18100006010 THESIS

TITLE:

SIGNIFICANCE OF SERUM PSEUDOCHOLINESTERASE LEVELS IN PATIENTS WITH ORGANOPHOSPHORUS COMPOUND POISONING”

INTRODUCTION:

Acute poisoning is important cause of morbidity and mortality in India.

In medical emergency 10% of admissions are due to poisoning and

organophosphorus poisoning contributes to nearly 50% of it.[1]Apart from

use of these substances as agricultural insecticides, pesticides, they are

frequently abused for suicidal purposes because of their low cost, rapid

action and easy availability.

They have been imported in India since 1951, but very few knew the nature

of these compounds as a virulent poison till the Kerala food poisoning

tragedy in 1958. This tragedy took a toll of hundred and add due to

inadvertent stocking of food stuff and folidol packages in the same hold

where the folidol containers leaked and contaminated the gunny bags

containing food stuff[2].

Exposure to organophosphorus compounds in the

form of nerve agents and pesticides poses an ever increasing military and

civilian threat[3] the majority of patients are younger than 30 yrs.[5]

In teenagers and adults the poisoning is generally due to suicidal intention

though accidental poisoning occurs during spraying[2]

They act by irreversibly inhibiting the enzyme cholinesterase resulting in accumulation

of acetylcholine at synapses and myoneural junction and leads to

cholinergic over activity.[6][7][8]

AIMS AND OBJECTIVES

AIM:

 To study the significance of serum pseudocholinesterase levels in patients

with organophosphorus compound poisoning .

OBJECTIVES:

 To study the clinical manifestations in patients with organophosphorus

compound poisoning

 To study the prognostic and diagnostic value of serum

pseudocholinesterase levels in patients with organophosphorus compound

poisoning.

 To study the outcome of patients with organophosphorus compound

poisoning.

MATERIALS AND METHODS:

SOURCE DATA:

This study was undertaken from October 2018 to September 2020 at

Kamineni Institute of Medical Sciences, Narketpally.100 patients of

suspected organophosphorous poisoning admitted to medicalemergency

ward, Kamineni Institute of Medical Sciences have formed thematerial for

the study.

STUDY DESIGN :

Single centre

Prospective study

INCLUSION CRITERIA:

In this study patients above 18 years with suspected Organophosphorus

compound poisoning

EXCLUSION CRITERIA:

• OP compound poisoning cases < 18 years of age.

• H/o consumption of other drugs along with OP compound

• H/o preexisting hepatic dysfunction which reduce the level of

Pseudocholinesterase.

• History of Carbamate poisoning.

DIAGNOSIS :

Based on

1) History or evidence of exposure to organophosphorus compound within

24hours.

2) Characteristic manifestations of OPC poisoning including, miosis,

fasciculations, excessive salivation.

3) Improvement of signs and symptoms with administration of atropine.

4) Corroborative evidence like empty containers and odour of gastric

aspirates.

Depending on the severity of manifestations patients were classified into

threegrades as mild, moderate and severe depending on serum

pseudocholinesterase levels.

INVESTIGATIONS :

Soon after admission blood samples were collected and investigated to

knowthe serum levels of pseudocholinesterase on Day 1, Day 3, and

before discharge. Other routine investigations such as

• Hemoglobin percentage

• Total blood count

• Differential count

• ESR

• Random blood sugar

• Serum creatinine

were done to exclude chronic conditions.

METHOD OF ESTIMATION OF PSEUDOCHOLINESTERASE :

Method with S-butyryl thiocholine iodide using Dibucaine as inhibitor.

LINK TO COMPLETE THESIS WITH MASTER CHART:

https://drive.google.com/file/d/16rjVcmfuzhZLCYfbQYSUMUlSgAbupvKt/view?usp=drivesdk