An Analytical Study about Serum Creatine Phosphokinase as Predictor and Marker of Severity in Organophosphorus Poisoning

Abstract

Introduction: Organophosphorus (OP) toxicity is an important global health problem, especially in many developing countries because of their widespread use and easy accessibility. The objectives of our study were to measure serial serum creatine phosphokinase (CPK) levels, to correlate CPK levels with severity of poisoning, and to record the total dose of atropine required. Methods: This was a retrospective and analytical study. One hundred patients of either sex, having age >14 years, presented within 12 h of ingestion or inhalation of OP. It was observed that confirmation of OP poisoning was done by seeing the packet/container with clinical presentation. Clinical severity was categorized according to Peradeniya organophosphorus poisoning (POP) scale. Results: The severity of the poisoning increased in respect to POP score, the serum CPK levels, and total dose of atropine required for treatment also increased. The difference in serial CPK levels in patients without intermediate syndrome (IMS) and with IMS, it was observed that the difference in CPK between these patients was highly significant at baseline and 48 h. There was an increase in CPK levels at admission and 48 h, but reduced by 96 h. A weak positive correlation was observed between POP score and CPK levels, as well as CPK, and atropine dose. A negative correlation was observed between butyrylcholinesterase and CPK levels. Conclusion: In our opinion, these observations suggest that there is a direct relation between serum CPK levels and IMS. Hence, it is necessary for estimating CPK levels, especially after 48 h, in moderate-to-severe poisoning patients so that IMS can be recognized at the earliest and patients can be referred to higher centers for immediate management of respiratory failure, reducing morbidity and mortality.