Diagnostic and prognostic efficacy of optic nerve sheath diameter in patients with dysnatremia.

AIM: This study aimed to investigate the diagnostic and prognostic value of optic nerve sheath diameter (ONSD) measurement in patients with dysnatremia. MATERIAL AND METHODS: This prospective clinical study included patients aged ≥18 years who were diagnosed with dysnatremia on admission to the emergency department. RESULTS: The present study included 65 patients (35 with hypernatremia [hypernatremia group] and 30 with hyponatremia [hyponatremia group]) and 14 healthy volunteers (control group). Comparison of these groups in terms of ONSD revealed that the right and left ONSDs were significantly higher in the hypernatremia and hyponatremia groups comparing to the control group (p<0.001). According to the optimal cutoff values determined, the right ONSD detected hypernatremia with 91.4% sensitivity and 92.9% specificity and the left ONSD detected the condition with 88.6% sensitivity and 85.7% specificity. Furthermore, the right ONSD detected hyponatremia with 83.3% sensitivity and 92.9% specificity, and the left ONSD detected it with 93.0% sensitivity and 86.0% specificity. Finally, ONSD was found to be an independent predictor of mortality in patients with hypernatremia. CONCLUSION: ONSD is a noninvasive, easy, cheap, and reproducible measurement and can be used as an effective and powerful tool for the diagnosis of patients with dysnatremia and the prognosis of patients with hypernatremia.

Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department.

BACKGROUND AND AIM: This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. METHODS: A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. RESULTS: At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0 mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0 mL. Upon analyzing the relationship between the Glasgow-Blatchford score (GBS) and SV, we identified a significant negative correlation (r = -0.7350; P < 0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r = -0.4718; P < 0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5 mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. CONCLUSION: IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB.

Evaluation of the Inferior Vena Cava Diameter in Dehydrated Children Using Bedside Ultrasonography.

Objective: Bedside ultrasonography (US) is a new imaging modality that has begun to be used in the Pediatric Emergency Unit to evaluate inferior vena cava (IVC) diameter for intravascular volume status. In this article, we aimed to evaluate IVC diameter with bedside US before and after the fluid therapy in dehydrated children. Methods: A total of 124 dehydrated patients were enrolled, aged 8 months to 17 years. The maximum diameters of the IVC and aorta (AO) were measured. IVC/AO ratio and IVC collapsibility index IVC-CI were calculated before and after the fluid therapy and correlation with the degree of dehydration and laboratory parameters was investigated. Results: Of the 124 patients, 49.2% (n = 61) were male, the mean age was 7.5 ± 4.94 years. The IVC/AOs ratio was increased in mild and moderate/severe groups after fluid therapy compared to before fluid administration. While the mean rate of heart rate, blood urea nitrogen (BUN), creatinine, and uric acid values were higher in the moderate/severe group, potassium and HCO3 were lower. There was no significant change in AO diameter and IVC-CI after fluid therapy in all groups. When the factors affecting the IVC/AOs ratio were analyzed with the logistic regression backward model; the IVC/AO ratio was found to increase as the degree of dehydration decreased (Adj.ß = -0.318) and as the age (Adj.ß = 0.242) and CRP (Adj.ß = 0.186) value increased. Conclusion: The IVC/AO ratio can be a promising index for the assessment and grading of dehydration in children, and cutoff values that vary according to age are necessary for a more objective assessment of dehydration.

Investigation of highly cited publications related to vaccines against COVID-19: current state and future predictions.

BACKGROUND: Since the date of declaring the COVID-19 outbreak a pandemic by the World Health Organization (March 11, 2020), vaccine studies have been initiated. In this article, we aimed to investigate highly cited articles on vaccines and guide researchers for future studies. MATERIAL AND METHODS: Publications with 6 or more citations (highly cited publications) were extracted from Web of Science (WoS) database. These publications were investigated according to the number of citations, language, publication year, WoS categories, publication types, organizations involved, authors, countries and research areas. Additionally, top 20 articles were investigated in detail. RESULTS: A total of 126 publications were determined. When WoS categories were investigated, 18 pertained to immunology (14.2 %), 17 to biochemistry (13.4 %) and 17 to multidisciplinary sciences (13.4 %). There were three types of publications, namely 80 original articles (63.4 %), 46 reviews (36.5 %) and 11 early access publications (8.7 %). Top universities were Harvard University (n=9, 7.1 %), Chinese Academy of Medical Sciences (n=7, 5.5 %) and University of California system (n=7, 5.5 %). Top authors were Qin CF with 4 articles (3.1 %), Wang L with 4 articles (3.1 %) and Baric RS with 3 articles (2.3 %). Top journals with the highest number of publications were Journal of Biomolecular Structure Dynamics (n=8, 6.3 %), Nature (n=8, 6.3 %) and Science (n=6, 4.7 %). Top countries were the United States of America (USA) with 45 articles (35.7 %), People's Republic of China with 44 articles (34.9 %), and India with 15 articles (11.9 %). Research areas of the publications were science technology other topics (n=21, 16.6 %), immunology (n=18, 14.2 %) and pharmacology (n=18, 14.2 %). CONCLUSION: Vaccine studies play a pivotal role in the warfare against COVID-19. Our results revealed that under the leadership of the USA, China and India, the number of scientists focusing on vaccines is increasing and gratifying results are obtained from vaccine studies (Tab. 3, Ref. 40).

The Effect of Biomarkers and Optic Nerve Sheath Diameter in Determining Mortality in non-Traumatic Subarachnoid Hemorrhage.

AIM: Although radiological methods are sufficient for the diagnosis of spontaneous subarachnoid hemorrhage (SAH), additional biomarkers are needed to predict prognosis. The aim of this study was to investigate the effects of serum S100B protein, Glial Fibrillary Acidic Protein (GFAP) levels and, Optic Nerve Sheath Diameter (ONSD) on mortality and clinical severity in patients with spontaneous SAH. MATERIALS AND METHODS: Fifty-six patients who were diagnosed with SAH after first evaluation in the emergency department (ED) were included in the study group; Forty-six patients who were admitted to the ED with headache of non-intracranial etiology, were included as the control group. Cerebral computed tomography (CT) images and peripheral blood samples were obtained from all patients; at the time of diagnosis and 24 h after diagnosis. Serum S100B protein and GFAP levels were measured from the blood samples and ONSD was measured on CT. RESULTS: Serum S100B protein and GFAP levels and, ONSDs at the time of diagnosis and 24 h after diagnosis were significantly higher in the study group (p < 0.05). Both GFAP levels and ONSD at the time of diagnosis and 24 h after the diagnosis were found to be related with increased mortality (p < 0.05). A similar association was found for serum S100B protein levels 24 h after the diagnosis, but not at the time of diagnosis (p = 0.540). CONCLUSION: Serum S100B protein and GFAP levels and, ONSD were increased in patients with spontaneous SAH. All parameters were found to be associated with increased mortality.

Comparison of performances of top emergency medicine journals in terms of COVID-19 publications in 2020.

INTRODUCTION: The aim of this study is to evaluate the qualitative and quantitative contribution of Emergency Medicine (EM) journals to scientific literature on COVID-19 and compare the journals in terms of publications. MATERIAL AND METHODS: We performed a comparison of top EM journals by hand-search in terms of COVID-19 publications and citations between January 1st and December 31st, 2020. Publications were also categorized according to research field, country and article types. Data were given as numbers and percentages. RESULTS: Among 18 EM journals, Resuscitation ranked in the first place and American Journal of Emergency Medicine ranked in the last place according to Impact Factor. In these journals, 512 (12.2%) articles related to COVID-19 were published. The American Journal of Emergency Medicine and Internal and Emergency Medicine published the greatest amount of publications related to COVID-19 (n = 71). The American Journal of Emergency Medicine was also the leading journal in terms of "Total Citations to COVID-19 Articles" (n = 1192). Western Journal of Emergency Medicine published the greatest proportion of COVID-19 articles (Total COVID-19 Articles/Total Articles = 0.3). World Journal of Emergency Surgery ranked in the first place in terms of citations per COVID-19 articles (n = 33.2). The most common studied field was Effects of COVID-19 on the Health System (n = 222). The US was the most productive country with 188 COVID-19 publications and 1411 citations to these publications, followed by Italy. CONCLUSION: The contribution of EM journals to COVID-19 literature is controversial. "Effects of COVID-19 on the Health System" is the most studied field. "Clinical Properties, Ethical Issues and Treatment Methods" are neglected fields in EM journals.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

Interleukin-33 (IL-33) as a Diagnostic and Prognostic Factor in Traumatic Brain Injury.

Interleukin-33 (IL-33) is a cytokine involved in interleukin-1 family. Role of IL-33 in immune system activation is well described in the literature. IL-33 has been identified as an endogenous alarm signal (alarmin) to alert various types of immune cells to trauma. In this narrative review, we aimed to underline the diagnostic and prognostic importance of IL-33 in trauma, particularly in brain trauma.

The Blunt Abdominal Trauma Bedside Ultrasonography Comparison with Trauma Severity Scores and Computerized Tomography.

OBJECTIVE: To investigate the accuracy of focussed assessment sonography for trauma (FAST) bedside ultrasonography application in patients with blunt abdominal trauma and patient management, clinical outcome, and trauma severity scores. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey, from April 2013 to June 2017. METHODOLOGY: The presence of intraperitoneal free fluid (FF) was investigated by FAST application by emergency physicians. Abdominal computed tomography (CT), which was considered the gold standard, was made use of for evaluating intraperitoneal FF presence. Patients were evaluated for urgent surgical intervention, requirement of blood transfusion, and mortality status. The relationship between the FF presence / absence in FAST practice and revised trauma score (RTS), injury severity score (ISS) and trauma injury severity score (TRISS) was statistically analysed. RESULTS: All 28 FAST (+) patients also had intraperitoneal FF in gold standart CT. Although the gold standart CT detected intraperitoneal FF in 6 (4.2%) of 140 FAST (-) patients, the compatibility between FAST and CT in the detection of intraperitoneal FF in patients with blunt abdominal trauma was statistically significant (k: 0.882, p<0.001). RTS and ISS scores were 6.24 ± 1.74 and 44.0 ± 15.7 in eleven (3.5%) dead patients. The sensitivity, specificity, positive predictive value, and negative predictive value were found to be 82.3% (95% CI: 65.4-93.2), 100% (95% CI: 97.2-100), 100% and 95.7% (95% CI: 91.5-97.8), respectively. CONCLUSION: FAST had a high accuracy compared to gold standard CT in detecting FF. Low RTS and high ISS are associated with impaired hemodynamic parameters and detected FF [FAST (+)].

How Prepared Are We for Possible Bioterrorist Attacks: An Approach from Emergency Medicine Perspective.

Preparedness for bioterrorist attacks and early recognition of specific agents are essential for public health. Emergency departments may play an important role in this field. The large spectrum of bioterrorism involves not only disastrous terrorism with mass casualties, but also microevents using low technology but producing civil unrest, disruption, disease, disabilities, and death. It aims not only to cause mortality and morbidity, but also to lead to social and political disruption. Preparedness appears to be the most potent defense against possible bioterrorist events. In this article, we aim to create awareness against biological agents and underline the importance of emergency departments in this public health problem.

Investigation of Geriatric Patients with Abdominal Pain Admitted to Emergency Department.

INTRODUCTION: The aim of this study is to detect the possible reasons of abdominal pain in the patients aged 65 and older admitted to emergency department (ED) with complaint of abdominal pain which is not related to trauma, to determine the length of hospitalization of old (65-75 age) and elderly (aged 75 and older) patients, and to define the hospitalization and mortality rates. MATERIAL AND METHODS: In the study, 336 patients were included. Groups were compared in respect to gender, internal or surgical prediagnoses, complaints accompanying abdominal pain, vital findings, comorbidities, requested consultations, hospitalizing service, waiting time in the ED and in the hospital, and treatment methods. RESULTS: Of the patients, 48.2% were male, and 51.8% were female. While 52.4% of the patients were in 65-74 age group, 47.6% of them were aged 75 years and above. An internal disease was detected in 76.8% of the patients as an origin of abdominal pain. Most common prediagnoses were biliary diseases and diseases related to biliary tract followed by nonspecific abdominal pain, abdominal pain secondary to malignity, ileus, and acute gastroenteritis, respectively. The most frequent finding accompanying abdominal pain was vomiting. The most frequent chronic disease accompanying abdominal pain was hypertension in both age groups. We observed that 75.9% of the patients required consultation. We detected that 48.8% of the patients with abdominal pain were hospitalized and they were hospitalized mostly by gastroenterology ward (24.8%). Surgical treatments were applied to the 17.6% of the patients with abdominal pain. CONCLUSION: Clinical findings become indistinct by age, and differential diagnosis of abdominal pain gets more difficult in geriatric patients. Therefore, physicians should consider age related physiological changes in order to distinguish geriatric patients admitted to emergency service with abdominal pain from pathological cases requiring immediate surgical operation.

Acute ischemic stroke and severe multiorgan dysfunction due to multiple bee stings.

Various manifestations after bee sting have been described. Local reactions, such as pain, wheal, flare, edema and swelling, are common and generally self-limiting. Uncommonly manifestations like vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, anaphylactic shock, myocardial infarction, hypotension, collapse, pulmonary hemorrhage, acute hemorrhagic pancreatitis, and atrial fibrillation may occur. We report a 59 year-old man who sustained ischemic stroke and multi-organ dysfunction following multiple bee stings.

Pentraxin 3, ischemia-modified albumin, and myeloperoxidase in predicting a cardiac damage in acute carbon monoxide poisoning.

BACKGROUND: Carbon monoxide (CO) poisoning is associated with cardiac injuries or manifestations, frequently attributing to direct hypoxic damage at cellular level. For this, the aims were to evaluate the role of serum pentraxin 3 (PTX 3), ischemia-modified albumin (IMA), and myeloperoxidase (MPO) as an early biomarker for cardiac damage when compared to cardiac troponin I (cTnI) and creatine kinase-MB fraction (CK-MB) in adult patients with acute CO poisoning. METHODS: Forty patients with acute CO poisoning admitted to the emergency department. The patients were divided into 2 main groups as follows: cardiac injury (group I, n=19) and nonsuspected cardiac injury (group II, n=21). Pentraxin 3, IMA, MPO, cTnI, CK-MB, and the other assays in the circulation were measured on admission. RESULTS: Upon measuring the serum PTX 3, IMA, MPO, cTnI, and CK-MB levels as well as large electrocardiography and echocardiography abnormalities of patients with cardiac injury on admission, no statistical difference for PTX 3, IMA, and MPO was found between the groups (P>.05). However, cTnI, CK-MB, and leukocyte count (white blood cell) were higher determined in patients of group I compared to group II (P<.05). Receiver operating characteristic curve was also performed to evaluate the diagnostic performance of these tests in patients with cardiac injury. CONCLUSIONS: Our results suggest that PTX, IMA, and MPO assays are not superior to cTnI and CK-MB in predicting a cardiac damage in patients with acute CO intoxication.

A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.

INTRODUCTION: The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS: This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture. RESULTS: A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%. CONCLUSION: With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.

The role of NT-proBNP and Apelin in the assessment of right ventricular dysfunction in acute pulmonary embolism.

OBJECTIVE: To investigate the role of N-terminal pro-brain natriuretic peptide and apelin in the assessment of right ventricular dysfunction in acute pulmonary embolism. METHODS: The prospective case-control study was conducted at Ondokuz Mayis University, Samsun, Turkey, from January 2008 to June 2009, and comprised adult patients with acute pulmonary embolism. A smaller group of healthy adults served as the control. Blood N-terminal pro-brain natriuretic peptide and apelin levels were measured on admission to the Emergency Department. SPSS 15 was used for data analysis. RESULTS: There were 56 cases and 20 controls in the study. Blood N-terminal pro-brain natriuretic peptide levels were higher in cases than the controls (p<0.05). Apelin levels were not different between the groups (p>0.05). Patients with right ventricular dysfunction had significantly higher peptide levels than those without the dysfunction (p<0.05). The cut-off value of peptide for the prediction of right ventricular dysfunction was 1000 pg/ml, with a sensitivity of 92.1% and specificity of 77.8%. CONCLUSIONS: There was no significant change in plasma apelin levels in acute pulmonary embolism. The blood N-terminal pro-brain natriuretic peptide maybe a useful parameter in the assessment of right ventricular dysfunction in acute pulmonary embolism.

Isolated unilateral oculomotor nerve palsy due to head trauma.

Unilateral oculomotor nerve palsy is a rare and challenging condition for both emergency department (ED) physicians and neurosurgeons. In this report, we present you a case of head trauma with oculomotor nerve palsy whose initial neuroimaging findings were normal. A 50-year-old female presented to our ED due to head trauma secondary to fall from height. On her physical examination, ptosis, minimal lateral deviation, and dilated pupilla unresponsive to the light were determined in the left eye. A computed tomography and magnetic resonance imaging were performed and both were found to be normal. Patient was consulted with an ophthalmologist and any sign of direct trauma to the eye was not determined. Then, the patient was consulted with a neurosurgeon and hospitalized. In some rare instances, minor traumas to the head may result in isolated oculomotor nerve palsy without accompanying findings. Neurosurgeons and ED physicians must be careful about this rare condition.

Ischemia-modified albumin is not better than creatine kinase-MB and cardiac troponin I in predicting a cardiac injury in nontraumatic subarachnoid hemorrhage.

BACKGROUND: The aims were to investigate the role of serum ischemia-modified albumin (IMA), tumor necrosis factor α (TNF-α), and myeloperoxidase (MPO) and to evaluate the relationship between IMA and cardiac markers (creatine kinase myocardial isoenzyme [CK-MB] and cardiac troponin I [cTnI]) related to cardiac abnormalities in adult patients after nontraumatic subarachnoid hemorrhage (SAH). METHODS: Twenty-nine patients with nontraumatic SAH admitted to the emergency department and 20 healthy adults as the control group were included in the study. Ischemia-modified albumin, TNF-α, MPO, CK-MB, cTnI, and leukocyte count (white blood cell [WBC]) in the circulation were measured on admission. RESULTS: Ischemia-modified albumin, TNF-α, and MPO levels were higher by mean values of 11.6%, 9.5%, and 2.9%, respectively, in patients with SAH compared with control group. However, levels of these parameters were not statistically different between the groups (P > .05). However, WBC, CK-MB, and cTnI values were significantly higher in patients with SAH compared with healthy control (P < .001, P < .01, and P < .05, respectively). White blood cell and cTnI levels in the circulation were positively correlated with patients' clinical severity (r = 0.598, P = .001 and r = 0.461, P = .012, respectively). Ischemia-modified albumin has a poor diagnostic value in comparison with WBC, CK-MB, and cTnI tests to differentiate between patients after SAH and controls according to receiver operating characteristic curve. CONCLUSIONS: The results suggest that IMA is not better than CK-MB and cTnI in predicting a cardiac injury in patients after nontraumatic SAH.

Investigation of anxiety levels of patients with chest pain admitted to emergency department.

INTRODUCTION: We aimed to investigate the demographical features, anxiety levels and clinical findings of the patients admitted to our Emergency department (ED) due to chest pain. METHODS: Patients with chest pain older than 18 years were included into the study. Demographical features such as age, sex and education level, initial diagnosis in the ED, whether they were hospitalized or coronary intervention performed, were recorded. To determine the anxiety levels of the patients, State-trait Anxiety Inventory (STAI) was performed. RESULTS: Two-hundred and eight adult patients with chest pain were included into the study. We could not determine a relationship between STAI levels of patients according to demographical findings, however, STAI scores tended to decrease by age. Considering the education levels of the patients, it was determined that STAI scores of university graduates were higher than others. The STAI scores of patients discharged from the ED were higher than those hospitalized. When patients were compared according to whether coronary intervention (CI) was performed or not, it was determined that patients who did not require CI had higher STAI scores. When coronary lesion localization of the patients hospitalized was investigated, any relationship could not be determined. CONCLUSION: In this study, we determined that anxiety levels of the patients with chest pain do not correlate with the severity of the disease. Higher anxiety levels of patients discharged from ED when compared to those with ACS is a challenging problem for both ED physicians and cardiologists.

Epidemiology of organophosphate intoxication and predictors of intermediate syndrome.

AIM: To evaluate the usefulness of plasma glucose and serum cholinesterase levels as predictors of organophosphate-induced intermediate syndrome. MATERIALS AND METHODS: Seventy-one organophosphate poisoning patients who were admitted to our emergency department during a 4-year period were evaluated retrospectively. Four patients were excluded from the study due to a lack of medical records. Categorical variables were analyzed using the chi-square test and nonparametric variables were analyzed using the Mann-Whitney U test. RESULTS: Thirty-five (52.2%) patients were male and 32(47.8%) were female. Patients had a mean age of 39.4 ± 15.9 years and 70.1% of the patients were married. Oral intake (68.7%) was the most common method of intoxication, and attempted suicide (67.2%) was the most common cause. The most common organophosphates were methamidophos (20.8%), dichlorvos (19.4%), parathion (7.5%), and methyl parathion (7.5%). Fifty-seven (85%) patients were treated in the emergency observation unit and 10 (15%) patients were admitted to the intensive care unit. Eleven (16%) patients developed intermediate syndrome and had significantly lower levels of serum cholinesterase (P < 0.01) and higher blood glucose levels (P = 0.037). CONCLUSION: Initial serum cholinesterase and glucose levels measured in the emergency department may be a useful marker in predicting organophosphate-induced intermediate syndrome.