Evaluation of intravenous lipid emulsion as a novel therapeutic antidote in severe organophosphorous poisoning- A prospective randomized, comparative study
Journal Title: Al Ameen Journal of Medical Sciences - Year 2019, Vol 12, Issue 3
Abstract
Background: Organophosphorus compounds are usually esters, amides or thiol derivatives of phosphonic acid and form a large family (>50000 compounds). The principal use of these compounds are as pesticides in agriculture, mainly as insecticides. Some formulations are used in veterinary and human medicine, particularly as antiparasitics, against ticks, lice and fleas. The development and use of some of these compounds as very potent agents of chemical warfare (tabun, sarin) is of global significance. Many organophosphorus compounds are highly toxic to plants, animals and humans. Methods: A total of 100 adult otherwise healthy patients were included in the study. The patients were randomly recruited into the group I (atropine + PAM) and group II (atropine + intravenous lipid emulsion), each group comprising 50 patients. The randomization was done as per computer generated Random number tables and patients straightway allocated to either into group I (atropine + PAM) or group II (atropine+ intravenous lipid emulsion). Patients were assessed everyday for cholinergic signs, atropine requirements, muscle power and the level of consciousness by GCS. All the patients were monitored continuously with ECG, pulse oximetry, invasive BP monitoring, CXR as needed. Results: Duration of mechanical ventilation in group I (atropine + PAM) was 3.7200 ± 1.77327 days and in group II (atropine + intravenous lipid emulsion) was 2.6875±1.40146 days. Duration of mechanical ventilation in days was longer in patients receiving atropine and PAM than in those receiving atropine and intravenous lipid emulsion and the difference was found to be statistically significant (p value=0.002). In group I the mean duration of ICU stay was 5.8400±2.98541 days and in group II 4.8800±1.69802 days. Hence the difference in mean duration of ICU stay between two groups was statistically significant (p value =0.049). That is in group II (atropine + intravenous lipid emulsion) patients were discharged early than in group I (atropine + PAM). Conclusion: IV emulsion improves GCS, mean arterial pressure, thereby, decreases need for ventilation, duration of ventilation, ICU stay and overall mortality of organophosphorus patients. It is much more effective if used at the beginning of organophosphorus poisoning.
Authors and Affiliations
Shabnum Majeed, Altaf H. Malik, B. A. DAR
Keywords
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