Experimental monitoring of organophosphate sompound poisoning and evaluating the prognosis in patients

Organophosphate compounds are most commonly used insecticides in India. These agents are also potent chemical warfare agents traditionally known as nerve gas. The toxicological efects of the organophosphate are almost entirely due to the inhibition of the acetylcholinesterase in the nervous system, resulting in accumulation of acetylcholine at synapses and the myoneural Junction. Most organophosphates inhibit both (true) RBC and (pseudo) serum cholinesterase. The serum cholinesterase level is depressed before the RBC cholinesterase level and is a sensitive indicator of exposure to organophosphates. 25 percent or greater depression of the RBC cholinesterase level is it true indicator of poisoning. RBC cholinesterase levels may take up to 90 to 120 days to return to normal values, whereas serum cholinesterase levels recover in days to weeks. Orgnnophosphates inhibit enzymatic hydrolysis of acetylcholine which gets accumulated at the nerve endings resulting in prolonged and intensified actions of acetylcholine on the effector site. Exposure to higher dose of these poisonous substances will produce more inhibition of this enzyme resulting in increased levels of acetylcholine, thereby increasing the severity of symptoms of poisoning indicating poor prognosis. A simple pharmacological method to monitor organophosphate poisoning has been developed. This can prove to be helpful to the consultant in assessing the extent of acetylcholinesterase inhibition and differentiating the organophosphate poisoning from other poisonings.