الفهرس 
Material and methodsOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Summary and Conclusion -84
Anticholinesterase insecticides specially organophosphates are the
insecticide group of choice in the agricultural works and are the most common
cause of poisoning among the pesticides. These types of insecticides had been
thoroughly investigated. Recently, pancreatitis was reported as a manifestation of
anticholinesterase poisoning both in adults and children and probably not rare.
The aim of the present work is to study anticholinesterase insecticide
poisoning as a cause of acute pancreatitis and to highlight its common presentation
and associated laboratory changes and so, we can only suspect and diagnose its
presence, so, we can provide patients with proper management and follow-up.
This study was conducted on twenty five acute anticholinesterase poisoned
patients admitted to the Poison Control Center, Ain Shams University Hospital, also
fifteen healthy subjects were taken as a control group. After thorough history
taking, patients were subjected to complete physical examination and to the
following laboratory investigations:
- True cholinesterase (AchE), plasma pseudocholinesterase (BuchE), blood
glucose, serum amylase, calcium, potassium and hematocrit value.
Summary and Conclusion -85
Our patients had highly significant lowered true and pseudocholinesterase
levels compared with the control group (p<O.0005). A highly significant negative
correlation was found between the severity of poisoning and true cholinesterase
level (p<O.005), while insignificant correlation was found between the severity of
poisoning and pseudocholinesterase level (p<O.05). Also, blood glucose and serum
amylase were highly significantly elevated as compared with the control group
(p<O.0005). Serum calcium and potassium were highly significantly lowered as
compared to the control group (p<O.0005) for both, and hematocrit value showed
highly significant elevation compared with the control group (p<O.0005).
In seven patients among the test group (28%), acute pancreatitis was
diagnosed. All these patients had abdominal symptoms in which severe abdominal
pain, vomiting and diarrhea were constantly present. They also had significantly
elevated serum amylase compared with other patients and the control group
(p<O.0005). Serum calcium of these patients showed highly significant lowering
compared with other patients and the control group (p<O.0005). Also, their
hematocrit values were significantly elevated compared with other patients and the
control group (p<O.0005). The other eighteen patients had gastrointestinal
symptoms, inclUding nausea, vomiting and diarrhea but none of them had severe
abdominal pain, some also showed elevated serum amylase. Ultrasonographic
Summary and Conclusion -86
examination of these 7 patients failed to detect any echogenic abnormality In their
pancreas.
Patients with pancreatitis had significantly higher serum glucose compared
with other patients who did not have pancreatitis and also with the control group
(p<O.0005).
from the previous findings, we can conclude that acute pancreatitis is
probably not rare in anticholinesterase intoxication and can be diagnosed based
on presence of gastrointestinal symptoms in which severe abdominal pain is a
hallmark, in association with elevated serum amylase, lowered serum calcium and
elevated hematocrit value. Early recognition of acute pancreatitis in these patients
may improve management and outcome.
Accordingly, we recommend safety measures in packing insecticides, also
prophylactic and safety measures during its spray by users, e.g., wearing gloves,
high boots and masks. This may decrease the high incidence of accidental
poisoning seen in our study. Also, for clinician to early recognize anticholinesterase
induced pancreatitis by clinical assessment and by determination of serum
pancreatic enzyme levels (amylase, lipase and trypsin) if available, also, serum
calcium, blood sugar and hematocrit value specially in severely poisoned patients.
Serial ultrasonographic study for these patients is also recommended.