Agriculture is one of the major occupation in developing nation like India.Organophosphorous compounds are one among the most commonly used insecticide in India. They are widely used for the control of insects damaging the agriculture and homes[1]. Due to its easy availability and accessibility, organophosphorus poisoning is the most common poisoning encountered in day to day practice. Organ phosphorus compounds (OPC) were first developed by Schrader during world war II. The compounds were first used as insecticides in agriculture and later used in weapons for chemical warfare as nerve gas[2].

In Indian studies the incidence of suicidal poisoning using op compounds is about 10.3 to 43.8%[3].

Op compounds are organic derivatives of phosphorous containing acids, they combine with esteratic sites of acetyl cholinesterase that is phosphorylated and then undergo hydrolysis. These cause disruption of transmission of nerve impulses in both central and peripheral nervous system[4].

The mechanism of cardiac toxicity is caused by more than one mechanism and are sympathetic, parasympathetic overactivity, hypoxemia, acidosis, electrolyte derangements and direct toxicity on myocardium and conduction system of the heart[5-6].  The antidote Atropine may itself induce arrhythmia. Hypotension and prolong QTc interval have been described to be independent predictors of mortality in patients with OPC induced cardiotoxicity.

Cardiac manifestations with op compound poisoning may manifest vas Hypotension, Hypertension, SinusBradycardia ,Tachycardia, QT cprolongation, ventriculartachycardia, ventricular fibrillation[7-8].

These complications are potentially preventable if identified early and treated early.

Normal serum magnesium (Mg) level is 1.7 – 2.1 mg/ dl. Mg has a co-factor role in the metabolism of proteins, lipids, fat and carbohydrates as well as the enzyme ATPase. Acetylcholine release is hampered by low magnesium ions, which also prevent neurosynaptic communication. Hypokalaemia and hypomagnesemia are frequently seen together[9]. Hypomagnesemia precipitates cardiac arrhythmias, convulsions, muscle cramps, depression and generalized weakness like quadriplegia with respiratory muscle weakness. Acute OPC will produce hypomagnesemia due to prolonged nasogastric suction, severe diarrhoea, underlying illness like starvation, chronic alcoholism, diabetes mellitus, hyperthyroidism etc[10].

Hence this study is intended to study various ecg changes and serum magnesium level in organophosphorus poisoning and its importance in early detection and  managing the complication so as to decrease the mortality associated with Organophosphorus poisoning.

 OBJECTIVES:

1. To evaluate for magnesium level in organophosphorus poisoning cases..
2. To assess the correlation between Serum Magnesium level and ECG changes in Acute Organophosphorus poisoning .

This was a cross sectional  observational study conducted in Department of General medicine GR Medical college ,Mangalore.

This study included Acuteorganophosphorus poisoning cases admitted between June 2024 to May 2025 ,GR Medical college , Mangalore , KARNTAKA.

 Sampling Method: Convenient sampling.

Study Duration: 1 Year ( June 2024 – May 2025)

Methods of collection of data

After obtaining clearance and approval from Institutional Ethics Committee, a Cross-sectional Observational study was conducted from Department of General Medicine, GR Medical college, Mangalore, Karnataka.

 The Ecg report and serum magnesium reports were collected from the medical records of the cases. Diagnosis of Organophosphorus poisoning was made based on the history of exposure to the insecticide, serum Ach esterase level, signs of op poisoning on clinical examination and subsequent improvement with administration of atropine and oximes.

 Inclusion Criteria

• Age more than 18yrs.
• Acute OP poisoning cases admitted in wards and ICU .

 Exclusion Criteria

• Patients with established chronic kidney disease , chronic liver disease ,myopathy ,malignancy , coronary artery disease .
• Patients with history of concomitant other compound poisoning
• Patients on magnesiumsupplements .
• Pregnant women .
• Patient who were on chronic drug usage with steroids ,statins, diuretics.

Methodology :

After getting approval from Institutional ethics committee, written informed consent was taken. Patients were selected according to inclusion and exclusion criteria. The aims and objectives of the intended study was properly explained to the subject.

The Ecg report and serum magnesium reports were collected from the medical records of the cases. Diagnosis of Organophosphorus poisoning was made based on the history of exposure to the insecticide, serum Ach esterase level, signs of op poisoning on clinical examination and subsequent improvement with administration of atropine and oximes.

 T-Test

In Developing countries Organophosphorus poisoning forms one of the most commonly used compound for suicides[11].

The purpose of my study was to study the electrocardiographic changes in organophosphorus consumption patients and assessing serum magnesium level in Patients admitted in GR Medical College, Mangalore.

The sample size of the study was 50, out of which 43 were male, 7 females with male predominance in the study. Mean age was 43 years among males and 34years among females.

In a similar study conducted by S K Tripathy, P.K Rout Mean Age was found to be 33.78 closely related our study sample[12].

Chlorpyriphos poisoning was the predominant compound agent used by the study cases for poisoning with acephate being the second common agent.Organophosphorus available widely and less expensive could have been the probable cause for its high incidence[13].

In our study about 7 ECG morphological changes were observed with Sinus Tachycardia(38%)as the most common manifestation in my study with Normal sinus Rhythm (20%) Second most common finding,QT prolongation(18%),St-t changes(12%),Premature ventricular complex(6%),Sinus bradycardia(2%),Ventricular tachycardia(4%).These Ecg changes were similar to other studies conducted like Uttam Kumar in 2012 with varied proportion .Sinus tachycardia could be related to nicotinic effects of OP compounds while sinus bradycardia can be attributed to muscarinic effects.[14] Although bradycardia is thought to dominate in the early cholinergic phase of the OP poisoning, sinus tachycardia was a more frequent finding in our study probably due to the fact that most of the patients were visited in antimuscarinic phase of OP toxicity.

Hypokalaemia was seen in 17 patients with mean of 3.45 among Female and 3.70 among Males.

Mean Serum magnesium was 1.73 among males and 1.64 among Females. Mean Pseudocholinesterase level observed was 1885.

Electrolyte abnormalities like Hypokalaemia and Hypomagnesemia has been frequently noted with organophosphorus poisoning probably due to usage of Oximes and gastric lavage.

Poisoning with OP compounds can produce significant ECG abnormalities especially sinus tachycardia, non specific ST-T changes and QTc interval prolongation. Since these abnormalities can cause lethal arrhythmia and cardiac damage, careful observation of the electrocardiogram of the patients exposed to OP compound is necessary, parallel to the appropriate medical management.Electrolyte abnormalities like Hypomagnesemia and Hypokalaemiaadds  a risk to the morbidity and mortality hence this study emphasises the importance of maintaining a normal electrolytes level as a part of treatment .

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