A CLINICAL STUDY OF ORGANOSPHOSPHORUS COMPOUNDS POISONING WITH SPECIAL REFERENCE TO ECG CHANGES AND TROPONIN I

Abstract

Background: The modern world thrives well on revolution in the agricultural practices that has resulted in a massive thrust in agricultural productivity. One of the most important step in green revolution is pesticides. In the developing world, poisoning is a common method of suicide. Organophosphorus compounds inhibit acetyl cholinesterase and butyryl cholinesterase enzymes resulting in excess acetyl choline in the neuromuscular junction causing overstimulation at the cholinergic synapses. The cardiac manifestations occur in a majority of affected patients and may range from innocuous ECG manifestations, such as sinus tachycardia, to life-threatening complications including cardiogenic pulmonary edema. Repolarization abnormalities, including ST-segment elevation and T-wave inversion as well as prolongation of the QTc interval, are among the most frequent cardiac manifestations of acute OP poisoning. . study was carried out in the Department of Medicine, Assam MedicalMethods: College & Hospital,admitting in various ward of medicine,satisfying the inclusion and exclusion criteria. Patients were classied into three grades using 'Peradeniya organophosphorus poisoning scale'.76 Changes in ECG was monitored and Troponin I levels were measured at admission and repeated if required. . In our study, mean age of the cases was 44.32 years with 57.9% cases were below 40 years i.e. young adults. In theResults : study among the 190 patients 123 were males and 67 females. Among our study participants most of the cases were of suicidal OP poisoning (79.5%) while only 20.5% cases were accidental. Most common presenting symptoms in the study were blurring of vision (94.7%), lacrimation (92.1%), breathlessness (64.7%) and salivation (63.7%). In the present study out of 190 cases ECG changes were noted in 75 patients i.e 39.5% cases. Among them most common ECG nding was QTc prolongation (74.7%) followed by ST depression (24%) and T wave inversion (21.3%). A signicant association was observed between severity of poisoning and incidence of ECG changes (p<0.01). Saadeh AM et al.39 in a similar study observed arrhythmias in 11 (24%); prolonged Q-Tc interval in 31 (67%), ST-T changes in 19 (41%) and conduction defects, 4 (9%) cases. Karki P et al.40 observed electrocardiographical abnormalities including prolonged Q-Tc interval in 14 cases (37.8 percent), ST-T changes in 11 cases (29.7 percent), and conduction defects in two cases (5.4 percent). In our study out of 190 cases raised troponin I levels were seen in 30 (15.8%) cases. A signicant association was observed between severity of poisoning and increase in troponin I levels (p<0.01). Wan WG et al.45 discussed the diagnostic value of cardiac enzyme and troponin in acute organophosphorus pesticide poisoning (AOPP). We thus conclude thatConclusions: organophosphorus compounds poisoning is a major cause of morbidity and mortality and is suicidal in most of the cases. ECG abnormalities and myocardial injury is associated with OP poisoning and are more in POP severe grade of poisoning. Morbidity and mortality increases in patients with ECG changes (especially prolonged QTc) and raised Troponin I levels. Therefore, early hospitalization, treatment and follow up with ECG monitoring can be lifesaving in organophosphorus poisoning.