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The age, sex, cause of contact, compound involved, time elapsed between exposure and admission to the ED, duration of hospital stay, and cardiac manifestations at the time of presentation were recorded. Sixty-two patients with OP poisoning presented to our ED from January to December from which 54 patients were included in the study. The mean age was Of the cases, Twenty-six patients had a prolonged QTc interval.
Mean PSS of men and women was 1. GCS is a parameter that helps clinician to identify advanced grade OP poisoning patients in the initial assessment in the ED. Keywords clinical toxicology, organophosphates, poisoning Introduction accumulates. The continued stimulation of the acetyl- choline receptor account for the clinical signs and Organophosphates OP are used as insecticides in symptoms of OP poisoning.
According to the World Health Organization, 1 million serious accidental and 2 million suicidal 1 Canakkale Onsekiz Mart University Faculty of Medicine, poisonings with insecticides occur worldwide every Departments of Emergency Medicine, Canakkale, Turkey year, and of these, approximately , die, mostly 2 Department of Emergency Medicine, Erciyes University Faculty in developing countries.
Cardiac complications include tachycardia Table 1. The Glasgow coma scale provides a score in the or bradycardia, prolonged corrected QT QTc inter- range 3—15 val, PR interval prolongation, and dysrhythmias. GCS and interval in predicting outcomes in OP poisoning. We PSS were calculated for each patient using the also was to describe the clinical characteristics of criteria in Tables 1 and 2.
Pulse rate, blood pressure, adult OP poisoning cases admitted to our hospital. The QT interval was corrected Turkey. The diagnosis of OP poisoning cians.
The manifestations of OP poisoning, including excessive protocol included rapid atropinization, with doubling salivation, miosis, and fasciculations, and improve- dose of atropine at 5—10 min intervals, starting at 1—3 ment of the signs and symptoms of OP poisoning after mg, given until muscarinic signs were abolished. The administration of atropine. Exclusion criteria included decision to intubate and mechanically ventilate was carbamate poisoning or severe pre-existing chronic made by the medical team.
All symptomatic patients health status and co-ingestion of other drugs. The results were Downloaded from het. Cardiac manifestations of acute organophosphate Table 4. Chi-square test was used in All of the cases according PSS were assessed in the statistical analysis of gender distribution. After four grades. As 32 There was no significant cor- tributed data, and the Kruskal-Wallis test for data not relation between the PSS score and gender difference normally distributed.
Bonferroni correction. Findings were considered sig- Mean hospitalization period was 6. ED from January to December The ages During the study, 3 5. The of the patients ranged from 17 to 80 years. The mean PSS of these three cases was 4. There was no significant difference in the mean age between males Of the Discussion cases, 29 We OP compound. The average time lapse between aimed to evaluate whether clinical parameters that exposure to the time of administration at the ED can be obtained rapidly in cases presenting to the pre-hospitalization period was 4.
OP compound that caused the intoxication could According to the demographic data that we be determined in 25 of the cases. Our data were consistent with the results Cardiac manifestations and electrocardiographical achieved in the previous studies on OP poisoning. Twenty severity of the cases and manage the patients on the six Table 6.
PSS measures the severity of the illness after the acute cases. Davies et al. Our results show consistency with and outcomes of the poisonings. PSS is not a prognos- those two studies. GCS is a neurological scale, which is No statistical correlation was found between commonly employed in Emergency Services for the pre-hospitalization period and PSS. Actually, as this assessment of the consciousness of patients.
Because, the delay in treatment enables poison poisoning on admission to Emergency Service and to increase its initial peak serum level, which leads to evaluated those along with GCSs and other clinical irreversible tissue damage. Sam et al. GCSs of these cases were significantly influence over the clinical outcome. This result suggests PSS early intervention is known to be one of the most and GCS as effective tools for determination of the important factors that could affect survival.
Moreover, because GCS important result of our study was the significantly high has less complex parameters, it is more easily used PSS scores in OP poisoning cases over 50 years of age. Grmec et al. Downloaded from het. Lancet ; Sivangnanam S. Potential therapeutic agents in the be used as a prognostic parameter. Yurumez Y, et al.
Acute organophosphate poisoning in study. The mechanism of cardiac symptoms occurring university hospital emergency room patients. Intern in OP poisoning cases is not yet understood clearly. Med ; However, more than one mechanism is thought to 4. Karki P, et al. Cardiac and electrocardiographical man- be involved in the process. Parasympathetic and sym- ifestations of acute organophosphate poisoning. Singa- pathetic overactivity, hypoxemia, acidosis, electrolyte pore Med J ; Q-T interval prolonga- indicated as the underlying causes of myocardial tion and pleomorphic ventricular tachyarrhythmia damage.
Hum Exp Toxicol ; Electrocardiographic findings of is a prolonged period of parasympathetic activity; and acute organophosphate poisoning. J Emerg Med in phase 3, QT prolongation is followed by torsades ; Rubinshtein R, et al. Early onset of ventricular tachyar- lar fibrillation. Isr Med itorization is recommended for detection of dynamic Assoc J ; 4: In the current study, most com- 8.
Cardiac manifes- mon ECG finding in OP poisoning cases was the pro- tations of acute carbamate and organophosphate longed QTc interval. This result is consistent with the poisoning. Heart ; Kose A, et al. Cardiac damage in acute organo- Another important result of our study was the phosphate poisoning in rats: Effects of atropine and absence of a relationship between QTc interval and pralidoxime.
Am J Emerg Med ; However, there are studies that show different Abdollahi M, et al. Pesticides and oxidative stress: a results concerning the value of ECG for determining review. Med Sci Monit ; — Eddleston M, et al.
Differences between organop- poisoning. Nevertheless, Persson HE, et al. Poisoning severity score. Grading another study described prolonged QTc interval as a of acute poisoning.
J Toxicol Clin Toxicol ; poor indicator for prognosis. Cevik AA, et al. Interrelation between the poisoning cannot solely suffice to determine the severity of the severity score, carboxyhaemoglobin levels and in- poisoning. Int J Clin Pract ; Casey PB, et al. J Toxicol Clin Toxicol ; Bazett HC. An analysis of the time-relationship of grade OP poisoning patients in the initial assessment electrocardiograms.
Die Glasgow-Koma-Skala: Definition, Verwendung und Vorteile
Glasgow Coma Scale