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Early diagnosis of nerve agent exposure with a mobile test kit and implications for medical countermeasures: a trigger to react
  1. Timo Wille1,
  2. Snezana Djordjević2,
  3. Franz Worek1,
  4. Horst Thiermann1 and
  5. Slavica Vučinić2
  1. 1 Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany
  2. 2 Military Medical Academy, National Poison Control Center, Belgrade, Serbia
  1. Correspondence to Timo Wille, Bundeswehr Institute of Pharmacology and Toxicology, Munich 80937, Germany; timowille{at}bundeswehr.org

Abstract

Recent uses of nerve agents underline the need of early diagnosis as trigger to react (initiating medical countermeasures, avoiding cross-contamination). As organophosphorus (OP) pesticide poisoning exerts the same pathomechanism, that is, inhibition of the pivotal enzyme acetylcholinesterase (AChE), a portable cholinesterase (ChE) test kit was applied in an emergency room for rapid diagnosis of OP poisoning. OP nerve agents or pesticides result in the inhibition of AChE. As AChE is also expressed on erythrocytes, patient samples are easily available. However, in most clinics only determination of plasma butyrylcholinesterase (BChE) is established which lacks a pathophysiological correlate, shows higher variability in the population and behaves different regarding inhibition by OP and reactivation by oximes. The ChE test kit helped to diagnose atypical cases of OP poisoning, for example, missing of typical muscarinic symptoms, and resulted in administration of pralidoxime, the oxime used in Serbia. The ChE test kit also allows an initial assessment whether an oxime therapy is successful. In one case report, AChE activity increased after oxime administration indicating therapeutic success whereas BChE activity did not. With only BChE at hand, this therapeutic effect would have been missed. As inhibition of AChE or BChE activity is determined, the CE-certified device is a global diagnostic tool for all ChE inhibitors including carbamates which might also be misused as chemical weapon. The ChE test kit is a helpful point-of-care device for the diagnosis of ChE inhibitor poisoning. Its small size and easy menu-driven use advocate procurement where nerve agent and OP pesticide exposure are possible.

  • toxicology
  • nerve agent
  • point-of-care diagnosis
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Footnotes

  • Contributors All authors made substantial contribution to conception/design or acquisition of data or analysis/interpretation of the data. All authors contributed to design the article and revised it critically. In addition, all authors approved the manuscript and agree with the submission to JRAMC.

  • Funding The study was funded by the German Ministry of Defence (34Z1-S-481518).

  • Disclaimer The design, performance, data interpretation and manuscript writing was under the complete control of the authors and has never been influenced by the funder.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval MMA Ethis Committee, Belgrade, Serbia.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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