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

Shimaa M Motawei, Azza A. Elbiomy, Hala S. Abou ElWafa

Introduction: Organo Phosphorus Poisoning (OPP) remains a detrimental health problem in many parts of the world particularly in developing countries. The treatment did not change since many years, despite the increasing complications and case fatalities of the exposure. Separate clinical trials were conducted to test, if sodium bicarbonate and N-Acetylcysteine (NAC) are useful in improving the outcome and the prognosis of the OPP.

Aim: This study was conducted based on a previous clinical trial 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, according to the severity of cases.

Methods: Seventy patients of OPP were given N-Acetylcysteine (NAC) and NaHCO₃ together with the classic treatment of OPP. Serum Malondialdehyde (MDA), Glutathione Peroxidase (GPx), pH, plasma butyryl cholinesterase were measured and compared of a matched group of patients, who received the classic treatment only, on presentation and after 24 hours of the classic treatment only. The effects of the new antidotes were compared for the severe cases with the mild and moderate degrees of OPP.

Results: There were no significant differences between the two groups of the study in the initial levels of MDA, GPx, pH, plasma butyryl cholinesterase that turned highly significant after 24 hours of treatment and observation. There was a highly significant difference (P=0.001) in the Length of the Hospital Stay (LOS) between the two groups. No adverse effects of the supplements were observed. The percentage of improvement to the initial enzymes levels was higher to the severe cases than to the mild and moderate degrees of poisoning.

Conclusion: NAC and sodium bicarbonate are affordable agents and are very helpful in improving the outcome of OPP patients, particularly the severe cases.