Atropine Challenge Test in Screening the Organophosphorus Poisoning Cases with Atypical Presentation; a Brief Report
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
,
Page e46
https://doi.org/10.22037/aaem.v7i1.428
Abstract
Introduction: Atropine is not recommended in organophosphorus (OPs) poisoning cases without any obvious clinical signs. This study aimed to evaluate the clinical utility of Atropine challenge test in screening OPs poisoning cases with atypical presentation.
Methods: In this prospective cross sectional study, after primary supportive care, patients with atypical pretentions of OPs poisoning underwent Atropine challenge test (1 mg intravenously) and demographic parameters, clinical presentations, and serum level of cholinesterase enzyme were compared between cases with positive and negative test results.
Results: 20 patients with the mean age of 47.60 ± 13.25 years were studied. The mean time since exposure and initial symptoms was 6.17 ± 2.99 hours. The most common clinical presentations were tachycardia (55%) and flushing (35%). The atropine challenge test was positive in 3 (15.00%) cases. The two groups were the same regarding gender distribution (p = 0.582), mean age (p = 0.957), clinical presentation (p > 0.05), and mean PR interval (p = 0.729). The level of cholinesterase was 220.00 ± 15.52 U/mL and 332.17 ± 143.99 U/mL in patients with positive and negative Atropine challenge test, respectively (p = 0.006).
Conclusion: Patients with positive Atropine challenge test had a significantly lower level of serum cholinesterase and response to Atropine in their therapeutic management. Hence, Atropine challenge test could be considered as a useful clinical test in the setting of acute OPs poising.
- Organophosphorus Compounds
- Atropine
- Organophosphate Poisoning
- Acetylcholine
- Toxicity
How to Cite
References
Soltaninejad K, Shadnia S. History of the use and epidemiology of organophosphorus poisoning. Basic and Clinical Toxicology of Organophosphorus Compounds: Springer; 2014. p. 25-43.
Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. The Lancet. 2008;371(9612):597-607.
Hung D-Z, Yang H-J, Li Y-F, Lin C-L, Chang S-Y, Sung F-C, et al. The long-term effects of organophosphates poisoning as a risk factor of CVDs: a nationwide population-based cohort study. PLoS One. 2015;10(9):e0137632.
Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: systematic review. BMC public health. 2007;7(1):357.
Eddleston M, Phillips MR. Self poisoning with pesticides. Bmj. 2004;328(7430):42-4.
Eddleston M. Patterns and problems of deliberate selfâ€poisoning in the developing world. Qjm. 2000;93(11):715-31.
Shadnia S, Ashrafivand S, Mostafalou S, Abdollahi M. N-acetylcysteine a novel treatment for acute human organophosphate poisoning. Int J Pharmacol. 2011;7(6):732-5.
Aghabiklooei A, Mostafazadeh B, Farzaneh E, Morteza A. Does organophosphate poisoning cause cardiac injury? Pakistan journal of pharmaceutical sciences. 2013;26(6).
Shadnia S, Okazi A, Akhlaghi N, Sasanian G, Abdollahi M. Prognostic value of long QT interval in acute and severe organophosphate poisoning. Journal of medical toxicology. 2009;5(4):196.
Pajoumand A, Shadnia S, Rezaie A, Abdi M, Abdollahi M. Benefits of magnesium sulfate in the management of acute human poisoning by organophosphorus insecticides. Human & experimental toxicology. 2004;23(12):565-9.
Paudyal BP. Organophosphorus poisoning. JNMA; journal of the Nepal Medical Association. 2008;47(172):251-8.
Isha IT, Alam ZN, Shaha BK, Bari MS, Bari MZJ, Chowdhury FR. Paraquat induced acute kidney injury and lung fibrosis: a case report from Bangladesh. BMC research notes. 2018;11(1):344.
Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittarage A, Azher S, et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide–a treatment protocol for junior doctors. Critical Care. 2004;8(6):R391.
Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F, et al. Pralidoxime in acute organophosphorus insecticide poisoning—a randomised controlled trial. PLoS medicine. 2009;6(6):e1000104.
Kumar SV, Fareedullah M, Sudhakar Y, Venkateswarlu B, Kumar EA. Current review on organophosphorus poisoning. Arch Appl Sci Res. 2010;2(4):199-215.
Cappato R, Alboni P, Paparella N, Toselli T, Candini GC, Tomasi AM. Bedside evaluation of sinus bradycardia: usefulness of atropine test in discriminating organic from autonomic involvement of sinus automaticity. American heart journal. 1987;114(6):1384-8.
Heide E. Cholinesterase inhibitors: Including insecticides and chemical warfare nerve agents Part 5: The intermediate syndrome. 2012th. Agency for toxic substances and disease registry (ATSDR), Avalable at: http://www.atsdr.cdc.gov/csem/csem.asp. 2012.
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