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*
Yuganti Prabhakar Vaidya, Sandip Meghnad Hulke
Department of Physiology, Laxminarayan Medical College, Bhopal, Madhya Pradesh, India
**Organophosphate compounds are widely used in agricultural
sector as PESTICIDES and as chemical war fare.
*Easily accessible ,associate with self poisoning
*200,000 /500,00 Mortality associated self-poisoning with
pesticides in rural Asia.
*50-70 % in hospital based study.
*Suicidal rate with OPC 20.6-
56.3%
Irreversibly bind to serine-OH group at the active site of acetylcholinesterase (AChE) establish covalent bond
(phosphorylation)
AGING: loss of alkyl group + strengthening of covalent bond
Phosphorylated AChE is very stable
Inhibition of enzyme activity accumulation of ACh in the synapse and NMJ
Overstimulation of cholinergic receptors
*
Nicotinic Effects
Muscle weakness
A-Adrenal medulla activity ↑
tachycardia
Cramping of skeletal muscle
Hypertension
*
To evaluate the cases of suicide using organophosphorous
compound as intoxicant with the objective to bring up
possible preventive measures based upon modifiable
factors associated with lethality.
*Retrospective study
*66 patient of poisoning
*Period: January 2010 –December 2010
*Diagnosis was made from history
*Clinical investigation:
Serum and RBC cholinesterase level
Blood gases
Electrolytes
pH
LDH
*
S.NO TYPES OF POISIONING NO OF CASES PERCENTAGE
1 Organophosphorus poisoning 38 57.58%
2 Alcohol poisoning 08 12.12%
3 Heroine poisoning 06 9.09%
4 Acid ingestion 03 4.54%
5 Other poisoning 11 16.67%
TOTAL 66 100.00%
Parameter Range Mean
pH 7.43-7.52 7.2±0.29
PCO2 17-48.3 32.65±15.65
po2 55-72.2 73.0±17.0
Sao₂ 89-97% 86.5±8.5
Hco3 11.2-25mmol/l 18±7.0
sodium 146-149mEq/l 147.5±1.5
Potassium 2.6-3.2 mEq/l 2.9±0.3
Chloride 108-118mEq/l 113±5
Blood urea nitrogen 7-9 mg/dl 8±1
Creatinine 0.6 mg/dl-1.3 0.95±0.35
Serum cholinesterase level 0.2-6.5 u/ml 3.35±3.15
Total bilirubin 0.9-1.6mg/dl 1.25±0.35
Direct bilirubin 0.5-0.6mg/dl 0.55±0.05
Indirect bilirubin 0.8-0.9 mg/dl 0.85±0.05
Alkaline phosphatase 102-107u/l 104.5±2.5
Gamma GT 28-50u/l 39.0±11.0
LDH 321-325u/l 323±2.0
PT 14-18 16±20
**Mortality due to delay admission
*Mortality due to Misdiagnose
*Uncontrolled sale all over the country
*Mortality due to intermediate syndrome
*Mortality due to respiratory failure
* Mortality rate was insignificant in patient treated or not
treated with Pralidoxime sulfate .
** ijayakumar L: Suicide prevention: the urgent need in developing
countries. World Psychiatry. 2004, 3 (3): 158-159.
* Ponnudurai R, Heyakar J: Suicide in Madras. Indian Journal of Psychiatry. 1980, 22: 203-20
* Gururaj G, Isaac MK: Epidemiology of suicide in Bangalore. 2001, NIMHANS Publication No. 43, Bangalore
* Nandi DN, Mukherjee SP, Banerjee G, Ghosh A, Boral GC, Chowdhury A, Bose J: Is suicide preventable by restricting the availability of lethal agents? A rural survey of West Bengal. Indian Journal of Psychiatry. 1979, 21: 251-255.
* Nandi DN, Banerjee G, Boral GC: Suicide in West Bengal – A century apart. Indian Journal of Psychiatry. 1978, 20: 155-160.
* Badrinarayana A: Suicide attempt in Gulbarga. Indian Journal of Psychiatry. 1977, 19 (4): 69-70.
* Kar N: Psychosocial aspects of suicide attempt. MD Thesis, UtkalUniversity, Bhubaneswar. 1996