Date of Award

Winter 1-4-2019

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Sudha Viday Sagar

Abstract

Introduction Organophosphate consumption is a most common form of poisoning in Asian countries such as India and Srilanka. These compounds being highly lipid soluble they can easily distribute in the tissues and can cross the blood brain barrier and result in various complications. There is an increased rate of morbidity and mortality associated with these compounds. Eventhough, ATR is the most widely used antidote, treatment with PAM and GPR are also noteworthy. However, there are no clear studies stating benefits of individual or combination of regimens with respect to the outcomes. This study is carried out to compare the efficacy and safety profile of various treatment regimens of these drugs in our hospital setting. Objectives To study the various treatment patterns and outcomes in OP poisoning. Methodology A retrospective study conducted in Kasturba Hospital on OP poisoning patients admitted during the year 2012- 2017. Patients were identified through medical records with ICD coding T60.0 corresponding to organophosphate and carbamate poisoning. Patients’ demographical details, clinical symptoms, treatment and outcomes were collected in a suitably designed CRF and data was analysed using SPSS 20. Results A total of 541 patients were enrolled in the study with a mean age 38.60 ± 15.11years (Mean ± SD). Majority of the patients were males (70.2%) and have consumed poison with an intention of self-harm (98.3%). Chlorpyriphos (24.2%) was the most common OP compound consumed in our study. Prescription pattern showed a majority treated with ATR+PAM (41.22%) followed by ATR alone (30.5%), ATR+PAM+GPR was used in (20.9%) and ATR+GPR in (7.4%) of the study population. Outcome analysis with respect to treatment pattern revealed better improvement in subject treated with ATR & PAM (74.9%) compared to other treatment regimens. Similarly the days of ICU (8.97± 5.85), ventilator days 8.37 ±7.11 and development of complications (42%) was comparatively less in the group treated with ATR & PAM. The addition of GPR was not found to be beneficial in any terms of primary or secondary outcomes. Secondary complications have a significant association with intermittent dosing of ATR, quantity of poison ingested, lower levels of pseudocholinesterase, duration of ventilation and ICU days. Conclusion The treatment analysis revealed combination of ATR & PAM ensured better clinical outcomes in terms of improvement and development of secondary complications. However, addition of GPR did not improve the overall outcome of the patients. Secondary complications have a significant association with intermittent dosing of ATR, quantity of poison ingested, lower levels of pseudocholinesterase, duration of ventilation and ICU days.

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