Red cell distribution width and Serum Lactate as predictors of severity and outcome of acute organophosphorus poisoned cases admitted to Poison Control Center Ain Shams University Hospitals

Abstract

Worldwide, acute organophosphate poisoning is still a major public health problem. It is the most common toxicological emergency especially in the developing countries as Egypt. They are alarmingly increasing method of suicide although it can result from occupational exposure or accidental ingestion. High mortality due to organophosphorus compounds is usually attributed to delay in diagnosis and improper treatment. This study aimed to investigate and assess the prognostic value of red cell distribution width, complete blood count and other hematological parameters including serum lactate measured on admission to the emergency department on severity and outcome in patients with Acute organophosphate poisoning. A prospective cross-sectional study was carried on 100 patients of Acute organophosphate poisoning admitted to poison control center- Ain Shams University hospitals. Investigations in conjunction with clinical signs using POP score in patients admitted to the Poison Control Center - Ain Shams University Hospitals during the period from June 2019 till December 2019. The diagnosis was based on history of organophosphorus compounds exposure and assessment of clinical manifestations on admission. Patients were selected after ruling out of the previously mentioned exclusion criteria. The collected data was recorded in a special sheet for each patient. • Sociodemographic data (age, sex, residence and occupation). • Intoxication data (manner and route of poisoning). • Clinical data assessed on admission and classified into mild, moderate and severe groups based on POP score. • Laboratory data: samples collected on admission for biochemical analysis of complete blood count, serum lactate and serum PChE levels. • Treatment received and hospital disposition. • Outcome (discharged or dead). • Complications (mechanical ventilation, intermediate syndrome and coma).

Results were statistically analyzed and resulting in the following: In this study the mean age of patients was (27±12.5) ranged from (16 to 64) years with female predominance. Patients from urban areas were more than rural areas with predominance of the students. Suicide was the most common manner of poisoning. Moreover, the oral route was the main route of poisoning. The mean delay time between poisoning and seeking medical advice was (5±5.68) hours and there was a significant correlation between delay time and the need for mechanical ventilation. According to need of mechanical ventilation, there was no significant difference between it and sociodemographic data nor intoxication data. The majority of patients had normal pulse rate (86%), (8%) had tachycardia and (6%) had bradycardia. Normal mean blood pressure was recorded on (79%) and (21%) had hypertension. Moreover, there was a high significant correlation between mean blood pressure and the need of mechanical ventilation. At the initial presentation, patients were categorized according to their clinical manifestations based on POP score into (70%) were recorded moderate, (21%) were severe and (9%) were mild cases. Additionally, there was a high significant correlation between POP score with the need of mechanical ventilation.