Vol.20 Issue No.2 (2024): Journal of Indian Society of Toxicology

A Study of Serum Creatine Phosphokinase Levels as a Prognostic Indicator in Acute Organophosphorus Poisoning

VVSB Thejaswini*, Vignessh Raveekumaran*

Introduction :

Organophosphorus compound (OPC) poisoning is a significant global health concern, particularly in developing countries, results in high mortality rates. Conventional markers such as serum cholinesterase levels have limitations in predicting disease severity, necessitating the exploration of alternative biochemical markers like serum creatinine phosphokinase (CPK).

Aims :

To evaluate the significance of serum CPK levels as the prognostic indicator in acute OPC poisoning and assess its correlation with clinical severity using the Peradeniya OPC poisoning (POP) score.

Methodology :

A hospital-based cross-sectional study was conducted in a tertiary-care teaching hospital over 18 months, including 30 patients with confirmed OPC poisoning. Serum CPK levels were measured on day 0, 3, and 5 and correlated with POP scores and the need for mechanical ventilation. Statistical analysis was performed using SPSS. Ethics clearance was obtained.

Results :

A strong positive correlation was observed between POP scores and CPK levels (r on day 0 – 0.763, day 3 – 0.803, day 5 – 0.683; all p values <0.001), indicating increased poisoning severity is associated with elevated CPK levels. Additionally, a significant negative correlation was found between the mechanical ventilation and both POP scores (r -1.000 on day 5) and CPK levels (r -0.683, p <0.001).

Conclusion :

Serum CPK serves as a valuable prognostic marker in OPC poisoning, correlating with disease severity and the need for mechanical ventilation. The integration of CPK monitoring with POP scoring can enhance early risk stratification and guide clinical decision-making for better patient outcomes.

Filicide-Suicide - Foeticide : Can it be Termed as Triadic Death?

Soniya B Parchake*,Nilesh Keshav Tumram**

Murder-suicide, homicide-suicide, and dyadic death all refer to an incident where a homicide is committed followed by the perpetrator's suicide almost immediately or soon after the homicide. However, when there is occurrence of Homicidesuicide – foeticide aka Filicide- suicide - Foeticide then there is triad of event occurring in a single incidence. In present case, such triad of event occurred when there was female perpetrator, who killed her son and would be born child.

The author wants to highlight that in such triad of event the deaths occurring can be termed as Triadic death.

A Rare Case of Organophosphorus Compound Poisoning - induced Acute Necrotising Pancreatitis

MA Tharoon Kumar*, Vignessh Raveekumaran*

One of the most recognized signicant health concerns is organophosphorus compound (OPC) poisoning, especially prevalent in India where these compounds are commonly used as pesticides.While OPC poisoning is linked to an array of complications affecting various bodily systems, the occurrence of acute necrotizing pancreatitis remains notably rare. we report a case of a 54-year-old male with intentional OPC ingestion, who developed acute necrotising pancreatitis a rare complication. We describe the early recognition of the complication and the successful management strategies employed to treat this rare and serious condition.

The Forensic Challenges of Poisoning Cases in India : Trend, Impact and Post-COVID-19 Insights

Pankaj Malia*, Sheikh Mohammad Abdur Rahman*, Gourav Panchal*

Poisoning is a significant medico-legal and public health issue in India, accounting for a considerable proportion of accidental and intentional deaths. This paper examines the trends in poisoning cases using data from the National Crime Records Bureau (NCRB), highlighting the common agents, Demographic patterns, and regional variations. It also explores the challenges faced by forensic toxicologists and medico-legal professionals in investigating and managing poisoning cases. Special attention is given to the surge in suicidal poisoning cases post-COVID19 and the absence of toxicological databases, which adversely impacts forensic investigations and policy making. The lack of centralized and comprehensive toxicological data complicates the identification of poisoning patterns, delays judicial proceedings, and hinders the formulation of targeted public health policies. Strengthening toxicological databases can significantly improve the quality of forensic investigations and provide actionable insights for regulatory frameworks. This paper provides r e commenda tions for improving for ensi c infrastructure, adopting advanced analytical techniques, and implementing preventive strategies to mitigate the incidence and impact of poisoning in India.

Chloroform-the Quest for Oblivion : A Case Report

Kavya Jagadeesh*, Aadamali Nadaf**, Santosh Kumar P***

Chloroform is a halogenated hydrocarbon and is a colourless, volatile liquid with potent anaesthetic properties. Nowadays, the use of chloroform as an anaesthetic is abandoned, because it causes central nervous system depression, cardiac arrhythmias and delayed hepatotoxicity. However, it is used as an organic solvent in industry and in analytical laboratories. Most cases of chloroform toxicity are the result of inhalational exposures, and very few reports involve oral ingestion. A 35-year-old male microbiologist was working in a corn products manufacturing factory was found in anunresponsive state at his guest house which was found locked from inside. The police found a bottle of “EMPURA Chloroform 500ml” near the body and suspected consumption of about 300ml out of 500ml. Also recovered dried datura seed capsule/pods from the crime scene. Some colleagues of the deceased gave a history of chronic use of datura seeds by him. This case highlights the rare and incidental chloroform toxicity.