Romanian Society of Pharmaceutical Sciences

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IMPROVING DIAGNOSTIC ACCURACY IN DIMPYLATE POISONING: A COMPARATIVE STUDY OF CHOLINESTERASE ASSAYS

ANDREEA-CAMELIA HÎRJĂU 1,2*, ILINCA-MIHAELA MARANDIUC 1,3, GABRIEL-LUCIAN RADU 2

1 “Cantacuzino” National Institute for Medical-Military Research and Development, Bucharest, Romania
2 Doctoral Schools in the Faculty of Chemical Engineering and Biotechnologies, “Politehnica” University of Bucharest, Bucharest, Romania
3 “Carol Davila” University of Medicine and Pharmacy, Faculty of Pharmacy, Bucharest, Romania

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Organophosphate (OP) intoxication remains a significant public health issue due to the widespread use of these compounds. Dimpylate, a widely used organophosphate insecticide, causes acute intoxication by inhibiting acetylcholinesterase. A sensitive gas chromatography-mass spectrometry (GC-MS/MS) method was developed to detect dimpylate and its primary metabolite in urine. Liquid-liquid extraction was performed using a solvent system consisting of dichloroethane, methyl chloride and chloroform in a 1:1:1 ratio. A comparative analysis of the Ellman and EMIT methods for assessing acetylcholinesterase and butyrylcholinesterase activity in one patient with acute dimpylate intoxication was also conducted. Rapid diagnosis is crucial for effective treatment, but current literature lacks detailed analytical toxicology methods for emergency settings. While Ellman’s method is commonly used, its accuracy is debated in the actual research field. Butyrylcholinesterase inhibition level exceeded acetylcholinesterase level initially, supporting its potential as a biomarker. Despite both enzymes declining rapidly, persistent low acetylcholinesterase levels for 16 days, despite clinical improvement, indicated a dissociation between enzyme recovery and clinical status. Acetylcholinesterase inhibition alone may not fully reflect the clinical course of dimpylate poisoning. Both point-of-care and laboratory-based methodologies, such as EMIT, hold promise as diagnostic tools for dimpylate intoxications.