Effect of Alcohol Co-Ingestion on Clinical Severity and Outcomes in Acute Organophosphorus Poisoning: An Observational Cohort Study.

Dr. Anand  Acharya; Dr. Tejasvi  J; Dr. Vinod Vamsi Kiran  Omini

doi:10.51168/sjhrafrica.v6i12.2337

Authors

Dr. Anand Acharya Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India
Dr. Tejasvi J Assistant Professor, Department of Forensic Medicine and Toxicology, Government Medical College, Bhadradri Kothagudem, Telangana, India.
Dr. Vinod Vamsi Kiran Omini Associate Professor, Department of Forensic Medicine and Toxicology, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2337

Keywords:

Organophosphorus poisoning, alcohol co-ingestion, Peradeniya Organophosphorus Poisoning Scale (POPS), ventilator requirement, cholinesterase inhibition, aspiration pneumonia, mortality

Abstract

Background:
Organophosphorus (OP) compound poisoning continues to impose a substantial health burden in many developing regions where pesticide access is high and timely medical care is inconsistent.

Aim:
To compare the clinical severity and outcomes of OP poisoning among adults with and without alcohol co-ingestion.

Methods:
This hospital-based observational cohort study included 120 adults presenting with acute OP poisoning. Participants were classified into Group A (OP poisoning with alcohol co-ingestion; n = 48) and Group B (OP poisoning without alcohol; n = 72). Severity at admission was quantified using the Peradeniya Organophosphorus Poisoning Scale (POPS). Key outcomes assessed were ventilator requirement, major complications such as aspiration pneumonia, duration of hospitalization, and mortality.

Results:
The cohort had a mean age of 34.2 ± 10.6 years, and 74.1% were men. Patients with alcohol co-ingestion demonstrated higher clinical severity (mean POPS: 4.9 ± 1.8 vs. 3.8 ± 1.6; p = 0.002). The need for ventilatory support was almost twice as frequent in Group A (41.7% vs. 22.2%; p = 0.02). Aspiration pneumonia occurred more often among those who consumed alcohol (25% vs. 11.1%; p = 0.04). Hospital stay was significantly longer in the co-ingestion group (8.7 ± 3.6 vs. 6.4 ± 2.9 days; p = 0.01). Mortality was also higher (16.7% vs. 6.9%; p = 0.04).

Conclusion:
Alcohol co-ingestion intensifies the clinical severity of OP poisoning and increases the likelihood of complications, prolonged hospitalization, and death. Early identification of alcohol intake is essential to guide risk stratification and ensure timely, aggressive supportive care.

Recommendations:
Clinicians should routinely assess alcohol use in all suspected OP poisoning cases and classify such patients as high-risk at presentation. Early airway protection, rapid initiation of antidotes, and close hemodynamic and respiratory monitoring are advised.

Author Biographies

Dr. Anand Acharya, Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India

MBBS, MD (Pharmacology), currently serves as Dean and Professor, Department of Pharmacology, at the Konaseema Institute of Medical Sciences & Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India. A distinguished academician, researcher, and medical education leader, he has been pivotal in transforming KIMS&RF from its formative phase into a premier medical institution with over 200 undergraduate and 100 postgraduate seats.

With more than 18 years of teaching and administrative experience, Dr. Acharya has held several leadership positions, including Vice Principal, Principal, Chief Warden, Member Secretary of Institutional Ethics and Animal Ethics Committees, and is an approved PhD Guide under Dr. NTR University of Health Sciences, Vijayawada. His visionary leadership has significantly enhanced the institution’s academic quality, clinical exposure, research infrastructure, and postgraduate training standards.

He has successfully completed prestigious national faculty development programs such as the Revised Basic Course Workshop (rBCW), Advanced Course in Medical Education (ACME), and National Teacher Training Course (NTTC, JIPMER, Puducherry). He also serves as Coordinator for Pharmacovigilance and Materiovigilance Programs under IPC–PvPI and MoHFW, Government of India, contributing actively to national drug safety and regulatory initiatives.

A prolific academician, Dr. Acharya has authored and co-authored more than 100 scientific publications in reputed national and international indexed journals. His wide-ranging research covers toxicology, pharmacovigilance, antimicrobial resistance, endocrinology, neuropharmacology, and clinical pharmacology. His recent studies include long-term analyses of pyrethroid, paraquat, and chlorpyrifos poisoning, investigations into antimicrobial resistance trends, and predictive models for treatment outcomes in dermatological and toxicological emergencies.

Dr. Acharya’s professional interests include clinical pharmacology, toxicovigilance, rational drug use, pharmacovigilance systems, and innovations in medical education technologies. He continues to mentor numerous postgraduate and undergraduate researchers while playing an integral role in curriculum reform, ethics governance, and institutional academic advancement. ORCID iD: https://orcid.org/0009-0000-7967-9092

Dr. Tejasvi J, Assistant Professor, Department of Forensic Medicine and Toxicology, Government Medical College, Bhadradri Kothagudem, Telangana, India.

is an Assistant Professor in the Department of Forensic Medicine and Toxicology at Government Medical College, Bhadradri Kothagudem, Telangana, India. She completed her MBBS from Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, and earned her MD in Forensic Medicine and Toxicology from Osmania Medical College, Hyderabad. With more than three years of teaching experience, she has actively mentored undergraduate students in ICMR-funded research projects. She has published research in a reputed journal, with academic interests centered on medico-legal case management, toxicology, and forensic pathology. ORCID iD: https://orcid.org/0009-0008-7009-5056

Dr. Vinod Vamsi Kiran Omini, Associate Professor, Department of Forensic Medicine and Toxicology, Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India

is an Associate Professor in the Department of Forensic Medicine at Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India. He is engaged in both undergraduate and postgraduate teaching and has keen interests in forensic pathology, toxicology, medicolegal autopsy practice, and injury interpretation. His professional focus lies in applying forensic science to clinical and public health challenges, particularly poisoning and trauma-related deaths. He is actively involved in academic research, student mentoring, and institutional academic activities, contributing to the advancement of forensic medicine.

References

Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. 2008 Feb 16;371(9612):597-607. doi: 10.1016/S0140-6736(07)61202-1. PMID: 17706760; PMCID: PMC2493390.

Singh S, Sharma N. Neurological syndromes following organophosphate poisoning. Neurol India. 2000 Dec;48(4):308-13. PMID: 11146591.

Peter JV, Cherian AM. Organic insecticides. Anaesth Intensive Care. 2000 Feb;28(1):11-21. doi: 10.1177/0310057X0002800102. PMID: 10701030.

Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, Sempos CT, Jernigan D. Alcohol as a risk factor for global burden of disease. Eur Addict Res. 2003 Oct;9(4):157-64. doi: 10.1159/000072222. PMID: 12970584.

Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome. N Engl J Med. 1987 Mar 26;316(13):761-3. doi: 10.1056/NEJM198703263161301. PMID: 3029588.

Thiermann H, Kehe K, Steinritz D, Mikler J, Hill I, Zilker T, et al. Red blood cell acetylcholinesterase and plasma butyrylcholinesterase status: important indicators for the treatment of patients poisoned by organophosphorus compounds. Arh Hig Rada Toksikol. 2007 Sep;58(3):359-66. doi: 10.2478/v10004-007-0030-6. PMID: 17913691.

Peter JV, Sudarsan TI, Moran JL. Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med. 2014 Nov;18(11):735-45. doi: 10.4103/0972-5229.144017. PMID: 25425841; PMCID: PMC4238091.

White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999 Jul;94(7):961-72. PMID: 10707430.

Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71. doi: 10.1056/NEJM200103013440908. PMID: 11228282.

Moretto A. Experimental and clinical toxicology of anticholinesterase agents. Toxicol Lett. 1998 Dec 28;102-103:509-13. doi: 10.1016/s0378-4274(98)00245-8. PMID: 10022304.

Abdel Baseer KA, Gad EF, Abdel Raheem YF. Clinical profile and outcome of acute organophosphate poisoning in children of Upper Egypt: a cross-sectional study. BMC Pediatr. 2021 Feb 26;21(1):98. doi: 10.1186/s12887-021-02563-w. PMID: 33637060; PMCID: PMC7908781.

Karki P, Ansari JA, Bhandary S, Koirala S. Cardiac and electrocardiographical manifestations of acute organophosphate poisoning. Singapore Med J. 2004 Aug;45(8):385-9. PMID: 15284933.

Eyer F, Meischner V, Kiderlen D, Thiermann H, Worek F, Haberkorn M, Felgenhauer N, Zilker T, Eyer P. Human parathion poisoning. A toxicokinetic analysis. Toxicol Rev. 2003;22(3):143-63. doi: 10.2165/00139709-200322030-00003. PMID: 15181664.

Lee P, Tai DY. Clinical features of patients with acute organophosphate poisoning requiring intensive care. Intensive Care Med. 2001 Apr;27(4):694-9. doi: 10.1007/s001340100895. PMID: 11398695.

Kang EJ, Seok SJ, Lee KH, Gil HW, Yang JO, Lee EY, Hong SY. Factors for determining survival in acute organophosphate poisoning. Korean J Intern Med. 2009 Dec;24(4):362-7. doi: 10.3904/kjim.2009.24.4.362. Epub 2009 Nov 27. PMID: 19949736; PMCID: PMC2784981.

Pawar KS, Bhoite RR, Pillay CP, Chavan SC, Malshikare DS, Garad SG. Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. Lancet. 2006 Dec 16;368(9553):2136-41. doi: 10.1016/S0140-6736(06)69862-0. PMID: 17174705.