الفهرس 
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Abstract
A
cute organophosphorus poisoning (AOPP) is a common medico toxic emergency all over the world especially in the developing countries as Egypt. Although poisoning can result from occupational exposure or accidental ingestion, most of the cases have suicidal intention. Thus, it is important to identify the clinical features and other factors that can indicate the severity of poisoning and predict the need of ventilatory support at the initial presentation.
Peradeniya OP poisoning (POP) score is a poisoning severity score that has not been much studied in the Egyptian scenario. POP score can easily assess the severity of the poisoning based on the symptoms at initial presentation.
This study aimed to evaluate and correlate the role of serum Copeptin level and Peradeniya organophosphorus poisoning (POP) score in predicting AOPP severity and outcome in 90 patients admitted to the Poison Control Center - Ain Shams University Hospitals (PCC-ASUHs) during the period from November 2016 till March 2018.
This study represented a prospective cross sectional, hospital-based study, that was carried out on 90 patients with AOPP admitted to PCC-ASUHs, who were selected after ruling out of the predetermined exclusion criteria. The diagnosis was verified by history of OP exposure, initial assessment of clinical manifestations and measuring serum PChE level.
The obtained data was documented and recorded in a special sheet constructed for each patient.
For every patient, the following data was studied:
Sociodemographic data (age, sex, residence and occupation).
Intoxication data (manner, place and route of poisoning).
Clinical data (general and systemic examination).
Laboratory data: sample was collected on admission for biochemical analysis of serum Na, serum K, serum PChE levels, ABGs and serum Copeptin level.
Peradeniya OP poisoning (POP) score: patients were assessed on admission and classified into mild, moderate and severe groups.
Treatment received and hospital disposition.
Outcome (discharged or dead).
Complications (ICU admission, hospital stay duration, mechanical ventilation, IMS and coma).
The results were tabulated and statistically analyzed and revealed the following:
The mean age of the patients in the study was 30.2 ± 11 years, ranged from (18 – 65) years. Females and males were equally presented and patients from urban areas were more than rural areas.
Ingestion was the most common route of exposure, while suicidal attempt was the most common manner of poisoning. Home was the most common place of exposure to OP compounds. The mean ± SD of the delay time was 3.6 ± 2.33 hours.
The majority of the patients were presented conscious and rational (60%). Most of the patients (76%) had normal pulse value, while 15% presented with bradycardia and 7% had tachycardia. Normal blood pressure was recorded in 83% of the patients, followed by hypotension that was recorded in 11% of the patients, then 5% of patients were presented with hypertension. Tachypnea was the most common recorded respiratory rate (73%).
There was a significant correlation between pulse, blood pressure, respiratory rate and the severity status, as bradycardia, hypotension and tachypnea were predominantly recorded in the severe group.
The most common cutaneous manifestation was sweating (45%), followed by cyanosis (12%). While pin pointed pupillary size was predominant (62%) over constricted pupillary size (37%).
Both cutaneous and pupillary manifestations were significantly associated with the degree of severity.
The most common GIT manifestation was vomiting (100%), while the most common respiratory manifestation was crepitation (51%).
There was a statistical significance correlation between respiratory manifestations and the degree of severity.
All patients were assessed and categorized according to POP score at the initial presentation, where 47.7% of cases were recorded mild, 42.2% were recorded moderate and 10% were severe cases.
Most of the patients had normal serum Na, K levels and ABGs value, meanwhile, 20% had hyponatremia, 43% had hypokalemia, respiratory acidosis was the most common ABGs disorders (31%).
There was significant association between ABGs disorders and degree of severity as well as the outcome.
Mean serum PChE level was 1042 ± 664 U/L and ranged 250-3587 U/L, with significant correlation with the outcome.
Regarding mean serum Copeptin level it was 2.9 ± 1.5 ng/ml, ranging from 1.2 to 8.5 ng/ml, with high statistically significant correlation with the degree of severity and the outcome. In addition to its ability for prediction of mortality in AOPP as revealed by applying multivariant logistic regression analysis, with cut off value of ≥ 3.9 ng/ml for mortality prediction, as well as 90% sensitivity and specificity.
Whereas, POP score was positively associated with hospital stay duration, total atropine dose, the incidence of mechanical ventilation, as well as the outcome. Hence 78% of deaths were classified as severe cases while 8% were from the moderate group.
Gastric lavage was performed in 54% of the cases in the ER for decontamination, 30% required intubation in the ER. Regarding hospital disposition, 42% were admitted into the in-patient department, 58% required ICU admission and hospital stay duration ranged from one to 21days with mean 3.7 days.
Twenty three percent of the patients required mechanical ventilation, 40% were presented with disturbed level of consciousness and 5% developed IMS. Mechanical ventilation and coma were significantly associated with the degree of severity. In addition, mechanical ventilation was also significantly associated with the outcome. where deaths accounted for 11% of the patients and the rest were discharged.