Title: Evaluation of Serum Potassium Levels as Prognostic Marker in Acute Organophosphorus Poisoning in a Tertiary Care Centre
Authors: Dr Vandana Dandekar, Dr Ashiti Jain, Dr Aakash Barad, Dr Jaishree Ghanekar
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.58
Abstract
Background: It is apparent that although inhibition of cholinesterase plays an important role in organophosphate (OP) toxicity, other factors are also important. One of the contributing factors for its severity is electrolyte imbalances esp. hypokalemia. This study was aimed at evaluating the levels of hypokalemia along with plasma cholinesterase (PChE) levels in predicting morbidity and mortality of acute OP poisoning in patients presenting in our hospital.
Methods: In this cross sectional study, patients with definitive diagnosis of OPC poisoning were enrolled. Pre-interventional history and clinical features were noted with severity assessment done according to Proudfoot classification, along with measurement of serum potassium ([K+]) and PChE levels.
Results: Thirty OP poisoned patients (22 men, 8 women) were enrolled. A total of 30 cases who presented with clinical features of opc poisoning were classified according to Proud foot classification. Among them, 68.4% of cases (13 out of 17) developed hypokalemia. Muscle weakness and fasciculations developed with mean serum [K+] levels of 2.90 ± 0.11. Ventilatory support was required at the mean serum [K+] levels of ± 0.10 mmol/L. Mortality was noted when the mean serum [K+] reduced to 2.7 ± 0.06 mmol/L. Correlation of the ventilator support and mortality with serum [K+] was significant (P < 0.001). Death was mostly observed among patients who had respiratory distress associated with hypokalemia and severly reduced PChE.
Conclusion: With severe clinical features of OP poisoning, there was severe reduction in serum [K+] and PChE levels. Hence, these biochemical findings can be encouraged as predictive markers of severity of op poisoning. Clinicians and medical toxicologists should consider hypokalemia as an alarming sign of poor prognosis in OPC poisoned patients.
Keywords: Hypokalemia ; Organophosphate Poisoning; Prognosis.
References
- Banday TH, Tathineni B, Desai MS, Naik V. Predictors of morbidity and mortality in organophosphorus poisoning: A case study in rural hospital in Karnataka, India. North Am J Med Sci 2015;7:259-65
- Safdar A, Saeed A, Muhammad NR. Organophosphorus poisoning: Emergency management in intensive care unit. Prof 2003;10:308-14.
- Hussain AM, Sultan ST. Organophosphorus insecticide poisoning: Management in surgical intensive care unit. J Coll Physicians Surg Pak 2005;15:100-2.
- Ather NA, Ara J, Khan EA, Sattar RA, Durrani R. Acute organophosphate insecticide poisoning. J Surg Pak 2008;13:71-4.
- Tall A, Ly AB, Nabeth P, Sall AA, Sarr FD, Faye J, et al. Epidemiological investigation of death cases by pesticide poisoning. J Agric Biotechnol Sustainable Develop 2010;2:51-5.
- Syed M Ahmed et al., Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital, Indian J Anaesth. 2014 Jan-Feb; 58(1): 11–17
- Mahadeshwara Prasad D.R et al., A Study of Acute Organophosphate Poisoning at a Tertiary Hospital, Belgaum, Karnataka, Medico legal Update,2012;Volume 12 (2):75-79
- Indranil Banerjee et al., Clinico-Epidemiological Characteristics of Patients Presenting with Organophosphorus Poisoning, N Am J Med Sci. 2012 Mar; 4(3): 147–150.
- Lyzhnikov EA, Savina AS, Shepelev VM.Kardiologiia.1975 Sep;15(9):126-9.