Cholinesterase Surveillance
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About Cholinesterase Surveillance
Cholinesterase (ko-li-nes-ter-ace) is one of many important enzymes needed for the proper functioning of the nervous system.
There are two major types of Cholinesterase: acetyl-cholinesterase, which is also termed red blood cell or true cholinesterase; and pseudo-cholinesterase, also called serum or plasma cholinesterase. Both enzymes are measured to assess exposures to or effects of certain pesticides. Human exposure to cholinesterase inhibiting chemicals can result from inhalation, ingestion, or eye or skin contact during the manufacture, mixing, or application of many pesticides. Exposures can occur in the workplace, from food and drinking water, and in the environment. Most pesticides in this category are organophosphorus or carbamate insecticides.
Any pesticides that can bind or inhibit cholinesterase, making it unable to breakdown acetylcholine, is called a “cholinesterase inhibitor” or “anticholinesterase agent”.
The most serious pesticide poisonings usually result from acute exposure to organophosphate and carbamate insecticides.
Signs and symptoms of cholinesterase inhibition include:
- In mild cases (this could be immediately after exposure to 24 hours) – tiredness, weakness, dizziness, nausea and blurred vision.
- In moderate cases (this could be immediately after exposure to 24 hours) – headache, sweating, tearing, drooling, vomiting, tunnel vision, and twitching.
- In severe cases (after continued daily absorption) – abdominal cramps, urinating, diarrhea, muscular tremors, staggering gait, pinpoint pupils, Hypotension (abnormally low blood pressure), slow heartbeat, breathing difficulty, and possibly death, if not promptly treated by a physician.
Unfortunately, some of the above symptoms can be confused with influenza (flu), heat prostration, alcohol intoxication, exhaustion, hypoglycemia (low blood sugar), asthma, gastroenteritis, pneumonia, and brain hemorrhage. This can cause problems if the symptoms of lowered cholinesterase levels are either ignored or misdiagnosed as something more or less harmful than they really are.
The types and severity of cholinesterase inhibition symptoms depend on:
- Toxicity of the pesticide
- Amount of pesticide involved in the exposure
- Route of exposure
- Duration of exposure
The following people should be concerned with having their cholinesterase levels checked on a regular basis:
- anyone that mixes, loads, applies or expects to handle or come in contact with organophosphate and/or carbamate pesticides (this includes anyone servicing equipment used in the process);
- anyone that is in contact with these chemicals for more than 30 hours at a time in one 30-day period.
Mild Exposure:
50% of less reduction from normal or baseline – not usually a health hazard
Moderate Exposure:
50 – 70% reduction from normal or baseline – health hazard
Chronic Exposure:
80 – 90% reduction from normal or baseline – Toxic
(90% or greater reduction indicates that the risk of death from exposure is high)
Red blood cell (RBC) cholinesterase
– requires EDTA anti-coagulated whole blood sample with RBC separated from plasma within 60 minutes
Plasma or serum (pseudo) cholinesterase
– EDTA or heparin anti-coagulated whole blood samples with plasma separated from the RBC within 60 minutes.
Cholinesterase (ko-li-nes-ter-ace) is one of many important enzymes needed for the proper functioning of the nervous system.
There are two major types of Cholinesterase: acetyl-cholinesterase, which is also termed red blood cell or true cholinesterase; and pseudo-cholinesterase, also called serum or plasma cholinesterase. Both enzymes are measured to assess exposures to or effects of certain pesticides. Human exposure to cholinesterase inhibiting chemicals can result from inhalation, ingestion, or eye or skin contact during the manufacture, mixing, or application of many pesticides. Exposures can occur in the workplace, from food and drinking water, and in the environment. Most pesticides in this category are organophosphorus or carbamate insecticides.
Any pesticides that can bind or inhibit cholinesterase, making it unable to breakdown acetylcholine, is called a “cholinesterase inhibitor” or “anticholinesterase agent”.
The most serious pesticide poisonings usually result from acute exposure to organophosphate and carbamate insecticides.
Signs and symptoms of cholinesterase inhibition include:
- In mild cases (this could be immediately after exposure to 24 hours) – tiredness, weakness, dizziness, nausea and blurred vision.
- In moderate cases (this could be immediately after exposure to 24 hours) – headache, sweating, tearing, drooling, vomiting, tunnel vision, and twitching.
- In severe cases (after continued daily absorption) – abdominal cramps, urinating, diarrhea, muscular tremors, staggering gait, pinpoint pupils, Hypotension (abnormally low blood pressure), slow heartbeat, breathing difficulty, and possibly death, if not promptly treated by a physician.
Unfortunately, some of the above symptoms can be confused with influenza (flu), heat prostration, alcohol intoxication, exhaustion, hypoglycemia (low blood sugar), asthma, gastroenteritis, pneumonia, and brain hemorrhage. This can cause problems if the symptoms of lowered cholinesterase levels are either ignored or misdiagnosed as something more or less harmful than they really are.
The types and severity of cholinesterase inhibition symptoms depend on:
- Toxicity of the pesticide
- Amount of pesticide involved in the exposure
- Route of exposure
- Duration of exposure
The following people should be concerned with having their cholinesterase levels checked on a regular basis:
- anyone that mixes, loads, applies or expects to handle or come in contact with organophosphate and/or carbamate pesticides (this includes anyone servicing equipment used in the process);
- anyone that is in contact with these chemicals for more than 30 hours at a time in one 30-day period.
Mild Exposure:
50% of less reduction from normal or baseline – not usually a health hazard
Moderate Exposure:
50 – 70% reduction from normal or baseline – health hazard
Chronic Exposure:
80 – 90% reduction from normal or baseline – Toxic
(90% or greater reduction indicates that the risk of death from exposure is high)
Red blood cell (RBC) cholinesterase
– requires EDTA anti-coagulated whole blood sample with RBC separated from plasma within 60 minutes
Plasma or serum (pseudo) cholinesterase
– EDTA or heparin anti-coagulated whole blood samples with plasma separated from the RBC within 60 minutes.