Effectiveness of serum glucose/potassium ratio as a tool for predictor of intermediate syndrome

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.