Cholinesterase, Amylase, Lipase and Neutrophil-to-lymphocyte Ratio in Acute Pesticide Poisoning Cases

Overview

To estimate diagnostic levels of amylase, lipase, pseudocholinestrase and neutrophili lymphocytic ratio to different pesticide poisoning. In addition to detect prognostic values of theses enzymes \& NLR and its relation to the outcome of all pesticide poisoning. To assess descriptive sociodemographic criteria of these poisoned cases, mode of toxicity, type of pesticide poisoning at emergency room, any other associated toxicity as well as the clinical outcome.

Acute pesticide poisoning is a global health problem responsible for majority of deaths in poisoning cases. There is a study estimated that about 385 million cases of unintentional acute pesticide poisoning occur annually world-wide including about 11,000 fatalities. Thirty percent of global suicides are due to pesticide poisoning as they are of low cost and easily accessible. Most common suicidal pesticide are classified according to WHO to organophosphorus insecticides, carbamate insecticide, and methyl parathion /or the herbicide paraquat. . Aluminum phosphide(ALP) becomes one of the commonest causes of poisoning. It is extremely toxic after self-poisoning, with a case fatality often exceeding 70% after ingestion. Severe poisoning also has the potential to induce multi-organ failure. The exact site or mechanism of its action has not been proved in humans. Rather than targeting a single organ to cause gross damage. organophosphorus pesticides inhibit acetylcholine esterase enzyme so that lead to accumulation of Ach and muscarinic, nicotinic and central nervous system (CNS) receptor overstimulation. The severity of acute poisoning depends on level of cholinesterase. Detection of pseudocholinestrase is a good biomarker and the most specific lab test of acute pesticide poisoning. There is a relative relationship between plasma cholinesterase and manifestation and final outcome so that level of PChE is a good prognostic value and could help in treatment plans. Cholinergic stimulation of pancreas leads to hyperamylasemia so amylase could be used as a prognostic tool of acute pesticide poisoning, lipase can be helpful with amylase for early detect of pancreatitis as well as determination of severity of poisoning. The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of short- and long-term mortality in critically ill patients, and measurement is simple, cheap, and fast Furthermore, the NLR is a powerful prognostic predictor of cardiovascular affection, acute ischemic stroke, and many other diseases. So high NLR is associated with the risk of mortality of acute toxicity. laboratory evaluation through using rapid, simple, cheap tests plays an important and vital role for confirmation of poisoning, diagnosing the first acute organ damage as well as assessing the severity of poisoning. Emergency physicians can help in improvement of these patient and reduce deaths by accurate assessment of lab markers.

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