Presenter: Dr Afsheen Sayyar

Lecturer Forensic Medicine

*

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

*

*

*

Muscarinic effect

salivation

lacrimation

urination

Diarrhea

Emesis

Nicotinic Effects

Muscle weakness

A-Adrenal medulla activity ↑

tachycardia

Cramping of skeletal muscle

Hypertension

MANAGEMENT OF OP

ABC SUPPORT

IV ATROPINE

GASTRIC LAVAGE

CLEANSING PATIENT

VENTILATORY SUPPORT

*

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.

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*

*Intensive care unit of ward no 5 ,JPMC Karachi

*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%

0%

10%

20%

30%

40%

50%

60%

70%

DISTRIBUTION OF POISONING CASES

*

0

20

40

60

80

100

120

MALE FEMALE TOTAL

NO OF CASES

PERCENTAGE

52%47.3%

33 cases

5 cases

*

SR.NO INTERVAL NO.OF CASES

1 1-6 hours 22

2 7-12hours 03

3 13-18hours 03

4 18-24hours 09

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 .

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** 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