Organophosphorus Insecticides

Organophosphorus insecticides are important agents of self-poisoning in developing and developed countries alike. Rampant misuse of organophospharus insecticides has been found in our country. It is in this background that a study was undertaken in Burdwan Medical College and Hospital, Burdwan, on 150 adult patients who have been admitted in the Medicine wards after consuming organophosphorus insecticides or accidental exposure to organophosphorous poison. 64 patients were male and 86 patients were female. Majority of the patients (63 patients) were in the age group of 21-30 years, and the least (10 patients) were above 40 years. Mode of poisoning was suicidal in most patients. It was accidental in 6 patients, and no homicidal poisoning was

Of the 79 patients studied, serum Amylase was found to be elevated (> 200 S.U) in 37 patients (46.95%), among them in three patients it was 800 S.U. One of them showed swollen pancreas on ultrasonography which was confirmed by Computerised Tomography. In other two patients, evidence of pancreatitis was not observed. There was no significant correlation between the nature of compounds (OP or carbamates), duration and severity of cholinergic syndrome and increase in serum Amylase. It has been concluded that mild elevation of serum Amylase is common in patients with OP poisoning, however acute pancreatitis is rare

Four of the total 47 patients with acute OP poisoning had obviously elevated Amylase and Lipase levels (Amylase> 300 U/L; Lipase >60 U/L). Only two of the patients with Amylase levels between 100 and 300 U/L had elevated levels of Lipase. None of the patients with normal Amylase levels had elevated levels of Lipase. A total of 12.76% were diagnosed as acute Pancreatitis (19). Pathology behind development of acute pancreatitis in patients after organophosphorous ingestion is not very clear. Pancreatic ductal hypertension and stimulation of exocrine pancreatic secretion secondary to cholinergic stimulation are considered to be responsible for the development of pancreatitis .Furthermore, organophosphates such as echothiophate, which inhibit the two cholinesterase isoenzymes (butyrylcholinesterase and acetyl cholinesterase) in the human pancreas, increase pancreatic sensitivity to acetylcholine. Liver involvement observed in these patients was mostly secondary to pancreatic