Glycemic Status at the Time of Presentation in Acute Organophosphorous Poisoning and its Correlation with Severity and Clinical Outcome.

Background: Organophosphorus insecticides (OPI) are one of the most extensively used classes of insecticides. Huge scientific body of evidence suggests that OPI exposure is a major toxicological threat that may affect human and animal health because of their various toxicities such as neurotoxicity, endocrine toxicity, immunotoxicity, reproductive toxicity, genotoxicity and ability to induce organ damage, alterations in cellular oxidative balance and disrupt glucose homeostasis. Mortality among organophosphorous (OP) poisoning patients despite advancements in its management is of concern.Of the various contributing factors,extremes and fluctuation in the glycemic status is a well documented parameter affecting the outcomes in critical illness although studies with respect to OP poisoning are deficient. All varieties of glycemic changes from hypoglycemia to hyperglycemia and ketoacidosis in OP poisoning along with other toxicological effects are reported,studies corroborating these findings are only few. The present endeavor was undertaken to study various glycemic changes in acute OP poisoning and it's bearing on clinical severity and clinical outcome.

Aims And Objectives: 1. To assess the glycemic status by estimating random blood glucose level at the time of admission in cases of acute organophosphorous poisoning 2. To assess severity of the poisoning with various poisoning scales(PSS and POP) and level of serum pseudocholinesterase. 3. To correlate the documented blood glucose level with the severity and clinical outcome.

Method: A prospective analytical study of 100 patients with diagnosed acute poisoning, above the age of 18 years, non diabetic, with no history of mixed poisoning or condition affecting blood glucose levels and fulfilling the inclusion and exclusion criterias was done over a period of one year. The glycemic status at the time of presentation was documented and the patients were grouped into hypoglycemics, euglycemics and hyperglycemics and the same was correlated with the severity and clinical outcome using descriptive statistics, association and test of significance using MedCalc.

Results: A prospective analytical study of 100 patients of acute organophosphate poisoning was done and on the basis of blood glucose levels at the time of presentation were further categorised into hypoglycemics (37%), euglycemics (52%) hyperglycaemic (11%). The outcome in terms of mortality was 59.45%,9.6% and 63.63% in the respective groups. The ventilator requirements among the three groups were 94.59%,53.84% and 100% respectively. Chisquare test to study the association between the presentation Random Blood Glucose (RBG) and the established Peradeniya Organophosphorous Poisoning Scale (POP) (Table 1) and Poisoning Severity Scale (PSS) (Table 2) revealed the study to be statistically significant (p value= 0.001)indicating both the extremes of glycemic status are associated with higher clinical severity and poorer outcomes.

Conclusion: We conclude that the glycemic status at the time of presentation in acute organophosphate poisoning patients is a simple, cheap, reliable marker in guiding the clinical severity and outcome when considered with clinical severity scores and S.ChE in a resource limited country like India.