title: Body mass index as a prognostic factor in organophosphate-poisoned patients.
abstract: Organophosphate poisoning is a serious clinical entity and considerable morbidity and mortality. Several factors have been identified to predict outcomes of organophosphate poisoning. Organophosphates are lipophilic and therefore predicted to have a large volume of distribution and to rapidly distribute into tissue and fat. Thus, toxic effects of organophosphate would be expected to last longer in obese patients. We investigated the relationship between obesity and clinical course in 112 acute organophosphate-poisoned patients from an initial medical record review of 234 patients. One hundred twenty-two patients were excluded: 6 were children, 14 had an uncertain history of exposure and of uncertain agent, 10 were transferred to another hospital, 67 were discharged from the emergency department because their toxicity was mild, 21 had carbamate poisoning, and 4 did not have height or weight checked. Clinical features, body mass index, Glasgow Coma Scale, laboratory findings, serum cholinesterase activity, electrocardiogram finding, management, and outcomes were examined. The lipid solubility of the implicated organophosphate was characterized by its octanol/water coefficient. Forty of 112 patients were obese. Obese patients who were poisoned by high lipophilicity organophosphate compounds had a need for longer use of mechanical ventilation, intensive care unit care, and total length of admission. Body mass index can provide a guide to physicians in predicting clinical course and management in organophosphate-poisoned patients.
authors.affiliation: Department of Emergency Medicine, Ewha Womans University, Seoul, Korea. Electronic address: calla521@empas.com.
authors.forename: Duk Hee
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, College of Medicine, Eulji University, Eulji Hospital, Seoul, Korea. Electronic address: kyjung@ewha.ac.kr.
authors.forename: Koo Young
authors.initials: KY
authors.lastname: Jung
authors.affiliation: Department of Emergency Medicine, College of Medicine, Eulji University, Eulji Hospital, Seoul, Korea.
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, College of Medicine, Eulji University, Eulji Hospital, Seoul, Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Cheon
mesh_terms: D000328:Adult; D000368:Aged; D001285:Atropine / Q000627:therapeutic use*; D015992:Body Mass Index; D002801:Cholinesterase Reactivators / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D009765:Obesity / Q000150:complications / Q000378:metabolism*; D062025:Organophosphate Poisoning / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D010755:Organophosphates / Q000378:metabolism*; D011220:Pralidoxime Compounds / Q000627:therapeutic use*; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012995:Solubility
chemical_list: D002801:Cholinesterase Reactivators; D018727:Muscarinic Antagonists; D010755:Organophosphates; D011220:Pralidoxime Compounds; D001285:Atropine; C028797:pralidoxime