J Korean Soc Emerg Med.  2020 Apr;31(2):228-235.

Clinical characteristics and cholinesterase levels in childrenwith carbofuran poisoning

• Yoon SA
• Woo SI

Abstract

Objective
Acute group poisoning caused by food ingestion occurred in an elementary school in Korea. We aimed to describe the clinical characteristics, emergency treatment, outcomes, and the cholinesterase level of children with carbofuran poisoning.
Methods
We recruited 32 children who were transferred to hospitals, and they underwent physical examination and laboratory investigations with detailed history-taking performed at one week after carbofuran poisoning. A questionnaire about presenting symptoms, the transport process, treatment, and the clinical course was conducted with their parent’s agreement. We compared the level of cholinesterase in red blood cells (RBCs) of the child patients without poisoning.
Results
The most common presenting symptoms were hypersalivation (84.4%), dizziness (68.8%), nausea (65.6%), and tremor of the limbs (56.3%). Among them, nine children were transported from the initial hospital to a higher level emergency medical center. Both cholinesterase measurements and atropine injection were done only at a provincial emergency medical center. One child who required ventilator care and was admitted to the intensive care unit showed a low serum cholinesterase level until one week. Six children had symptoms that lasted until a week. Patients showed a significantly lower RBC cholinesterase level than did the children without poisoning (11974 [95% CI 10257-13997] vs 13025 [95% CI 12157-13552] IU/gHb) (P=0.017).
Conclusion
The clinical features and cholinesterase activity of children with carbamate poisoning may be different from those of adults with carbamate poisoning. RBC acetylcholinestrase was significantly lower than that of healthy children until a week after carbofuran poisoning. Cholinersterase could be decreased for a long time, against our expectations, and it is a biomarker of exposure to carbofuran in children by serial monitoring.

Keyword

Carbamate; Poisoning; Child; Cholinesterase