Autonomic Function following Acute Organophosphorus Poisoning: A Cohort Study

Autonomic dysfunction after chronic low level exposure to organophosphorus (OP) pesticides has been consistently reported in the literature, but not following a single acute overdose. In order to study autonomic function after an acute OP overdose, sixty-six overdose patients were compared to 70 matched controls. Assessment of autonomic function was done by heart rate response to standing, deep breathing (HR-DB) and Valsalva manoeuvre; blood pressure (BP) response to standing and sustained hand grip; amplitude and latency of sympathetic skin response (SSR); pupil size and post-void urine volume. The patients were assessed one and six weeks after the exposure. The number of patients who showed abnormal autonomic function compared to standard cut-off values did not show statistically significantly difference from that of controls by Chi-Square test. When compared to the controls at one week the only significant differences consistent with autonomic dysfunction were change of diastolic BP 3 min after standing, HR-DB, SSR-Amplitude, SSR-Latency, post-void urine volume and size of the pupil. At 6 weeks significant recovery of autonomic function was observed and only HR-DB was decreased to a minor degree, −5 beats/min [95%CI 2–8]. This study provides good evidence for the lack of long term autonomic dysfunction following acute exposure to OP pesticides

Correlation matrix to identify multicollinearity.

<p>Analyzed with Spearman's correlation. Values are Spearmans's rho (P value),</p>‡<p>significant at 0.05 level.</p

Descriptive data of the participants.

©<p>values are mean (SD).</p

Autonomic function assessment in patients and controls.

<p>Values are in mean (SD) except</p>†<p>median (interquartile range),</p>‡<p>significant at 0.05 level (2-tailed).</p

Cut-off values of autonomic function tests [11].

<p>Cut-off values of autonomic function tests <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0037987#pone.0037987-Ewing3" target="_blank">[11]</a>.</p

Number of poisoned cases by type of OP.

<p>Number of poisoned cases by type of OP.</p

Recruitment of the participants to the study.

<p>Recruitment of the participants to the study.</p

Results of the blood pressure response to sustained hand grip.

$<p>odds ratio,</p>‡<p>significant at 0.05 level.</p

Effects of acute organophosphorus poisoning on function of peripheral nerves: a cohort study.

BACKGROUND: Following acute organophosphorus (OP) poisoning patients complain of numbness without objective sensory abnormalities or other features of OP induced delayed polyneuropathy. The aim of this study was to measure peripheral nerve function after acute exposure to OP. METHODS: A cohort study was conducted with age, gender and occupation matched controls. Motor nerve conduction velocity (MNCV), amplitude and area of compound muscle action potential (CMAP), sensory nerve conduction velocity (SNCV), F- waves and electromyography (EMG) on the deltoid and the first dorsal interosseous muscles on the dominant side were performed, following acute OP poisoning. All neurophysiological assessments except EMG were performed on the controls. Assessments were performed on the day of discharge from the hospital (the first assessment) and six weeks (the second assessment) after the exposure. The controls were assessed only once. RESULTS: There were 70 patients (50 males) and 70 controls. Fifty-three patients attended for the second assessment. In the first assessment MNCV of all the motor nerves examined, CMAP amplitude and SNCV of ulnar nerve, median and ulnar F-wave occurrence in the patients were significantly reduced compared to the controls. In the second assessment significant reduction was found in SNCV of both sensory nerves examined, MNCV of ulnar nerve, CMAP amplitude of common peroneal nerve, F-wave occurrence of median and ulnar nerves. No abnormalities were detected in the patients when compared to the standard cut-off values of nerve conduction studies except F-wave occurrence. EMG studies did not show any abnormality. CONCLUSION: There was no strong evidence of irreversible peripheral nerve damage following acute OP poisoning, however further studies are required

F wave studies - multiple linear regression for confounders.

¥<p>Significant at 0.05 level.</p