Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

Abstract

Background: Organophosphorus Compounds (OPC) are main cause of accidental and suicidal poisoning in agrarian countries like India. Aim was to study the clinical profile of OPC-Poisoning and correlate it with the electrocardiographic (ECG) changes and electrolyte abnormalities.Methods: Hundred consecutive cases admitted to Medicine Department underwent clinical examination, ECG, electrolytes, Acetyl Choline Esterase (AChE) estimation from time to time and Paradeniya Organophosphorus Poisoning (POP) score at the time of admission. All these parameter with duration of hospital stay and outcome were statistically analysed using X2 test, Fisher exact test, and inference was drawn.Results: In hundred OPC-Poisoning patients [Male (n=48), Female (n=52), M: F ratio 0.92:1] with mean age of 37.78±12.95 years, commonest poison was cholropyrifos+cypermethrin and was mostly suicidal (96%). Common symptoms were sweating (48%), salivation, blurring of vision, breathlessness and signs were smell of poison (90%), tachypnea, altered sensorium, miosis and fasciculation. POP scoring found 41% of patients in mild, 26% in moderate and 33% in sever grade of poisoning. Hospital stay ranged from 4-18 days. Complications were pulmonary Edema (PE) in 28%, Respiratory Failure (RF) 18%, Aspiration Pneumonia (AP) 15% and Intermediate Syndrome (IS) 4%. 10 died out of 42 patients who had complications and the cause of death was RF in 4, Ventricular Fibrillation (VF) 2 and IS in 2. ECG finding showed sinus tachycardia (31%), prolonged corrected QT (QTc) interval (28%), sinus bradycardia (25%), ST-T changes (17%) and Premature Ventricular Contraction (PVC) in 4% which degenerated to VF in 2%. 24 patients were Hypokalemic from which 16 developed complications.Conclusions: Similar to earlier studies we observed poisoning which was suicidal. QTc prolongation and Hypokalemia are associated with high morbidity and mortality in OPC-Poisoning.

Evaluation of Copeptin level and Peradeniya Score as Predictors of Severity and Outcome in Acute Organophosphorus Pesticides Poisoned Patients Admitted to the Poison Control Center Ain Shams University Hospitals (A Prospective Study)

“…Regarding serum K level, hypokalemia was recorded in 43 % of patients, with mean value 3.5 ± 0.4 (mEq/L), with no significant correlation to severity, these results were similar to Banday et al, (2015) results that failed to correlate hypokalemia to severity of OP poisoning. However, mean serum K level was lower in deaths than in discharged patients, showing significant association between hypokalemia and the outcome, this finding was similar to a study performed by Tripathy et al, (2018) that associated hypokalemia with mortality.…”

Clinical Profile of Acute Organophosphorus Poisoning with Special Reference to Its Metabolic Complications

“…Cases were selected based on history of exposure to OP compounds, characteristic clinical signs and symptoms of OP poisoning and improvement of the signs and symptoms of poisoning after administration of atropine and oximes. 4 Patients with co-morbidities like diabetes, renal disease, liver disease, cardiovascular disease were excluded. A detailed history regarding age, occupation, residence, socio-economic status, approximate time of ingestion, circumstances leading to poisoning were recorded.…”

“…Atropinisation was confirmed by dry secretions, dilated pupils and tachycardia. 4 Laboratory investigations viz. Blood R/E, Urine for R/E, Liver function tests, Renal function tests, blood sugar, ECG were done in each case.…”

“…5 Patient was said to be atropinised with the following signs-dilatation of pupils, dry secretions and tachycardia. 4 all data were documented and analysed as per laid down protocol.…”

“…1,3 Common muscarinic features are vomiting, diarrhoea, salivation, miosis, sweating, bradycardia, hypotension, bronchoalveolar secretions, bronchoconstriction and nicotinic features are fasciculation, paralysis, tachycardia, reduced ventilation, mydriasis. 1,4 the present study is undertaken to assess the clinical feature and metabolic complications of acute OP poisoning.…”