Sodium Bicarbonate and N-Acetyl Cysteine in Treatment of Organophosphorus Poisoning Cases: A Randomized Controlled Clinical Trial

Abstract

Introduction: Organophosphorus poisoning (OPP) is an important health problem in many parts of the world particularly in developing countries. However, the treatment did not change since many years, despite the increasing complications and case fatalities of the exposure. From the clinical experience, some pharmacologic agents had proved useful in improving the outcome and decreasing the complications of this exposure. Aim: This study was conducted to test the efficacy of N-acetyl cysteine; the famous antioxidant, and of blood alkalization by sodium bicarbonate in improving the outcome of OPP cases. Methods: Seventy patients of OPP were given N-acetylcysteine (NAC) and NaHCO3 together with classic treatment of OPP. Serum Malondialdehyde (MDA), Glutathione peroxidase (GPx), pH, plasma butyrylcholinesterase were measured and compared of a matched group of patients, who received classic treatment only, on presentation and after 24 hours of classic treatment only. Results: There were no significant differences between the two groups of study in initial levels of MDA, GPx, pH, plasma butyrylcholinesterase that turned highly significant after 24 h of treatment and observation. There was a highly significant difference (P=0.001) in length of hospital stay (LOS) between the two groups. No adverse effects for the supplements were observed. Conclusion: NAC and sodium bicarbonate are affordable agents and are very helpful in improving the outcome in OPP and decreasing LOS.