S. Chandrasekhar1, M. Abdur Rahim2, S.M.S. Quraishi3, C. Ravi Theja4, K. Sai Kiran5
BACKGROUND
Organophosphorus compound poisoning is the most common poisonings in India because of easy availability often requiring ICU care and ventilator support. Clinical research has indicated that respiratory failure is the most important cause of death due to organophosphorus poisoning. It results in respiratory muscle weakness, pulmonary oedema, respiratory depression, increased secretions and bronchospasm. These complications and death can be prevented with timely institution of ventilator support.
MATERIALS AND METHODS
Hundred consecutive patients admitted with a history of organophosphorus poisoning at Kurnool Medical College, Kurnool, were taken for study after considering the inclusion and exclusion criteria. Detailed history, confirmation of poisoning, examination and other than routine investigations, serum pseudocholinesterase and arterial blood gas analysis was done. The severity and clinical outcomes in OP poisoning is graded by PSS (poison severity score) and GCS (Glasgow coma scale) scoring systems.
RESULTS
This study was conducted in 100 patients with male preponderance. Majority of poisoning occurred in 21-30 age group (n=5). Most common compound consumed in our study was methyl parathion and least common was phosphoran. Slightly more than half of the patients consumed less than 50 mL of poison. 21 patients consumed between 50 to 100 mL. Distribution of poison severity score of patients studied showed 45 cases of grade 1 poisoning. 26 cases of grade 2 poisoning, 23 cases of grade 3 poisoning and 6 cases of grade 4 poisoning (death within first 24 hours). Distribution of GCS score of patients studied GCS scores were <10 in 25 patients at admission and 24 patients after 24 hours. GCS scores were ≥10 in 75 patients at admission and 76 patients after 24 hours. Poison severity score is not prognostic, but merely defines severity of OP poisoning at a given time.
CONCLUSION
Both Glasgow coma scale and poison severity scoring systems are effective in predicting severity and outcome of OP compound poisoning. Glasgow coma scale maybe more helpful as it is easy to use, does not require any laboratory investigations. GCS being less time consuming and can be done easily can be used in peripheral areas to identify high-risk patients for urgent referral to tertiary care centers.
