Random blood sugar levels and pseudocholinesterase levels their relevance in organophosphorus compound poisoning

Abstract

INTRODUCTIONOrganophosphorus and organocarbamate compounds are used as agricultural and household insecticides and in the eradication of animal ectoparasites and human lice infestations. Of the various substances used for suicidal attempts in India, organophosphates and organocarbamates form a majority group. Estimation of plasma cholinesterase (pseudo cholinesterase) has an advantage because the measurement is simpler and more accurate than estimation of erythrocyte cholinesterase.1,2 In acute poisoning, manifestations generally occur only after more than 50% of serum cholinesterase is inhibited. The severity or manifestations parallels the degree of inhibition of serum cholinesterase action. Reduction of serum cholinesterase activity to 20-50% is considered as mild poisoning and less than 10% in severe poisoning in between 10-20% moderate poisoning. In severe poisoning, return to normal levels requires about four weeks for plasma cholinesterase and three weeks to several months for RBC cholinesterase when PAM is not administered. ABSTRACTBackground: Most of the organophosphates used as the insecticides inhibit both pseudocholinesterase and acetylcholinesterase. Estimation of erythrocyte cholinesterase (acetylcholinesterase) is theoretically preferred, since it would indicate the degree of inhibition of synaptic cholinesterase (also acetyle-cholinesterase). Estimation of plasma cholinesterase (pseudo cholinesterase) has an advantage because the measurement is simpler and more accurate than estimation of erythrocyte cholinesterase. Methods:We studied fifty cases of organophsphorus poisoning directly admitted in acute medical care of Osmania General Hospital, Hyderabad, India. Results: Out of fifty patients 26% of the patients had mild depression of serum pseudo cholinesterase levels and 42% of patients had moderate depression of serum cholinesterase levels and 32% of patients showed severe depressions of cholinesterase levels. Mortality rates of 26% were observed in our study, 6% of the patients required ventilatory support and two patients (4%) developed intermediate syndrome. Respiratory paralysis was the major cause of death. Conclusions: Hyperglycemia at admission correlates with depression of pseudo cholinesterase levels in organophosphorus poisoning. Random blood sugar levels of >200 mg/dl at admission and depression in pseudocholinesterase levels <1000 U/L (p<0.005) are reliable parameters to predict mortality and ventilator requirement in organophosphorus poisoning.

A prospective study to assess glycemic status as a possible prognostic marker in non diabetic acute organophosphate poisoning patients

“…However greatest levels of suppression (<500 U/L) were found in 9 patients, all of whom had severe grade of poisoning with 4 out of 9 having hyperglycemia at admission. This correlated with the findings of the study conducted by Rao et al 7 A prospective observational study was carried out in Cuttak, by Rachita et al, to assess the glycemic status of OP poisoned patients. 8 It concluded that a fall in serum cholinesterase value was more pronounced in patients having RBS >140 mg%, in parallel with severity of poisoning.…”

“…An observational study of 50 patients was conducted by Rao et al, in Hyderabad, to study the relevance of RBS levels in acute OP poisoning. 7 They concluded that hyperglycemia at admission was commoner than expected, in cases with moderate to severe poisoning. Hyperglycemia at admission correlates with depression of pseudocholinesterase levels in OP poisoning.…”

The Potential Role Of Glial Fibrillary Acidic Protein In Evaluation of Organophosphorus- Induced Neurotoxicity: A prospective clinical study

“…At the time of admission, a patient's glycemic status may help determine the severity of OPC. Also Rao and Raju, (2016) discovered that levels of glucose greater than 200 mg/dl were reliable parameters for predicting mortality and the need for ventilator support, and that hyperglycemia on admission was correlated with the severity of the cases.…”

Do Lab Parameter Could be used as Indicators of Severity in Case of Acute Cholinestrase Inhibitor Insecticides?

“…found that there was a rise in the random blood glucose with increase in severity and blood glucose status at time of admission may help in identifying the severity of poisoning. Rao and Raju, (2016) [29] . found that elevated blood glucose at the time of admission linked well with severity of cases and levels of RBS more than 200 mg/dl were fair parameters to guess mortality and the need for ventilatory support.…”