J Korean Soc Emerg Med.  2014 Jun;25(3):277-283.

Trends of Lipase and General Features in Organophosphates Induced Acute Pancreatitis

• Cho NH
• Kim H
• Jung WJ
• Kim YW
• Kim TH
• Kim OH
• Cha KC
• Lee KH
• Hwang SO
• Cha YS

Abstract

PURPOSE
There have been few case reports and studies on acute pancreatitis associated with organophosphate (OP) poisoning. We investigated prevalence, general characteristics, trends of lipase levels, and findings of computed tomography (CT) in acute pancreatitis associated with OP poisoning.
METHODS
A retrospective review was conducted of 84 consecutive cases of organophosphate insecticide poisoning that were diagnosed and treated at the Emergency Department of the Wonju Severance Christian Hospital from January 2008 to April 2012.
RESULTS
Acute pancreatitis was seen in 14 patients (16.7%). In pancreatitis patients, diagnosis was made at ED presentation in eight patients (57.1%) and after hospital day (HD) #2 in six patients (42.9%). In the subgroup of patients with an elevated lipase level, after OP poisoning time of peak lipase level and time to normalization were 3.6 (IQR 2.2-5.6) h and 50.6 (IQR 26.7-86.1) h, respectively. CTs were all grade A according to Balthazar classification. Significant differences were observed between the pancreatitis vs. non-pancreatitis groups in terms of ingested amounts [300 (IQR 125-450) mL vs. 100 (IQR 30-200) mL, p=0.007], pH [7.26 (IQR 7.11-7.36) vs. 7.35 (IQR 7.27-7.40), p=0.048], and serum lactate [5.85 (IQR 3.53-9.53) mmol/L vs. 3.39 (IQR 2.31-5.99) mmol/L, p=0.037], respectively. No statistical differences in terms of respiratory failure requiring ventilator care, shock, pneumonia, and AKI were observed between the pancreatitis vs. non-pancreatitis groups. No statistical differences in terms of total admission length, ICU admission length, and mortality were observed between the pancreatitis vs. non-pancreatitis groups.
CONCLUSION
The prevalence of acute pancreatitis in OP poisoning was 16.7%. After OP poisoning time of peak lipase level and time to normalization were 3.6 (IQR 2.2-5.6) h and 50.6 (IQR 26.7-86.1) h, respectively. In the acute pancreatitis group, ingested amounts, serum lactate were higher and serum pH was less than in the non-pancreatitis group.

Keyword

Pancreatitis; Lipase; Organophosphates

MeSH Terms

Classification
Diagnosis
Emergency Service, Hospital
Gangwon-do
Humans
Hydrogen-Ion Concentration
Lactic Acid
Lipase*
Mortality
Organophosphates*
Pancreatitis*
Pneumonia
Poisoning
Prevalence
Respiratory Insufficiency
Retrospective Studies
Shock
Ventilators, Mechanical
Lactic Acid
Lipase
Organophosphates