Abstract:
Introduction: Intermediate syndrome (IMS) is a delayed neuromuscular complication of
organophosphate (OP) poisoning, developing 24–96 hours after acute cholinergic crisis. It
manifests as muscle weakness, particularly affecting the proximal muscles, neck flexors, and
respiratory muscles, leading to potential respiratory failure. The precise pathophysiology
remains unclear, but persistent acetylcholinesterase inhibition and neuromuscular dysfunction
are key contributors.
Objective: The study will evaluate the value of the predictive potential of serum
glucose/potassium ratio among patients with at-risk potential of IMS development after OP
poisoning.
Materials and Methods: Prospective observational study was performed at Shri B M Patil
Medical College with an enrollment of 228 patients of acute OP poisoning. The patients were
clinically and biochemically evaluated, and serum glucose and potassium were measured at
admission. G/K ratio was performed, and how its creation takes place regarding IMS was
related by statistical correlation using ROC curve analysis.
Results: Out of 228 patients, IMS was found in 21 (9.2%). G/K ratio was significantly higher
in IMS-positive patients (82.5 ± 29.8) than in IMS-negative patients (24.7 ± 12.6)
(p<0.0001). ROC analysis provided AUC as 0.910 with cutoff as 53.2 with high sensitivity
(94.3%) and specificity (93.1%) for the prediction of IMS.
Conclusion: Serum G/K ratio is a good and valid predictor of IMS in OP poisoning that
facilitates early identification of high-risk patients. Its implementation into clinical routines
can enhance monitoring and intervention methods and minimize the risk of critical
complications.
