Organophosphorus (OP), the commonest agent for
poisoning in India due to its easy availability, acts by inhibiting
acetylcholinesterase at
muscarinic and
nicotinic receptors. Erythrocyte
cholinesterase (EchE) and plasma
cholinesterase (PchE) are reduced in OP
poisoning, but their estimation is costly and not regularly performed. There are emerging options for new cheaper
biochemical markers in relation to OP
poisoning. Serum level of
creatine phosphokinase (CPK) is often found to be elevated in OP
poisoning. This study was conducted to see if CPK may be used as an alternative of
cholinesterase levels in blood to assess the severity of OP
poisoning. This was a prospective and observational study. Sixty-three patients of OP
poisoning without any prior treatment, presenting within 6 hours, were selected and their clinical severity was categorized according to Peradeniya
organophosphorus poisoning (POP) scale. Level of serum CPK, blood EchE and pH were measured following admission, and total dose of
atropine (mg) until the final clinical outcome (complete recovery or death) was calculated. Student's t-test and Pearson's correlation coefficient was used for the assessment of statistical significance. According to POP scale, clinical severity was mild (score 0-3) in 17 (27%), moderate (score 4-7) in 32 (50.8%) and severe (score 8-11) in 14 (22.2%) patients. Serum CPK, EchE level, blood pH and total
atropine dose strongly correlated with clinical severity. Our study recommends serum CPK as an alternative marker.