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J Korean Soc Emerg Med > Volume 25(3); 2014 > Article
Journal of The Korean Society of Emergency Medicine 2014;25(3): 277-283.
Trends of Lipase and General Features in Organophosphates Induced Acute Pancreatitis
Nam Hyub Cho, Hyun Kim, Woo Jin Jung, Yong Won Kim, Tae Hoon Kim, Oh Hyun Kim, Kyoung Chul Cha, Kang Hyun Lee, Sung Oh Hwang, Yong Sung Cha
Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea. zza96@hanmail.net
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.
Key words: Pancreatitis, Lipase, Organophosphates
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