title: Prognostic significance of estimation of pseudocholinesterase activity and role of pralidoxime therapy in organophosphorous poisoning.
abstract: BACKGROUND
  Organophosphorous (OP) poisoning is one of the most common poisonings seen in India. OP compounds act through inhibition of enzyme acetylcholinesterase and estimation of pseudocholinesterase (PCE) activity strengthens the diagnosis in clinically uncertain cases of OP poisoning. The role of pralidoxime (PAM) therapy in OP poisoning has been controversial.
  
  
  OBJECTIVE
  This study was aimed to determine the prognostic significance of estimation of PCE activity and also to assess the role of PAM therapy in OP poisoning.
  
  
  METHODS
  Patients of suspected OP poisoning of age >12 years admitted to emergency unit at a tertiary healthcare center of north India were enrolled. Patients were categorized into two groups; group A who were given intravenous atropine and group B who were given injectable PAM along with atropine. Serum PCE level was estimated at the time of admission in all patients and severity of OP poisoning was assessed according to PCE level. Requirement of atropine, oxygen inhalation, intubation and ventilatory support, total hospital stay, and mortality were compared between different classes of severity and also between Groups A and B.
  
  
  RESULTS
  This study included a total of 70 subjects, 35 in each group with mean age of 24.99 ± 8.7 years. Out of 70 subjects 49 (70%) were male and 21 (30%) were female. Forty nine patients (70%) of OP poisoning were with suicidal intent while 21 (30%) cases were accidentally poisoned. In all suicidal cases route of poisoning was ingestion whereas in all the accidental cases route of exposure was inhalational. PCE levels were reduced in all the cases and the mean level was 3,154.16 ± 2,562.40 IU/L. The total dose of atropine required, need for oxygen inhalation and need for intubation and ventilatory support, mean duration of hospital stay and mortality rate (P = 0.003) were higher in moderate to severe cases and did not have significant difference between Groups A and B.
  
  
  CONCLUSIONS
  The study recommends estimation of PCE level at admission to classify severity of OP poisoning and to estimate prognosis. This study did not find any beneficial role of PAM therapy in reducing morbidity as well as mortality.
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Shyam Chand
authors.initials: SC
authors.lastname: Chaudhary
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Khemraj
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Kamal Kumar
authors.initials: KK
authors.lastname: Sawlani
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Nirdesh
authors.initials: N
authors.lastname: Jain
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Arvind Kumar
authors.initials: AK
authors.lastname: Vaish
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Virendra
authors.initials: V
authors.lastname: Atam
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Munna Lal
authors.initials: ML
authors.lastname: Patel
authors.affiliation: Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Avinash
authors.initials: A
authors.lastname: Agarwal
keywords: Atropine; insecticides; organophosphorous; pralidoxime; pseudocholinesterase