We had a query organophosphate poisoning, who presented to A/E 2 hours post
intake.and a serum cholinesterase was sent out of hours, the level of which
was "normal". Red cell cholinesterase is the assay of choice, but do many
laboratories do that? If not, where is it sent and is the assay available
out of hours? Finally, the item supposedly taken (but probably not, as
patient is well) was an organophosphorous insecticide, how long after oral
intake would one see an effect on cholinesterase?
Thomas and Watson in Ann Clin Biochem 2002 suggest the red cell
cholinesterase should be available within 6 hrs for optimal clinical
management, but they state that serum cholinesterase is inhibited more
rapidly, but a reduced level could be due to other reasons. If so at what
time does a "normal" serum cholinesterase exclude organophosphate poisoning.
Thanks to anyone who can answer some or all of the questions!
____________________________________________________________
Dr. Helen Grimes, Dept. of Clinical Biochemistry, UCH, Galway, Ireland
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