This document summarizes a study on cases of suicide by organophosphorus compound poisoning in Karachi, Pakistan. It finds that 57.58% of poisoning cases were due to organophosphorus compounds. The majority (52%) of these cases were male. Most cases (33) were treated within 6 hours of poisoning. While mortality was associated with delays in admission and misdiagnosis, the study found mortality rates were not significantly different between those treated with pralidoxime sulfate and those not treated. The study concludes more efforts are needed to control the sale of these compounds and prevent delays in treatment to reduce mortality from suicide by organophosphorus poisoning.

1. Presenter: Dr Afsheen Sayyar
Lecturer Forensic Medicine

3. *
Yuganti Prabhakar Vaidya, Sandip Meghnad Hulke
Department of Physiology, Laxminarayan Medical College, Bhopal, Madhya Pradesh, India

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*Organophosphate compounds are widely used in agricultural
sector as PESTICIDES and as chemical war fare.
*Easily accessible ,associate with self poisoning
*200,000 /500,00 Mortality associated self-poisoning with
pesticides in rural Asia.
*50-70 % in hospital based study.
*Suicidal rate with OPC 20.6-
56.3%

7. Irreversibly bind to serine-OH group at the active site of
acetylcholinesterase (AChE)  establish covalent bond
(phosphorylation)
AGING: loss of alkyl group + strengthening of covalent bond
Phosphorylated AChE is very stable
Inhibition of enzyme activity  accumulation of ACh in the synapse
and NMJ
Overstimulation of cholinergic receptors
*

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10. Muscarinic
effect
salivation
lacrimation
urination
Diarrhea
Emesis

11. Nicotinic
Effects
Muscle weakness
A-Adrenal medulla
activity ↑
tachycardia
Cramping of skeletal
muscle
Hypertension

13. MANAGEMENT
OF OP
ABC SUPPORT
IV ATROPINE
GASTRIC LAVAGE
CLEANSING PATIENT
VENTILATORY SUPPORT

14. *
To evaluate the cases of suicide using organophosphorous
compound as intoxicant with the objective to bring up
possible preventive measures based upon modifiable
factors associated with lethality.

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*Intensive care unit of ward no 5 ,JPMC Karachi

17. *Retrospective study
*66 patient of poisoning
*Period: January 2010 –December 2010
*Diagnosis was made from history
*Clinical investigation:
Serum and RBC cholinesterase level
Blood gases
Electrolytes
pH
LDH

18. *
S.NO TYPES OF POISIONING NO OF CASES PERCENTAGE
1 Organophosphorus poisoning 38 57.58%
2 Alcohol poisoning 08 12.12%
3 Heroine poisoning 06 9.09%
4 Acid ingestion 03 4.54%
5 Other poisoning 11 16.67%
TOTAL 66 100.00%

19. 0%
10%
20%
30%
40%
50%
60%
70%
DISTRIBUTION OF POISONING CASES

20. *
0
20
40
60
80
100
120
MALE FEMALE TOTAL
NO OF CASES
PERCENTAGE
52% 47.3%

21. 33 cases
5 cases

22. *
SR.NO INTERVAL NO.OF CASES
1 1-6 hours 22
2 7-12hours 03
3 13-18hours 03
4 18-24hours 09

23. Parameter Range Mean
pH 7.43-7.52 7.2±0.29
PCO2 17-48.3 32.65±15.65
po2 55-72.2 73.0±17.0
Sao₂ 89-97% 86.5±8.5
Hco3 11.2-25mmol/l 18±7.0
sodium 146-149mEq/l 147.5±1.5
Potassium 2.6-3.2 mEq/l 2.9±0.3
Chloride 108-118mEq/l 113±5
Blood urea nitrogen 7-9 mg/dl 8±1
Creatinine 0.6 mg/dl-1.3 0.95±0.35
Serum cholinesterase level 0.2-6.5 u/ml 3.35±3.15
Total bilirubin 0.9-1.6mg/dl 1.25±0.35
Direct bilirubin 0.5-0.6mg/dl 0.55±0.05
Indirect bilirubin 0.8-0.9 mg/dl 0.85±0.05
Alkaline phosphatase 102-107u/l 104.5±2.5
Gamma GT 28-50u/l 39.0±11.0
LDH 321-325u/l 323±2.0
PT 14-18 16±20

24. *
*Mortality due to delay admission
*Mortality due to Misdiagnose
*Uncontrolled sale all over the country
*Mortality due to intermediate syndrome
*Mortality due to respiratory failure
* Mortality rate was insignificant in patient treated or not
treated with Pralidoxime sulfate .

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