Hyperglycemia, Glycosuria, Ketonuria and their Association with Severity of Organophosphate Poisoning- A Cross-sectional Study

Abstract

Introduction: Organophosphate Poisoning (OP) is very common in India and presents with features of cholinergic excess. Timely diagnosis and prompt treatment helps in prevention of complications like aspiration pneumonitis, respiratory failure etc. Due to non availability of Pseudo cholinesterase measuring facility at many rural areas and subcentres and as hyperglycemia, glycosuria and ketonuria are commonly seen in OP poisoning, the study of association of these three parameters with OP poisoning is of utmost importance. Aim: To study the association of hyperglycemia, glycosuria and ketonuria with severity of OP. Materials and Methods: This was a cross-sectional study with a sample size of 120 patients of OP poisoning, who reported to Karnataka Institute of Medical Sciences Hospital, Hubli, during December 2017 to November 2018. Adults >18 years of age with OP poisoning with no pre-existing diabetes were included. Clinical features with Peradeniya Organophosphate Score (POP Score), Complete Blood Count (CBC), Pseudo cholinesterase level, serum amylase, Gylcated Haemoglobin (HBA1c), Random Blood Sugar (RBS), urine ketones, urine glucose levels were obtained. The data was analysed using Chi-square test, ANOVA, paired t-test, Pearsons and Spearman's correlation. Results: Majority of the study population belonged to age group of 20-40 years (57.5%). Mean RBS at presentation was 200.58±110.31 mg/dL. Mortality was associated with higher RBS at presentation and RBS after 12 hours. There was significant association between RBS and outcome. Increasing RBS levels had direct correlation with mean duration of AMBU ventilation, mechanical ventilation, ICU stay duration, hospital stay duration and mortality rate. Deaths in cases with RBS <150 mg/dL was 2 and in >250 mg/dL is 22. Among the study population, eight cases had glycosuria and six had ketonuria at presentation. Mean POP score was also higher among these subjects with hyperglycemia, glycosuria and ketonuria. Conclusion: Blood sugar levels, urine analysis for glucose and ketones are useful, simple and cheap markers for identifying the severity of OP. Their presence indicates patient is at higher risk of developing complications and patient may be planned for referral to higher centre from non equipped centres. Hyperglycaemic state is a poor prognosticating factor.