Pre-Interventional Cardiac and ECG Changes in Acute Organophosphate Poisoning Cases Admitted to a Tertiary Hospital in India
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 4 No. 4(Autumn) (2014),
5 Azar 2014
,
Page 130-135
https://doi.org/10.22037/ijmtfm.v4i4(Autumn).6122
Abstract
Background: Cardiac complications are the less common fatal effect of acute organophosphate poisoning. This study was undertaken to analyze the pre-interventional cardiac and Electrocardiographic (ECG) changes in acute organophosphate poisoning cases.
Materials and Methods: Clinical records of acute organophosphate poisoning patients of age less than 50 years admitted to KLE’s Dr. Prabhakar Kore Hospital, Belgaum, Karnataka, from 01-01-2010 to 31-12-2010 were analyzed. Cases of organophosphate poisonings referred from other hospitals, poisoning with multiple agents, patients with history of previous cardiac diseases and coexisting medical conditions were excluded from the study. Poisoning Severity Score was calculated as per International Programme on Chemical Safety and patients were grouped into 3 grades.
Results: In this study, 50 cases of acute organophosphate poisoning (male - 32; female - 18) were analyzed. Sinus tachycardia was present in 45 patients (90%), hypertension in 13 (26%) and hypotension in 12 (24%). Prolonged corrected QT interval was observed in 14 patients (28%), elevated ST segment in 2 (4%), inverted T wave in 13 (26%) and conduction defects in 1 (2%). Among 14 patients with prolonged corrected QT interval, 12 were in grade III and 2 in grade II severity; and, among 13 patients who had inverted T wave, 2 were in grade I, 4 in grade II and 7 in grade III severity. Acidosis, as assessed by blood pH and HCO3, was observed in 22 patients (44%).
Conclusion: Fatal cardiac complications do occur in acute organophosphate poisoning, which are overlooked at times as the most common complications expected are respiratory complications. Higher incidence of ECG changes in Grade III cases suggests that if the cardiac complications develop, the patient should be immediately transferred to an intensive cardiac care unit.
- Organophosphate
- Electro-Cardiogram
- Corrected QT Interval
- Heart Rate
- Blood Pressure
- Poisoning Severity Score
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References
Thunga G, Sam KG, Khera K, Pandey P, Sagar SV. Evaluation of incidence, clinical characteristics and management in organophosphorus poisoning patients in a tertiary care hospital. J. Toxicol. Environ. Health Sci. 2010;2(5):73-6.
Reddy KSN. The Essentials of Forensic Medicine and Toxicology. 29th ed. Hyderabad: K Sugunadevi, 2010.
Dalvi CP, Abraham PP, Iyer SS. Correlation of electrocardiographic changes with prognosis in organophosphorus poisoning. J Postgrad Med. 1986;32(3):115-9.
Al-Khatib SM, LaPointe NMA, Kramer JM, Califf RM. What Clinicians Should Know About the QT Interval. JAMA. 2003;289(16):2120-7.
Persson HE, Sjoberg GK, Haines JA, Pronczuk dG. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998;36:205–13.
Pillay VV. Comprehensive Medical Toxicology. 2nd ed. Hyderabad: Paras Publications, 2008.
Karki P, Ansari JA, Bhandary S, Koirala S. Cardiac and electrocardiographical manifestations of acute organophosphate poisoning. Singapore Med J. 2004;45(8):385-9.
Yurumez Y, Yavuz Y, Saglam H et al. Electrocardiographic findings of acute organophosphate poisoning. J Emerg Med. 2009;36(1):39-42.
Lee HJ, Yoon JC, Jeong TO, Jin YH, Lee JB. Initial Electrocardiographic Changes associated with Clinical Severity in Acute Organophosphate Poisoning. J Korean Soc Clin Toxicol. 2009;7(2):69-76.
Saadeh AM, Farsak NA, A-Ali MK. Cardiac manifestations of acute carbamate and organophosphate poisoning. Heart. 1997;77:461-4.
Paul UK, Bhattacharyya AK. ECG manifestations in acute organophosphorus poisoning. J Indian Med Assoc. 2012;110(2):98, 107-8.
Barrett KE, Brooks HL, Boitano S, Barman SM. Ganong’s review of Medical Physiology. 23rd ed. New York: McGrawHill Lange, 2009.
Vijayakumar S, Fareedullah M, Kumar AE, Rao MK. A prospective study on electrocardiographic findings of patients with organophosphorus poisoning. Cardiovascular Toxicol. 2011;11(2):113-7.
Yanowitz FG. Introduction to ECG interpretation V8.0. Intermountain Healthcare. Available from: http://ecg.utah.edu/pdf/ (last checked 03 March 2013).
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