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CORRELATION OF SERUM PSEUDOCHOLINESTERASE (PChE) AND CREATINE PHOSPHOKINASE LEVELS (CPK) LEVELS WITH PERADENIYA ORGANOPHSPHOROUS POISONING (POP) SCALE AMONG PATIENTS WITH ORGANOPHOSPHOROUS COMPOUND (OPC) POISONING

Author(s) Dr. Arya R P Anand, Dr. Padmakumar R Pillai, Dr. Chithra V R
Country India
Abstract STRUCTURED ABSTRACT Background
Due to their easy availability, organophosphorus (OP) compounds are one of the most frequent causes of poisoning in rural India. Acetylcholinesterase (AChE) and pseudocholinesterase (PChE) enzymes are inhibited by organophosphorus compounds, which causes muscarinic and nicotinic receptors to be overstimulated. In cases of OP chemical poisoning, serum levels of pseudocholinesterase enzymes are often assessed. The Peradeniya Organophosphorus Poisoning (POP) scale is easy to use and evaluates the degree of poisoning based on the symptoms at presentation. Patients with a high POP score had a significant rate of morbidity and mortality, according to a study by Senanayake et al.7. Serum pseudocholinesterase enzyme level estimation is expensive and not always available in all labs. The vast majority of patients in the organophosphorus complex are impoverished. Because health care systems have limited facilities and resources, and because patients are economically disadvantaged, it is vital to rely more on clinical aspects to determine the severity of poisoning and to appropriately manage the disease.
Aim and Objectives
The study aims to measure serum pseudocholinesterase (PChE) and creatine phosphokinase (CPK) levels and to correlate with the clinical criteria score described by the Peradeniya Organophosphorus Poisoning (POP) scale at initial presentation in determining severity of poisoning and in hospital outcomes of acute organophosphorus compound poisoning.
Methods
As the data was found to be non-normal Mann Whitney U test was done to compare gender, ventilatory support, survival with serum pseudo choline esterase and serum creatine phosphokinase. Kruskal Wallis test was done to compare Peradeniya Organophosphorus Poisoning scoring with Age, serum pseudo choline esterase, serum creatine phosphokinase, Atropine dose, Pralidoxime dose, and Duration of hospital stay. Kruskal Wallis test was also done to compare the S. pseudo choline esterase and S. creatine phosphokinase with occupation, marital status, and habits. Chi-square test was done to analyse the association of gender, marital status, occupation, habits, ventilatory support, survival with Peradeniya Organophosphorus Poisoning scoring criteria. Spearman correlation tests were done to assess the correlation between quantitative variables.
Results & Discussion
The pseudocholinesterase level and Peradeniya Organophosphorus Poisoning scale differed statistically significantly, with mild poisoning having higher values and moderate poisoning having lower values. Serum creatine phosphokinase levels were highest in cases of severe Peradeniya Organophosphorus Poisoning scale, and there was a statistically significant difference between the creatine phosphokinase and Peradeniya Organophosphorus Poisoning scales. The doses of atropine and pralidoxime given were higher in patients with severe Peradeniya Organophosphorus Poisoning scale values, and this difference was statistically significant (p < 0.05). Additionally, there was a statistically significant difference in the length of hospital stay, with patients with moderate poisoning experiencing a longer mean stay. The pseudocholinesterase levels of patients who requested ventilatory support and those who survived showed a statistically significant difference. The doses of atropine and pseudocholinesterase, as well as ventilatory support in days, showed a strong statistically significant negative connection. The length of hospital stays and the level of pseudocholinesterase showed a statistically significant negative connection. The dose of pralidoxime also showed a moderately significant statistical connection. Conclusion
Because it is readily available, organophosphorus (OP), the most prevalent poisoning agent in India, works by blocking acetylcholinesterase at muscarinic and nicotinic receptors. Although organophosphorus poisoning lowers erythrocyte cholinesterase (EchE) and plasma cholinesterase (PchE), estimating these levels is expensive. In the Indian context, the Peradeniya organophosphorus poisoning scale is a poisoning severity score that has not received much attention. Based on the symptoms at presentation, the Peradeniya Organophosphorus Poisoning (POP) scale evaluates the degree of poisoning and is easy to use. Patients who scored highly on the Peradeniya Organophosphorus Poisoning scale had a high rate of morbidity and mortality. According to Peradeniya Organophosphorus Poisoning scale, clinical severity was categorised to mild (score 0-3), moderate (score 4-7) and severe (score 8-11). Serum creatine phosphokinase, Pseudocholinesterase level, total atropine, total pralidoxime dose, need of ventilator support, duration of hospital stays strongly correlated with clinical severity at admission. The study recommends serum creatine phosphokinase as an alternative marker. In resource limited rural settings, estimation of serum Pseudocholinesterase is not frequently done, Peradeniya Organophosphorus Poisoning scale can be used to assess severity of poisoning and can be used to predict morbidity and mortality due to OPC poisoning.
Keywords Organo Phosphorous Compounds, Peradeniya Organophosphorus Poisoning Scale, Creatine Phosphokinase, Acetyl Cholinesterase, Plasma Cholinesterase, Intermediate Syndrome, Organo Phosphorous Induced Delayed Neuropathy, Length of stay, Pralidoxime, Atropine
Field Medical / Pharmacy
Published In Volume 8, Issue 1, January-February 2026
Published On 2026-01-17
DOI https://doi.org/10.36948/ijfmr.2026.v08i01.66741
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