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Category: Volume 07 Issue 05 May 2019
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Title: CPK MB levels in Organophosphorous Compound Poisoning

Authors: Dr K. Kamal Hasan, Dr Prahalad

 DOI: https://dx.doi.org/10.18535/jmscr/v7i5.85

Abstract

Organophosphorous compounds are one of the most commonly used compounds used for suicidal intentions in the developing countries. Organophosphates by their action at muscarinic and nicotinic receptors can have a myriad of presenting symptoms. Here we describe a fatal case of phorate (organophosphorus) toxicity manifesting with hypothermia and cardiotoxicity. CPK, CPK-MB, and Troponin I in acute organophosphorus poisoning, to analyse the correlation between these biochemical parameters and serum acetylcholinesterase levels and to assess the validity of these biochemical parameters in prediction of severity and prognosis in OP poisoning. CPK-MB levels are frequently raised among the OPC poisoning patients and ECG changes are also frequently observed among the OPC poisoning patients. Researchers tend to understand the association between CPK-MB levels and ECG changes to predict prognosis in OPC poisoning patients presenting in the department of emergency. Laboratory evidence of OP poisoning is usually confirmed by measuring the decreases in the blood and erythrocyte cholinesterase activities. Rise in CPK, CPK-MB, Troponin I and ALT indicate the severity of OP poisoning and is also statistically significant to predict the prognosis of the patient. There are emerging options for new cheaper and/or easily quantifiable biochemical markers in relation to OP poisoning like creatine phosphokinase (CPK).

Keywords: Creatinine phosphokinase-MB, Electrocardiographic changes, Organophosphorus poisoning,

References

  1. Kucukkilinc T, Cochran R, Kalisiak J, Garcia E, Valle A, Amitai G, Radic Z and Taylor P. Investigating the structural influence of surface mutations on acetylcholinesterase inhibition by organophosphorus compounds and oxime reactivation.Chem Biol Interact 2010; 187:238-240.
  2. Dutoit PW, Maller FO, Ventonder WM, Ungerer MJ. Experience with intensive care management of organophosphate insecticide poisoning. S Afr Med J 1981; 60:227-9.
  3. Vijayakumar L. Suicide prevention: the urgent need in developing countries. World psychiatry. 2004;3(3):158-9.
  4. Jeyaratnam J. Acute pesticide poisoning: a major global health problem. World Health Stat Q. 1990;43(3):139-44.
  5. Karalliedde L, Feldman R, Henry J, Marrs T. Organophosphates and health: World Scientific; 2001.
  6. Wyckoff DW, Davies JE, Barquet A, Davis JH. Diagnostic and therapeutic problems of parathion poisoning. Ann Intern Med 1968; 68:875-82.
  7. Morteza Rahbar Taromsari et al, Lockridge, O., and Masson, P. Pesticides and susceptible populations: People with butyrylcholinesterase genetic variants may be at risk. Neurotoxicology. 2000;21:113–126.
  8. WHO, 2002. The World Health report 2002. Reducing risks, promoting healthy life. WHO, Geneva.
  9. Cander B, Dur A, Yildiz M, Koyuncu F, Girisgin AS, Gul M, et al. The prognostic value of the Glasgow coma scale, serum acetylcholinesterase and leukocyte levels in acute organophosphorus poisoning. Annals of Saudi medicine. 2011;31 (2):163.
  10. Karalliedde l, Senanayake N, Acute organophosphate insecticide poisoning in Sri Lanka. Forensic Sci Int 1988;36:97-100.
  11. David A Warrell TMC, John D Firth. Oxford Text Book of Medicine 5th edition edition. 2003 ;vol 1:906-907p.
  12. De Bleecker J, Lison D, Van Den Abeel K, Acute and subacute organophosphate poisoning in the rat. Neurotoxicology 1994; 15:341-348.
  13. Manning GW, Hall GE, Banting FG. Vagus stimulation,and the production of myocardial damage. Can Med AssocJr. 1937;37:314-8.
  14. Yasue H, Touyama M, Shimamoto M, Kato H, Tanaka S,Akiyama F. Role-ofautonomic nervous system in the pathogenesis of Prinzmetal's variant form ofangina. Circulation. 1974;50:534-9.
  15. Horio Y, Yasue H, Rokutanda M, Nakamura N, Ogawa H, Takaoka K, et al. Effects of intracoronary injection of acetylcholine on coronary arterial diameter. Am J Cardiol. 1986;57:984-9.
  16. Kiss Z, Fazekas T. Arrhythmias in organophosphate poisonings. Acta Cardiol. 1979;34:323-30.
  17. Chharba ML, Sepaha GC, Jain SR, Bhagwat RR, Khandekar JD. ECG andnecropsy changes in organophosphorus compound (malathion) poisoning.Indian J Med Sci. 1970; 24:424-9.69.
  18. Kathi P, Ansari JA, Bhandari S, Koilara S: Cardiac and electrocardiographical manifestations of acute organophosphate poisoning. Singapore medical journal. 2004:45:385-389
  19. Ya-ying G, Fei-lai X, Chuan-kui Z. Clinical diagnostic value of serum troponin t in myocardial injury caused by acute organic phosphorous poisoning. Appl J Gen Pract 2007;8:31.
  20. Munidasa U, Gawarammana I, Kularatne S, Kumarasiri P, Goonasekera C. Survival pattern in patients with acute organophosphate poisoning receiving intensive care. Journal of Toxicology: Clinical Toxicology. 2004;42(4):343-7.
  21. Saadeh A, Farsakh N, Al-Ali M. Cardiac manifestations of acute carbamate and organophosphate poisoning. Heart. 1997;77(5):461-4
  22. Yurumez Y, Yavuz Y, Saglam H, Durukan P, Ozkan S, Akdur O, et al. Electrocardiographic findings of acute organophosphate poisoning. The Journal of emergency medicine. 2009;36(1):39-42.
  23. Vijayakumar S, Fareedullah M, Kumar EA, Rao KM. A prospective study on electrocardiographic findings of patients with organophosphorus poisoning. Cardiovascular toxicology. 2011;11(2):113-7.
  24. Aghabiklooei, Abbas, Babak Mostafazadeh, and Esmaeil Farzaneh and Afsaneh Morteza . Does organophosphate poisoning cause cardiac injury?. Pak J Pharm Sci 2013; 26:1247-1250.
  25. Senanayake N, Karalliedde L. Pattern of acute poisoning in a medical unit in central Sri Lanka. Forensic Sci Int 1988; 36:101-4
  26. Senanayake N, De Silva H J and Karalliedde L A, Scale to assess severity in organophosphorus intoxication: POP scale. Hum. Exp. Toxicol., 12: 297-299(1993)
  27. Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicological reviews. 2003;22(3):165-90.
  28. Kumar S, Fareedullah M, Sudhakar Y, Venkateswarlu B, Kumar E. Current review on organophosphorus poisoning. Arch Appl Sci Res. 2010;2(4):199-215.
  29. Bardin PG, van Eeden SF, Moolman JA, Foden AP, Joubert JR. Organophosphate and carbamate poisoning. Archives of internal medicine. 1994;154(13):1433-41.
  30. Johnson MK. Mechanisms of and biomarkers for acute and delayed neuropathic effects of organophosphorus esters. Use of Biomarkers in Assessing Health and Environmental Impacts of Chemical Pollutants: Springer; 1993. p. 169-82.
  31. International Programme on Chemical Safety, World Health Organization (WHO). Epidemiology of pesticide poisoning: harmonized collection of data on human pesticide exposure in selected countries. Geneva, Switzerland: WHO Press; 2004.
  32. Kasper, Braunwald, Fauci, et al. Harrison,s Principles of Internal Medicine, 18th Edition. 2011; 2:2741-8.
  33. World Health Organization (WHO), United Nations Environment Programme. Public Health Impacts of Pesticides Used in Agriculture. Geneva, Switzerland: WHO Press; 1990.
  34. Taylor P. Anticholinesterase agents. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. New York: McGraw-Hill; 2006. p.201-16.
  35. Worek F, Kleine A, Falke K, Szinicz L. Arrhythmias in organophosphate poisoning: effect of atropine and bispyridinium oximes. Arch Int Pharmacodyn Ther 1995; 329:418-35.
  36. Eddleston M, Phillips MR (2004) Self poisoning with pesticides. BMJ 328:42-44.
  37. Eddleston M, Buckley NA, Eyer P, Dawson AH (2008) Management of acuteorganophosphorus pesticide poisoning. Lancet 371: 597-607.
  38. Vijayakumar S, Fareedullah M, Ashok Kumar E, Mohan Rao K (2011) A prospective study on electrocardiographic findings of patients with organophosphorus poisoning. Cardiovasc Toxicol 11: 113-117.
  39. Karki P, Ansari JA, Bhandary S, Koirala S (2004) Cardiac and electrocardiographical manifestations of acute organophosphate poisoning. Singapore Med J 45: 385-389.
  40. Senanayake N, de Silva HJ, Karalliedde L. A scale to assess severity in organophosphorus intoxication: POP scale. Hum Exp Toxicol. 1993;12:297–9.
  41. Vance MV, Selden BS, Clark RF. Optimal patient position for transport and initial management of toxic ingestions. Annals of emergency medicine. 1992;21(3):243-6.
  42. Minton NA, Murray VS. A review of organophosphate poisoning. Medical toxicology and adverse drug experience. 1988;3(5):350-75.
  43. Stacey R, Morfey D, Payne S. Secondary contamination in organophosphate poisoning: analysis of an incident. QJM : monthly journal of the Association of Physicians. 2004;97(2):75-80.
  44. Nermeen A, Hassan MA. Correlation between serum creatine phosphokinase and severity of acute organophosphorus poisoning: A prospective clinical study (2012‑2013). J Environ Sci Tox Food Technol. 2013;4:18-29.
  45. John M, Oommen A, Zachariah A. Muscle injury in organophosphorous poisoning and its role in the development of intermediate syndrome. Neurotoxicology. 2003;24(1):43-53.
  46. Raddi D, Anikethana GV. Creatine kinase for prognostication in organophosphorus poisoning. International Journal of Science and Research 2014;3(11):1336-1338.
  47. Anand S, Singh S, Nahar Saikia U, Bhalla A, Paul Sharma Y, Singh D. Cardiac abnormalities in acute organophosphate poisoning. Clinical Toxicology. 2009;47(3):230-5.
  48. Aghabiklooei A, Mostafazadeh B, Farzaneh E, Morteza A. Does organophosphate poisoning cause cardiac injury? Pakistan journal of pharmaceutical sciences. 2013; 26(6).

Corresponding Author

Dr K. Kamal Hasan

Asst.Professor, Department of Medicine, Ayaan Institute of Medical Sciences, Teaching Hospital and Research Centre, Kanakamamidi (V), Moinabad (M), R.R. Dist, Telangana 501504