Correlation of serum creatine phosphokinase and serum cholinesterase in organophosphate poisoning in children

Authors

  • Dhanalakshmi K. Department of Paediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Febina K. Department of Paediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Sarala Sabapathy Department of Paediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Chaithra R. Department of Paediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Thileepan N. Department of Paediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20194546

Keywords:

Correlation, Mild poisoning, Moderate poisoning, Organophosphate poisoning, Serum creatine phosphokinase, Serum Pseudocholinesterase, Severe poisoning

Abstract

Background: Organophosphate (OP) poisoning is one of the most common pesticide poisoning in India in adolescents because of its easy availability. Serum pseudocholinesterase levels are commonly used to assess the severity and to know the prognosis in OP compound poisoning. Serum creatine phosphokinase (CPK) levels is another lab parameter which gets deranged in OP poisoning and has been tried in adults to assess the severity and to know the prognosis.

 Authors objective was to study the correlation of serum pseudocholinesterase and serum CPK in organophosphate poisoning at admission and to compare outcome with serum CPK levels.

Methods: All the children in the age group of 1 month to 18 yrs, who were admitted with the history of suspected OP compound poisoning were enrolled for the study. Estimation of cholinesterase and CPK levels were done at admission and after 1 week. Patients were categorised in to latent, mild, moderate and severe cases based on the S. Cholinesterase levels. These values were analysed to see the correlation.

Results: Among 34 OP poisoning cases,13(38%) were males and 21(62%) were females. Mean age of study population was12.6+4.25 yrs. The median CPK values in latent, mild, moderate and severe cases were 121.5 IU/L,276.5 IU/L, 308IU/L and 467IU/L respectively (p=0.015). Spearman’s rho Correlation coefficient was -0.522 between S. Cholinesterase and S CPK at admission which was significant. The median serum CPK level after 1week in non survivors was 2498.0IU/L and in survivors was 201.0IU/L (p0.014).

Conclusions: There was a strong negative relationship between serum cholinesterase and serum CPK at admission in OP poisoning. Follow up values at 1 week showed that significantly high serum CPK and low cholinesterase, which was also significant and was associated with mortality.

References

Dharmani C, Jaga K. Epidemiology of acute organophosphate poisoning in hospital emergency patients. Reviews on environmental health. 2005;20(3):215-32.

Jeyaratnam J. Acute pesticide poisoning: a major global health problem. World Health Stat Q. 1990;43:139-45.

Utpal KS. Organophosphorus poisoning. In: Utpal KS, Leyland FC, Rajniti P, Shinavi S. editors. Poisoning in children. 4thedn.Newdelhi: Jaypee brothers; 2013:108-116.

Sahjian M, Frakes M. Crush injuries: pathophysiology and current treatment. The Nurse Practitioner. 2007 Sep 1;32(9):13-8.

Ariens AT, Meeter E, Wolthuis OL, Van Benthem RM. Reversible necrosis at the end-plate region in striated muscles of the rat poisoned with cholinesterase inhibitors. Experientia. 1969 Jan 1;25(1):57-9.

Vanneste Y, Lison D. Biochemical changes associated with muscle fibre necrosis after experimental organophosphate poisoning. Human Experiment Toxicol. 1993 Sep;12(5):365-70.

John M, Oommen A, Zachariah A. Muscle injury in organophosphorous poisoning and its role in the development of intermediate syndrome. Neurotoxicology. 2003 Jan 1;24(1):43-53.

Proudfoot A. Organophosphate and Carbamate insecticides in Diagnosis and management of Acute poisoning 1. Edition of oxford Blackwell scientific; 1982:153-157.

Hassan NA, Madboly AG. Correlation between serum creatine phosphokinase and severity of acute organophosphorus poisoning: A prospective clinical study (2012-2013). IOSR J Environmen Sci, Toxicol Food Technol (IOSRJESTFT) e-ISSN. 2013:2319-402.

Bhattacharyya K, Phaujdar S, Sarkar R, Mullick OS. Serum creatine phosphokinase: A probable marker of severity in organophosphorus poisoning. Toxicology international. 2011 Jul;18(2):117-23.

Sen R, Nayak J, Khadanga S. Study of serum cholinesterase, CPK and LDH as prognostic biomarkers in organophosphorus poisoning. Int J Med Res Rev. 2014;2(3):185-9.

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Published

2019-10-21

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Original Research Articles