Objective In severe organophosphate (OP) poisoning, administration of atropine via continuous intravenous infusion is typically considered. To date, there have been no studies on predicting successful atropine discontinuation through plasma cholinesterase (PChE) and serum lactate levels, which are monitored during critical care in severe acute OP poisoning. Therefore, we retrospectively evaluated the usefulness of serum lactate and PChE as predictors of successful discontinuation of atropine infusion.
Methods This retrospective observational study was performed on consecutive adult patients treated for severe acute OP poisoning between March 2011 and December 2016. We sequentially evaluated serum lactate and PChE levels on emergency department arrival and before a discontinuation trial of atropine infusion. Discontinuation of atropine intravenous infusion was attempted in patients after clearance of respiratory secretions and cessation of bronchoconstriction. Discontinuation of atropine infusion attempts were divided into successful and failed trials.
Results A total of 95 trials were conducted in 62 patients. Serum lactate levels before trials were significantly different between patients with successful and failed trials. The area under the curve for prediction of successful atropine discontinuation using serum lactate levels before trial discontinuation were 0.742 (95% confidence interval, 0.638 to 0.846). PChE level was not significantly different between two groups.
Conclusion Serum lactate levels before the discontinuation trial of atropine infusion served to predict successful discontinuation in severe acute OP poisoning.
Citations
Citations to this article as recorded by
Early Markers in Severe Organophosphorus Poisoning and Their Association with Mortality Ashaq Hussain Parrey, Manzoor Koka, Mohd. Ismail, Mohd. Ashraf, Hyder Lone The Journal of Emergency Medicine.2025; 73: 95. CrossRef
Atropine sulfate as a continuous intravenous infusion for the treatment of organophosphate toxicity in a cat Edward Baker, Carl Southern, Jennifer Martinez Journal of Feline Medicine and Surgery Open Reports.2024;[Epub] CrossRef
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Objective Clinically, consumptive coagulopathy, such as disseminated intravascular coagulopathy (DIC), is the most important among the common venomous snakebite complications owing to the serious hemorrhage risk associated with this condition. We evaluated the predictive value of the delta neutrophil index (DNI)—a new indicator for immature granulocytes—for DIC diagnosis.
Methods This retrospective observational study consecutively assessed adult patients with venomous snakebites for over 51 months. Patients were categorized into the no DIC and DIC groups. DNI values were measured within 24 hours after snakebite.
Results Thirty patients (26.3%) developed DIC. The DIC group had significantly higher median initial DNI than the no DIC group (0% vs. 0.2%, P<0.001). When the DIC group was divided into early and late groups (within and over 24 hours after snakebite, respectively), the DNI of the former was significantly higher than that of the latter and no DIC group. The late DIC group had significantly higher DNI than the no DIC group. Furthermore, DNI positively correlated with the DIC score (r=0.548, P<0.001). The initial DNI (odds ratio, 4.449; 95% confidence interval, 1.738 to 11.388; P=0.002) was an early DIC predictor. The area under the curve based on the initial DNI’s receiver operating characteristic curve was 0.724.
Conclusion DNI values were significantly higher in the DIC group. Additionally, DNI was an early predictor of DIC development in patients with venomous snakebites in the emergency department.
Citations
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Haemotoxicity of snakes: a review of pathogenesis, clinical manifestations, novel diagnostics and challenges in management Bhawani Yasassri Alvitigala, Harsha A Dissanayake, Praveen N Weeratunga, P A Chanya D Padmaperuma, Lallindra Viranjan Gooneratne, Christeine Ariaranee Gnanathasan Transactions of The Royal Society of Tropical Medicine and Hygiene.2025; 119(3): 283. CrossRef
The association between the neutrophil lymphocyte ratio and local edema after viper snake envenomation in South Korea Jeong Mi Moon, B.J. Chun, Y.J. Koo Toxicon.2024; 240: 107635. CrossRef
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The Usefulness of Platelet Distribution Width and Platelet Distribution Width to Lymphocyte Ratio in Predicting Severity and Outcomes in Patients with Snakebite Ataman Köse, Aydan Akdeniz, Seyran Bozkurt Babus, Mert Göçmen, Gülhan Orekici Temel Wilderness & Environmental Medicine.2021; 32(3): 284. CrossRef
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