Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
권호 표지

Clinical Implication of Acetylcholinesterase in Acute Organophosphate Poisoning

유기인계 농약 중독 환자에서 초기 적혈구 아세틸콜린에스테라제 활성도의 임상적 의의

  • Kim, Hoon (Department of Emergency Medicine, Inha University College of Medicine) ;
  • Han, Seung-Baik (Department of Emergency Medicine, Inha University College of Medicine) ;
  • Kim, Jun-Sig (Department of Emergency Medicine, Inha University College of Medicine) ;
  • Lee, Mi-Jin (Department of Emergency Medicine, College of Medicine, Konyang University) ;
  • Park, Joon-Seok (Department of Emergency Medicine, College of Medicine, Konyang University) ;
  • Kwon, Woon-Yong (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Eo, Eun-Kyung (Department of Emergency Medicine, School of Medicine, Ewha Womans University) ;
  • Oh, Bum-Jin (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sung-Woo (Department of Emergency Medicine, Korea University College of Medicine) ;
  • Suh, Joo-Hyun (Department of Internal Medicine, Gachon University of Medicine and Science) ;
  • Roh, Hyung-Keun (Department of Internal Medicine, Gachon University of Medicine and Science)
  • 김훈 (인하대학교 의과대학 응급의학교실) ;
  • 한승백 (인하대학교 의과대학 응급의학교실) ;
  • 김준식 (인하대학교 의과대학 응급의학교실) ;
  • 이미진 (건양대학교 의과대학 응급의학교실) ;
  • 박준석 (건양대학교 의과대학 응급의학교실) ;
  • 권운용 (서울대학교 의과대학 응급의학교실) ;
  • 어은경 (이화여자대학교 의학전문대학원 응급의학교실) ;
  • 오범진 (울산의대 서울아산병원 응급의학과) ;
  • 이성우 (고려대학교 의과대학 응급의학교실) ;
  • 서주현 (가천의과학대학교 내과학교실) ;
  • 노형근 (가천의과학대학교 내과학교실)
  • Published : 2008.06.12
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.

Keywords