Predictors of the need for Intensive Care Unit admission in acute organophosphorus poisoning: One year prospective study

Abstract

Background: Organophosphorus (OP) poisoning is a very serious condition that needs rapid intervention and treatment. It can result from occupational, intentional or accidental exposure. Clinical manifestations include muscarinic, nicotinic and central effects which may be life threatening increasing the need for intensive care unit (ICU) management. Aim: The present study aims to identify the predictors which help in making timely decisions regarding transferring the patients for intensive care managements in acute organophosphorus poisoning. Material & Methods: A prospective study included all 404 organophosphorus poisoning cases that were admitted to Menoufia Poison Control Center; Menoufia University Hospitals within the period from the beginning of January 2018 till the end of December 2018. Diagnosis of OP poisoning was based on history of exposure to OP compounds, characteristic clinical manifestations, low serum pseudo cholinesterase levels and detection of OP in the biological fluids by thin layer chromatography. Results: Organophosphorus poisoning was the 2nd common cause of poisoning (15.02% - 404 cases out of 2689) among cases admitted to Menoufia Poison Control Center during the period of the study. Majority of the cases managed at MPCC department while 83 patients (20.54%) needed ICU admission. Most of the cases were suicidal and 94.31% were by oral exposures. 51.98% of the cases were poisoned by the liquid form of OP. Females outnumbered males. The majority of the cases were young students and single. There was statistically significant relation between pseudo cholinesterase activity and severity of the case according to POP classification (p value < 0.001), the more the severity of poisoning the more suppression of pseudo cholinesterase level in the serum. Severe degree of POP classification, presence of hypoxia (< 50 mmHg), convulsions, and severe affection of serum cholinesterase activity were significantly predictors for patients who needed ICU admission. Conclusions: Severe degree of POP classification, presence of hypoxia, convulsions, and severe affection of serum cholinesterase activity are important predictors for ICU admission in OP poisoning.