Glycemic status at the presentation and its role as marker of severity and outcome in patients with organophosphorus poisoning

Mohammad Hayat Bhat; Sajad Qadir Bhat; Ishrat Hussain Dar; Javaid Ahmad Bhat

Mohammad Hayat Bhat Department of Endocrinology, Superspeciality hospital, Government Medical College, Srinagar, Jammu and Kashmir, India.
Sajad Qadir Bhat Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India.
Ishrat Hussain Dar Professor MeDepartment of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India.
Javaid Ahmad Bhat Department of Endocrinology, Superspeciality Hospital, Government Medical College Srinagar, India

Keywords: Organophosphorus poisoning,, Glycemic Status, Hyperglycemia, Hypoglycemia.

Abstract

Background: There has been an increasing recognition of the various metabolic abnormalities in patients with acute organophosphorus (OP) poisoning including disturbed glucose homeostasis. We assessed the glycemic status at the presentation and its role as marker of severity and clinical outcome in patients admitted with acute OP poisoning.

Methods: This was a prospective observational study, involving 400 patients above 18 years of age admitted to the emergency department of a tertiary care institution in Northern India. The biochemical parameters including random plasma glucose, serum cholinesterase severity and outcome were determined. Patients were grouped according to their admission plasma glucose into hypoglycemics (<70mg/dL), euglycemics (RBS=70-199mg/dL) and hyperglycemics (RBS≥200mg/dL).

Results: The hyperglycemia, hypoglycemia and normoglycemia (RBS=70-199mg/dl) at admission was present in 29.5%, 14.5% and 56% of patients. Five patients (4.24%) among hyperglycemics presented with diabetic ketoacidosis (DKA).Extremes of glycemic status including hyperglycemia and hypoglycemia was significantly associated with prolonged hospital stay (>7days), need for mechanical ventilation and mortality in 66% and 60% , 68% and 69%, 35% and 33% respectively compared to 18%, 24% and 4% in normoglycemic group respectively. Overall mortality in our study cohort was 17%.

Furthermore, extremes of glycemic status at presentation was significantly associated with the clinical severity, depression in serum cholinesterase levels, need for ICU care and ventilation besides mortality.

Conclusion: Glycemic extremes including both hyperglycemia and hypoglycemia are common in patients with acute OP poisoning and are significantly associated with morbidity and mortality. It can be used as a simple and reliable predictive marker to identify patients in need of intensive monitoring and admission to intensive care unit (ICU).

Author Biography

Mohammad Hayat Bhat, Department of Endocrinology, Superspeciality hospital, Government Medical College, Srinagar, Jammu and Kashmir, India.

Department of Endocrinology, Superspeciality hospital, Government Medical College, Srinagar, Jammu and Kashmir, India.