A Hospital Based Longitudinal Study On The Electrocardiographic Findings In Acute Organophosphorus Poisoning (Opp) With Special Reference To Corrected Qt Interval (QTC)

Abstract

Aims and Objectives To study the Electrocardiographic findings in Acute OPP and to correlate the changes in corrected QT(QTc) interval with the severity of organophosphorous poisoning and to evaluate this relationship as a prognostic utility in OPP. Methodology The present one year hospital based longitudinal study was done on a total of 102 patients admitted with Acute organophosphorus compound poisoning in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2016 to December 2016. Standard 12 lead ECG done at admission in Casualty or ICU and at the time of discharge was studied and QTc interval was calculated using Bazett’s formula. The severity of OP poisoning was assessed based on the Peradeniya Organophosphorous Poisoning (POP) Scale, The number of days of hospitalization, requirement of Mechanical ventilation and Glasgow Comma Scale scoring at admission. Results Maximum number of cases had an age of 21-30 years (47.06%) and the mean age was 31.50980392 ± 3.57years. There was male preponderance with a male to female ratio of 1.4:1. The most commonly consumed compound was chlorpyrifos (46.08%). Majority of the patients (75.49%) presented after 3 to 6 hours of consumption. The most common symptom was nausea and vomiting (98.04%) and POP score revealed mild intoxication in 53.892% of the patients. ECG Tracing revealed 61 patients (59.80%) had tachycardia while 3 patients (2.94%) had bradycardia and in remaining 38 patients (37.25%) normal heart rate was noted. Prolonged Qtc was noted in 90 patients (88.23%) while a prolonged PR interval was noted in 14 patients (13.72%). We observed that the Mean QTc interval at Admission was higher (489.14ms) that than the QTc interval at Discharge (452.22ms). T inversion in 7 patients (6.86%), ST elevations in 6 patients (5.88%), VPCs in 4 patients (3.92%) and atrial Fibrillation was seen in 2 patients (1.96%). Sepsis was noted to be the commonest complication in the study i.e 21 patients (52.50%), Mortality was noted in 12.75% of the patients and ventricular tachycardia was the commonest cause (69.23%). Conclusion The commonest ECG abnormality noted was prolonged QTc followed by tachycardia and prolonged PR interval. We found that patients with a higher severity of poisoning had a longer corrected Qtc interval. Patients with longer corrected QT intervals had lower GCS scores on admission and were more likely to require Mechanical ventialation. They also had a longer duration of hospital stay, a longer duration of atropine use, with an increase in complications and a poorer outcome . This observation suggests that corrected Qtc interval is a useful prognostic utility in Organophosphorus poisoning.