Glycemic changes in acute anticholinesterase insecticide poisoning

Background: Patients admitted with acute anticholinesterase poisoning were observed to manifest certain glycemic changes, albeit transient. This study was undertaken to elucidate these changes in detail. Objective: To study the prevalence of any glycemic change in acute anticholinesterase insecticide poisoning and to establish their correlation, if any, with the severity of poisoning. Methods: All patients admitted at our center with a confirmed diagnosis of acute anticholinesterase insecticide poisoning were included in the study. The presence of any glycemic change (hyperglycemia or hypoglycemia or ketosis or glycosuria) was noted and its magnitude and duration were recorded. The presence of any glycemic change was correlated with the severity of poisoning. Results: Of the 76 patients studied, 39 (51%) had consumed organophosphate and 37 (49%) had consumed carbamate. Among the 39 organophosphate poisoning cases, glycosuria alone was observed in 22 cases (56.41%) and along with hyperglycemia in 8 cases. Among the 37 carbamate cases, 14 (37.84%) had glycosuria alone and 5 cases had hyperglycemia in addition. None had hypoglycemia or ketosis. However, the observed glycosuria was transient lasting for a mean of 2.75 days in organophosphate group and 2.25 days in carbamate group. Hyperglycemia lasted slightly longer with a mean duration of 3.25 days and 2.75 days in organophosphate and carbamate poisoning respectively. The glycemic changes observed occurred more frequently in patients with Bardin's grade 2 and 3 poisoning. Conclusion: Transient glycosuria with or without hyperglycemia occurred in a significant number of patients with organophosphate and carbamate poisoning. A positive correlation existed between the glycemic changes and the severity of poisoning. Long term clinical implications of these glycemic changes need to be further evaluated by follow-up studies.