Impairment in Clinical Indices in Acute Organophosphate Insecticide Poisoning Patients in India

Abstract

This report defines with the impairment in clinical indices and laboratory investigations in acute organophosphate poisoning patients admitted to Outdoor Patient Department of B.J. Medical College and Civil Hospital, Ahmedabad – 380016, India. Out of 121 OP poisoning patients (65.3% males and 35.7% females), about 70% cases were educated (matriculate and higher secondary passed) and remaining illiterate. It was noticed that suicidal and intentional poisoning being a major cause as recorded in 80.2% cases followed by occupational (9.1%), accidental (6.6%), homicidal (1.6%) and unknown (2.5%). The major signs and symptoms reported by the poisoning cases were muscarinic and nicotinic manifestations. ECG abnormalities were recorded in 46 cases (38%); the sinus tachycardia (24%), depression of ST segment and inversion of T wave (7.4%) and sinus bradycardia (6.6%). Plasma and RBCs ChE activities in OP poisoning cases were significantly decreased (p≤0.01). The activities of serum LDH and CK activities were significantly elevated (p≤0.01) in poisoning cases indicating muscular functional impairment due to OP toxicity. In a sub-set of samples, the serum levels of IgA, IgG and circulating immune complexes (C3 and C4) were also found significantly increased (p≤0.01). The findings indicated that administration of atropine with 2-PAM increases the probability of survival although the results showed no significant variation. Logistic regression analysis showed that the survival rate of the cases was about 6 times more when number of days (indirectly the quantum of atropine and 2-PAM received by the cases) increased from 3 days. When duration of atropine administration was divided into 4 quartiles, it was observed that there is significant trend of survival of the cases (63% survival in the 1st quartile, 80% survival for 2nd quartile and 100% for 3rd and 4th quartile). The findings of this study reflect the usefulness of few clinical indices in management of OP pesticide poisoning and also support to impose the restrictions on the access of very toxic pesticides.