several studies have demonstrated pancreatitis after exposure to OPI (Dressel et al, 1979;Moore & James, 1988;Hsiao et al, 1996). Increase in the serum lipase and amylase activities reported by us clearly indicates that DM results in a state of pancreatic damage.…”

“…Acute pancreatitis is also a well known complication of OP poisoning (Dressel et al, 1979;Frick et al, 1987;Hsiao et al, 1996), and epidemiological findings indicate that the incidence of pancreatitis is high in OPI intoxication based on various pathophysiological reports (Gokalp et al, 2005). The precise mechanisms underlying OPI-induced pancreatitis are still undefined, although it is believed to involve obstruction of pancreatic ducts and /or enhanced reactive oxygen species (Dressel et al, 1982;Sevillano et al, 2003, Sultatos, 1994.…”

Biochemical abnormalities in OPC poisoning and its prognostic significance

“…Matsumiya N et al (6) and Li T Nagayama N et al (7) stated that elevated serum amylase in the absence of clinical pancreatitis could be attributed to hypoxemia. Dressel et al (8) showed that OP intoxication causes increase in intraductal pressure and increase in exocrine pancreas flow rate resulting in extravasation of fluid. The mean serum potassium in our study is 3.2 meq/l (Table 2).…”

Hyperamylasemia After Over Purchase of Clonazepam

“…Hyperamylasemia and hyperlypasemia due to intraductal pressure increment, cholinergic stimulation resulted in acute pancreatitis had been shown in organophosphate poisoning [14][15][16].…”