Background and Objectives: Organophosphate (OP) compound poisoning is the most commonly encountered poisoning in tertiary care hospital.  Previously  plasma  cholinesterase  level  was  used  for  predicting  the  severity of  poisoning. It was also used to determine the clinical course. Recently serum amylase is being recommended as a better predictor of severity of poisoning. Hence in this study measurement of serum amylase in correlation with plasma cholinesterase level is being studied for assessing the severity of Organophosphate compound poisoning.

Methods:  A prospective study was conducted on 100 patients admitted to emergency ward and Intensive care  unit in tertiary care hospital.  Serum amylase and Plasma cholinesterase levels were measured at the time of admission and at 48 hours.    

Results: This Study  revealed that there is  significant  elevation  of  amylase  and  inhibition  of  cholinesterase at admission  and at 48 hours in OPC poisoning patients .  The  overall  mean  value  for  amylase  was    712.66 U/L  at  admission  (660  U/L  in  survivors  Vs  835.13  U/L  in  non-survivors,  p<0.001).  The  overall   mean  value  for  plasma  cholinesterase  was  1958.78  U/L  at  admission  (2236.54  U/L  in   survivors Vs 1310.67 U/L in non-survivors, p<0.05). The  overall  mean  value  for  amylase  was    401.62 U/L  at  48 hours  (248.71  U  in  survivors  Vs  758.40  U  in  non-survivors,  p<0.001).  The  overall  mean  value  for  plasma  cholinesterase  was  3524.06  U/L  at  48 hours.  (4358.70 U/L  in  survivors Vs 1576.57 U/L in non-survivors, p<0.05).

Interpretation:  The elevation of serum amylase in OP intoxicated patients can provide a  high  degree  of  prediction for subsequent  respiratory  failure and mortality. In such cases quick transfer of the patient to a intensive care unit will reduce the degree of mortality associated with OP poisoning. 

Keywords: Organophosphate poisoning, serum amylase, plasma cholinesterase.

1. Davies JE. Changing  profile  of  pesticide    New England  Journal  of    Medicine 1987;316:806-808.
2. Jeyaratnam J. Pesticide poisoning: as a major global health problem. World Health Stat Q 1990;43:139-144. 
3. Gossel, Thomas A. Principles of clinical toxicology 3rd ed., Raven Press New York
4. Orfila MJB  Traite  des  poisons  tines  mineral,  vegetal  et  animal  on  toxicology  generale sous le rapports de la medicine legale Paris: Crochard;1815 
5. Palmer Taylor. Anticholinesterase  agents,  Goodman-Gilman’s  The pharmacological basis of therapeutics 9th ed, McGraw Hill, New York 1996;160. 
6. Stedman E. Chemical constitution and miotic action, Am. J. Physiol. 1929;90:528- 529.
7. McCombie H  and  Saunders  BC  Alkyl  fluoro  phosphanates  preparation  and  physiological properties, Nature 1946;157(4):287-289.
8. Schrader  G.  Die  entwickling  rever  insektizide  auf  Grindlange  von  organischem  fluoro und phosphor verbindingen. Monographic No.62 Verlag Chemie, Winheim  1952.

Dr M. Ramesh MD