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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Predicting Outcome using Butyrylcholinesterase Activity in Organophosphorus Pesticide Self-Poisoning</title><author><name sortKey="Eddleston, Michael" sort="Eddleston, Michael" uniqKey="Eddleston M" first="Michael" last="Eddleston">Michael Eddleston</name><affiliation><nlm:aff id="A1">Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Clinical Medicine, University of Colombo, Sri Lanka</nlm:aff></affiliation><affiliation><nlm:aff id="A3">South Asian Clinical Toxicology Research Collaboration,<ext-link ext-link-type="uri" xlink:href="http://www.sactrc.org">www.sactrc.org</ext-link></nlm:aff></affiliation></author><author><name sortKey="Eyer, Peter" sort="Eyer, Peter" uniqKey="Eyer P" first="Peter" last="Eyer">Peter Eyer</name><affiliation><nlm:aff id="A4">Walther Straub Institute of Pharmacology and Toxicology, Ludwig Maximilians University, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Worek, Franz" sort="Worek, Franz" uniqKey="Worek F" first="Franz" last="Worek">Franz Worek</name><affiliation><nlm:aff id="A5">Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Rezvi Sheriff, Mh" sort="Rezvi Sheriff, Mh" uniqKey="Rezvi Sheriff M" first="Mh" last="Rezvi Sheriff">Mh Rezvi Sheriff</name><affiliation><nlm:aff id="A5">Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Buckley, Nick A" sort="Buckley, Nick A" uniqKey="Buckley N" first="Nick A" last="Buckley">Nick A. Buckley</name><affiliation><nlm:aff id="A3">South Asian Clinical Toxicology Research Collaboration,<ext-link ext-link-type="uri" xlink:href="http://www.sactrc.org">www.sactrc.org</ext-link></nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Clinical Pharmacology and Toxicology, Canberra Clinical School, ACT, Australia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">18375477</idno><idno type="pmc">2617722</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2617722</idno><idno type="RBID">PMC:2617722</idno><idno type="doi">10.1093/qjmed/hcn026</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">002170</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002170</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predicting Outcome using Butyrylcholinesterase Activity in Organophosphorus Pesticide Self-Poisoning</title><author><name sortKey="Eddleston, Michael" sort="Eddleston, Michael" uniqKey="Eddleston M" first="Michael" last="Eddleston">Michael Eddleston</name><affiliation><nlm:aff id="A1">Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Clinical Medicine, University of Colombo, Sri Lanka</nlm:aff></affiliation><affiliation><nlm:aff id="A3">South Asian Clinical Toxicology Research Collaboration,<ext-link ext-link-type="uri" xlink:href="http://www.sactrc.org">www.sactrc.org</ext-link></nlm:aff></affiliation></author><author><name sortKey="Eyer, Peter" sort="Eyer, Peter" uniqKey="Eyer P" first="Peter" last="Eyer">Peter Eyer</name><affiliation><nlm:aff id="A4">Walther Straub Institute of Pharmacology and Toxicology, Ludwig Maximilians University, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Worek, Franz" sort="Worek, Franz" uniqKey="Worek F" first="Franz" last="Worek">Franz Worek</name><affiliation><nlm:aff id="A5">Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Rezvi Sheriff, Mh" sort="Rezvi Sheriff, Mh" uniqKey="Rezvi Sheriff M" first="Mh" last="Rezvi Sheriff">Mh Rezvi Sheriff</name><affiliation><nlm:aff id="A5">Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany</nlm:aff></affiliation></author><author><name sortKey="Buckley, Nick A" sort="Buckley, Nick A" uniqKey="Buckley N" first="Nick A" last="Buckley">Nick A. Buckley</name><affiliation><nlm:aff id="A3">South Asian Clinical Toxicology Research Collaboration,<ext-link ext-link-type="uri" xlink:href="http://www.sactrc.org">www.sactrc.org</ext-link></nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Clinical Pharmacology and Toxicology, Canberra Clinical School, ACT, Australia</nlm:aff></affiliation></author></analytic><series><title level="j">QJM : monthly journal of the Association of Physicians</title><idno type="ISSN">1460-2725</idno><idno type="eISSN">1460-2393</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><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><sec id="S5"><title>Results</title><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></sec><sec id="S6"><title>Conclusions</title><p id="P6">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.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9438285</journal-id><journal-id journal-id-type="pubmed-jr-id">8560</journal-id><journal-id journal-id-type="nlm-ta">QJM</journal-id><journal-id journal-id-type="iso-abbrev">QJM</journal-id><journal-title-group><journal-title>QJM : monthly journal of the Association of Physicians</journal-title></journal-title-group><issn pub-type="ppub">1460-2725</issn><issn pub-type="epub">1460-2393</issn></journal-meta><article-meta><article-id pub-id-type="pmid">18375477</article-id><article-id pub-id-type="pmc">2617722</article-id><article-id pub-id-type="doi">10.1093/qjmed/hcn026</article-id><article-id pub-id-type="manuscript">UKMS1633</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Predicting Outcome using Butyrylcholinesterase Activity in Organophosphorus Pesticide Self-Poisoning</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Eddleston</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Eyer</surname><given-names>Peter</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Worek</surname><given-names>Franz</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Rezvi Sheriff</surname><given-names>MH</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Buckley</surname><given-names>Nick A</given-names></name><xref ref-type="aff" rid="A3">3</xref><xref ref-type="aff" rid="A6">6</xref></contrib></contrib-group><aff id="A1"><label>1</label>Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, UK</aff><aff id="A2"><label>2</label>Department of Clinical Medicine, University of Colombo, Sri Lanka</aff><aff id="A3"><label>3</label>South Asian Clinical Toxicology Research Collaboration,<ext-link ext-link-type="uri" xlink:href="http://www.sactrc.org">www.sactrc.org</ext-link></aff><aff id="A4"><label>4</label>Walther Straub Institute of Pharmacology and Toxicology, Ludwig Maximilians University, Munich, Germany</aff><aff id="A5"><label>5</label>Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany</aff><aff id="A6"><label>6</label>Department of Clinical Pharmacology and Toxicology, Canberra Clinical School, ACT, Australia</aff><author-notes><corresp id="CR1"><bold>Correspondence:</bold> M Eddleston, SPIB, Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA, UK. t +44-131-242-1383. <email>eddlestonm@yahoo.com</email>.
</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>7</day><month>4</month><year>2008</year></pub-date><pub-date pub-type="epub"><day>28</day><month>3</month><year>2008</year></pub-date><pub-date pub-type="ppub"><month>6</month><year>2008</year></pub-date><pub-date pub-type="pmc-release"><day>12</day><month>1</month><year>2009</year></pub-date><volume>101</volume><issue>6</issue><fpage>467</fpage><lpage>474</lpage><abstract><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><sec id="S5"><title>Results</title><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></sec><sec id="S6"><title>Conclusions</title><p id="P6">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.</p></sec></abstract><funding-group><award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source><award-id>071669 || WT</award-id></award-group><award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source><award-id>063560 || WT</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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