Assessment of hospitalizations of patients after intoxication with organophosphates used in agriculture

Introduction. Clinical manifestation of organophosphates toxicity may be differentiate and include cholinergic toxidrome, intermediate syndrome, OP-induced delayed polyneuropathy to chronic OP-induced neuropsychiatric disorder (OPIDN). Patients symptoms, along with decrease in cholinesterase serum level, determines the possible diagnosis of organophosphate poisoning. Objective. The aim of the study was to present the clinical manifestation and cholinesterase level changes in intoxication with organophosphorus compounds in patients. Materials and method. A data base was created by analysis of the hospital documents of 34 patients hospitalized due to organophosphate intoxication. Statistical analysis involved frequency tables with percentage values, the application of non-parametric Chi-square test and parametric t-Student test (with homogeneity of variance Levine test).The level of static significance was set to p=0.05. Results. In fatal hospitalizations (20.6%), cholinesterase level was significantly lower (265.87 U/I) than in other patients (4254.78 U/I; p<0.05). Similarly, levels of cholinesterase were decreased in group of patients with acute respiratory failure (999.79 U/I vs 4943.86 U/I in other patients; p<0.05), patients with multi-organ dysfunction syndrome (244.13 U/I vs 4914.89 U/I in other patients; p<0.05) and those with cardiac arrest (547 U/I vs 4636.25 U/I in other patients). A statistically significant difference was also observed in cholinesterase level of patients who required mechanical ventilation (548.17 U/I vs 5219.71 U/I in other group). The study revealed that 29.4% of poisonings were suicidal. Conclusions. The management of a patient with organophosphate poisoning remains challenging and requires continuous control. A significant step in the diagnostic process is the assessment changes in both the clinical picture and cholinesterase level.

Automated summary

The study revealed that cholinesterase levels were significantly lower in patients with fatal hospitalizations, acute respiratory failure, multi-organ dysfunction syndrome, and cardiac arrest. A significant proportion of poisonings were due to suicide attempts. Constant monitoring and assessing changes in both clinical presentation and cholinesterase levels are essential in managing patients with organophosphate poisoning.