AustralieFrV1, Main, Exploration, bibRecord, 008565

Predicting Outcome using Butyrylcholinesterase Activity in Organophosphorus Pesticide Self-Poisoning

Identifieur interne : 008565 ( Main/Exploration ); précédent : 008564; suivant : 008566

Predicting Outcome using Butyrylcholinesterase Activity in Organophosphorus Pesticide Self-Poisoning

Auteurs : Michael Eddleston [Royaume-Uni, Sri Lanka] ; Peter Eyer [Allemagne] ; Franz Worek [Allemagne] ; Mh Rezvi Sheriff [Allemagne] ; Nick A. Buckley [Australie]

Source :

QJM : monthly journal of the Association of Physicians [ 1460-2725 ] ; 2008.

RBID : PMC:2617722

Abstract

Background

The usefulness of a low butyrylcholinesterase activity on admission for predicting severity in acute organophosphorus insecticide poisoning has long been debated. Previous studies have been confounded by the inclusion of multiple insecticides with differing inhibitory kinetics.

Aim

We aimed to assess the usefulness of admission butyrylcholinesterase activity, together with plasma organophosphorus concentration, for predicting death with identified organophosphorus insecticides.

Design

A prospective cohort of self-poisoned patients

Methods

We prospectively studied 91 and 208 patients with proven dimethoate or chlorpyrifos self-poisoning treated using a standard protocol. Plasma butyrylcholinesterase activity and organophosphorus concentration were measured on admission and clinical outcomes recorded.

Results

The usefulness of a plasma butyrylcholinesterase activity <600mU/ml on admission varied markedly - while highly sensitive in chlorpyrifos poisoning (sensitivity 11/11 deaths; 100%, 95%CI 71.5-100), its specificity was only 17.7% (95%CI 12.6-23.7). In contrast, while poorly sensitive for deaths in dimethoate poisoning (12/25 patients; 48%, 95%CI 27.9-68.7) it was reasonably specific (86.4%, 95%CI 75.7-93.6). A high organophosphorus concentration on admission was associated with worse outcome; however, a clear threshold concentration was only present for dimethoate poisoning.

Conclusions

Plasma butyrylcholinesterase activity on admission can provide useful information; however, it must be interpreted carefully. It can only be used to predict need for critical care and death when the insecticide ingested is known and its sensitivity and specificity for that insecticide has been studied. Plasma concentration of some organophosphorus insecticides predicts outcome. The development of rapid bedside tests for organophosphorus detection may aid early assessment of severity.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2617722

DOI: 10.1093/qjmed/hcn026
PubMed: 18375477
PubMed Central: 2617722

Affiliations:

Le document en format XML

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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">The usefulness of a low butyrylcholinesterase activity on admission for predicting severity in acute organophosphorus insecticide poisoning has long been debated. Previous studies have been confounded by the inclusion of multiple insecticides with differing inhibitory kinetics.</p>
</sec>
<sec id="S2"><title>Aim</title>
<p id="P2">We aimed to assess the usefulness of admission butyrylcholinesterase activity, together with plasma organophosphorus concentration, for predicting death with identified organophosphorus insecticides.</p>
</sec>
<sec id="S3"><title>Design</title>
<p id="P3">A prospective cohort of self-poisoned patients</p>
</sec>
<sec id="S4"><title>Methods</title>
<p id="P4">We prospectively studied 91 and 208 patients with proven dimethoate or chlorpyrifos self-poisoning treated using a standard protocol. Plasma butyrylcholinesterase activity and organophosphorus concentration were measured on admission and clinical outcomes recorded.</p>
</sec>
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<p id="P5">The usefulness of a plasma butyrylcholinesterase activity <600mU/ml on admission varied markedly - while highly sensitive in chlorpyrifos poisoning (sensitivity 11/11 deaths; 100%, 95%CI 71.5-100), its specificity was only 17.7% (95%CI 12.6-23.7). In contrast, while poorly sensitive for deaths in dimethoate poisoning (12/25 patients; 48%, 95%CI 27.9-68.7) it was reasonably specific (86.4%, 95%CI 75.7-93.6). A high organophosphorus concentration on admission was associated with worse outcome; however, a clear threshold concentration was only present for dimethoate poisoning.</p>
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Serveur d'exploration sur les relations entre la France et l'Australie

Predicting Outcome using Butyrylcholinesterase Activity in Organophosphorus Pesticide Self-Poisoning

Predicting Outcome using Butyrylcholinesterase Activity in Organophosphorus Pesticide Self-Poisoning

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