Introduction: Organophosphate (OPC) and carbamate (CMC) compounds are
highly toxic anticholinesterase (AntiChE) pesticides, extensively used worldwide, and
still responsible for poisoning epidemics. Multi-organ dysfunctions have been reported
following AntiChE poisoning. Aim: This study aimed to assess the correlation
between poisoning severity score (PSS), Glasgow coma scale (GCS), and
butyrylcholinesterase (BuChE) levels with clinical and laboratory changes in adult
patients with acute AntiChE intoxication. Subjects and methods: This study included
25 individuals in healthy-control-group (HC-group) and 75 patients in AntiChE-group.
According to poisoning severity criteria, patients were allocated into mild, moderate,
or severe intoxicated-group. Gender, age, and causative substance data were reported.
Clinical parameters like grade of PSS, delay in hospital arrival time (DHA), vital signs
functions, GCS score, and length of hospital stay (LHS) were measured. The blood
levels of biochemical parameters (pH, sodium, potassium, and random blood glucose)
and enzymatic biomarkers (BuChE, cardiac creatine kinase-myocardial band and
cardiac troponin I, pancreatic amylase and lipase, hepatic aspartate and alanine
aminotransferases, and kidney urea and creatinine) were estimated. Results: Cases
were mostly females, aged 23.82±0.82-year, and intoxicated by OPC, especially
malathion. The commonest clinical findings were minor manifestations of PSS, DHA
for 2-hour, drowsy GCS level, and relatively short LHS for ≤24-hour, while vital signs
abnormalities predominantly included tachycardia, hypertension, tachypnea, and
hyperthermia. The main biochemical abnormalities were metabolic acidosis,
hypernatremia, hypokalemia, and hyperglycemia. Low BuChE levels were detected in
all cases, whereas increased enzymatic biomarkers levels were noticed in some cases.
On admission, the proportions and mean values of overall clinical and laboratory
parameters showed statistically significant differences among the three intoxicatedgroups and between AntiChE-group and HC-group. Additionally, PSS grade, GCS
score, and degree of BuChE inhibition significantly correlated with DHA, all vital
signs, LHS, and overall laboratory parameters as well as between each other. At
discharge, the initial clinical and laboratory abnormalities were markedly improved
and showed statistically insignificant differences from HC-group except for BuChE
levels remained significantly low. Conclusion: Although the PSS, GCS, and BuChE
seem similarly useful clinical indices at predicting severity of AntiChE poisoning,
however, the efficacy of PSS outperform the GCS and BuChE effectiveness. |
