Abstract:
Introduction: Organophosphate compounds are widely used pesticides that cause significant
morbidity and mortality worldwide, particularly in developing countries. The inhibition of
acetylcholinesterase enzyme leads to accumulation of acetylcholine, resulting in characteristic
cholinergic manifestations. While acetylcholinesterase levels are the gold standard for diagnosis
and severity assessment, their limited availability in resource-constrained settings necessitates
exploration of alternative biomarkers. This study aimed to evaluate serum amylase and creatine
phosphokinase (CPK) as potential markers for assessing the severity of organophosphate
poisoning and to correlate these findings with clinical severity and outcomes.
Materials and Methods: This prospective study included 73 patients with organophosphate
poisoning admitted to a tertiary care center. Clinical severity was assessed using the Peradeniya
Organophosphorus Poisoning (POP) scale. Serum acetylcholinesterase, amylase, and CPK levels
were measured on days 1, 3, and 5 of hospitalization. Statistical analysis was performed to
determine correlations between biochemical parameters and clinical severity, as well as their
associations with outcomes.
Results: Among the 73 patients, 67.1% were young adults (21-40 years), with a nearly equal
gender distribution. Based on the POP scale, 43.8% had mild poisoning, 39.7% moderate, and
16.4% severe. Elevated serum amylase levels (>110 units) were observed in 63% of patients on
day 1, while elevated CPK levels (>200 units) were noted in 16.4%. Strong correlations were
found between the POP score and both amylase (r=0.865, p<0.001) and CPK levels (r=0.817,
p<0.001). Acetylcholinesterase levels on admission were significantly associated with mortality,
with lower levels (<5320 units) corresponding to higher mortality rates (34.5% vs. 6.7%,
p=0.034). Ventilatory support was required in 26% of patients, and the overall mortality rate was
15.1%.
Conclusion: Serum amylase and CPK levels demonstrate strong correlations with clinical
severity in organophosphate poisoning, with amylase exhibiting a slightly stronger correlation.
These readily available biochemical markers can serve as valuable adjuncts to clinical
assessment in determining severity and predicting outcomes, particularly in settings where
acetylcholinesterase assays are not available. Future research with larger sample sizes is
warranted to establish definitive cut-off values for these markers in clinical decision-making.
