Raghapriya R, Dosi Rupal V, Parmar Aeshal
Senior Resident,Department of Medicine, Medical College Baroda and SSG Hospital; * Corresponding Author.
Professor, Department of Medicine, Medical College Baroda and SSG Hospital.
J Assoc Physicians India. 2018 Aug;66(8):18-22.
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.
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.
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.
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.
有机磷杀虫剂（OPI）是使用最为广泛的一类杀虫剂。大量科学证据表明，接触OPI是一个重大的毒理学威胁，因其具有多种毒性，如神经毒性、内分泌毒性、免疫毒性、生殖毒性、遗传毒性以及导致器官损伤、细胞氧化平衡改变和破坏葡萄糖稳态的能力，可能会影响人类和动物健康。尽管有机磷（OP）中毒患者的治疗取得了进展，但中毒患者的死亡率仍令人担忧。在各种促成因素中，血糖状态的极端变化和波动是一个有充分文献记载的影响危重病患者预后的参数，不过关于OP中毒的研究尚显不足。OP中毒时从低血糖到高血糖和酮症酸中毒的各种血糖变化以及其他毒理学效应均有报道，但证实这些发现的研究却很少。本研究旨在探讨急性OP中毒时的各种血糖变化及其对临床严重程度和临床结局的影响。
对100例年龄在18岁以上、非糖尿病、无混合中毒病史或无影响血糖水平的疾病且符合纳入和排除标准的确诊急性中毒患者进行了为期一年的前瞻性分析研究。记录患者就诊时的血糖状态，并将患者分为低血糖组、血糖正常组和高血糖组，然后使用描述性统计、关联性分析以及用MedCalc进行显著性检验，将其与严重程度和临床结局进行关联分析。
对100例急性有机磷中毒患者进行了前瞻性分析研究，并根据就诊时的血糖水平进一步分为低血糖组（37%）、血糖正常组（52%）和高血糖组（11%）。各组的死亡率分别为59.45%、9.6%和63.63%。三组的呼吸机使用率分别为94.59%、53.84%和100%。用于研究就诊时随机血糖（RBG）与既定的佩拉德尼亚有机磷中毒量表（POP）（表1）和中毒严重程度量表（PSS）（表2）之间关联的卡方检验显示，该研究具有统计学显著性（p值 = 0.001），表明血糖状态的两个极端均与较高的临床严重程度和较差的结局相关。
我们得出结论，在像印度这样资源有限的国家，急性有机磷中毒患者就诊时血糖状态与临床严重程度评分和血清胆碱酯酶（S.ChE）一起考虑时，是指导临床严重程度和结局的一个简单、廉价且可靠的指标。
