International Journal of Applied Research
Vol. 2, Issue 12, Part L (2016)
Total serum creatine phosphokinase in assessing severity of OP compound poison
Background and Objectives: Poisoning has been found to be a major cause of death or morbidity in the developing world, the commonest being Organophosporus (OP) poisoning. Erythrocyte cholinesterase (EchE) and pseudocholinesterase (Butyryl cholinesterase – BchE) are markers used for assessing the severity in OP poisoning, but estimation of these are costly, has variable values for different individuals and are not available at all centers. This study was done to estimate levels of serum Creatine Phosphokinase (CPK) serially in acute OP poisoning patients and to correlate with Peradeniya Organophosphorus Poisoning (POP) score to predict the prognosis. Methods: Patients with history of OP compound consumption who fulfil the inclusion and exclusion criteria, getting admitted at Shadan Intitute of Medical Sciences, during period of January 2014 to October 2016 is taken up for study.Method of Collecting Data: One hundred cases of OP compound consumption meeting inclusion criteria will be undergoing detailed history, clinical examination and biochemical examination.Information needed for this study collected through a proforma and pre-test proforma from each patient.Results: In this study which included 200 patients of OP compound consumption, Bradycardia (33%) was the common clinical sign, followed by Hypertension (2%), Tachycardia (15%) and Hypotension (2%). The most common ECG finding seen was sinus bradycardia (31%) followed by sinus tachycardia (16%) and normal ECG (53%). Raised initial total serum creatine phosphokinase was 9%. Serial measurement of total serum creatine phosphokinase was done at day1, day3 and at discharge. All the 9 patients whose raised initial CPK level continued to be elevated at day 3 also. That means serial measurement of CPK level more important in assessing severity than the single value. It is well known that CPK level will raise at day3 if any ongoing intermediate syndrome due to rhabdomyolysis. Hence it is taken as confounding factor. But it is ruled out in this because all the 18 patients CPK level found to be high at day1. So CPK level will raise even in absence of intermediate syndrome.The levels of CPK were elevated significantly in patients with respiratory failure. In this study 14 out of 16 patients with raised initial CPK level has respiratory failure and eventually death. Only one patient with mildly elevated CPK level has no respiratory failure. All patients who has initial raise of CPK level with only moderate decrement in plasma AchE is the valuable outcome in this study. Hence AchE cannot be a strong prognostic predicted as compared to total serum CPK level. The mean total serum CPK level of patients who went into respiratory failure and death was 1078 iu/l.Conclusion: In this study only 8 out of 100 case shows raised total serum CPK level. 14 out of 16 positive case who developed respiratory failure and death. All 14 patients has marked raise in total serum CPK level. So the initial raise in total serum CPK level correlated well with severity of OP compound poison and prognosis, suggesting its use as a prognostic indicator of OP compound poison.
How to cite this article:
Dr. Sripada Venkata Subhramanyam. Total serum creatine phosphokinase in assessing severity of OP compound poison. Int J Appl Res 2016;2(12):858-862.