Selected Liver Markers and its Association with the Severity in Acute Organophosphate and Carbamate Poisoning

Abstract

Intentional ingestion of pesticides [organophosphate/carbamate] has become a major health issue globally. In addition to cholinergic outcomes, harmful effects on liver have also been Aminotransferase (AST), Alanine Aminotransferase (ALT), Direct bilirubin (D. bil), Total bilirubin (T. bil)] on admission with severity of poisoning. This prospective study was carried out with acute organophosphate (OP), (n=38) and carbamate poisoned patients (n=70) admitted to Teaching Hospital Anuradhapura. Patients presenting within 24 hours of poisoning were recruited. Severity of poisoning was measured by assessing Red Blood Cell (RBC) cholinesterase level and Peradeniya organophosphorus poisoning scale (POP). Decrease of RBC cholinesterase activity > 50% (group 2), were considered as mild poisoning and decrease < 50% (group 1), indicates severe poisoning. According to POP scale, 0-3 score was considered as mild poisoning, 4-7 moderate poisoning & 8-11-severe poisoning. In-group 1 (n=40) mean (±SD) AST, ALT, D.bil & T.bil were 73±115 mg/dL, 46±103 mg/dL, mg/dL, 20±15 mg/dL, 0.12±0.04mg/dL and 0.62±0.31 mg/dL. All the mean values of group 1 were higher than group 2 although not significant (p >0.05). According to POP scale, moderate poisoning patients had significantly higher mean AST (p=0.002) and ALT (p=0.000) levels compared to mild poisoning. AST and ALT were elevated in both POP moderate poisoned group and acute anticholinesterase group 1 but was significantly elevated in POP moderate scale group only.