5/30/2014 Cholinesterase Tests: The Test

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Alsoknownas:CHSAChERBCCholinesteraseRedCellCholinesteraseBChE
PlasmaCholinesterasePseudocholinesterasePCHE
Formalname:ErythrocyteAcetylcholinesteraseButyrylcholinesterase
Relatedtests:DibucaineInhibitionLiverPanel
Wereyoulookinginsteadforacetylcholinesterasetestingofamnioticfluidforneuraltubedefects?
The Test
Howisitused?
Whenisitordered?
Whatdoesthetestresultmean?
IsthereanythingelseIshouldknow?
Howisitused?
Cholinesterasetestinghastwomainuses:
Itcanbeusedtodetectanddiagnoseorganophosphatepesticideexposureand/orpoisoning.Itmayalsobeusedto
monitorthosewhomaybeatincreasedriskofexposuretoorganophosphatecompounds,suchasthosewhoworkin
agriculturalandchemicalindustries,andtomonitorthosewhoarebeingtreatedforexposure.Typically,testsforred
bloodcellacetylcholinesterase(AChE)andserumpseudocholinesterase(PChE)areusedforthispurpose.
Itcanbeusedseveraldayspriortoasurgicalproceduretodetermineifsomeonewithahistoryoforfamilyhistoryof
postoperativeparalysisfollowingtheuseofsuccinylcholine,acommonmusclerelaxantusedforanesthesia,isatrisk
ofhavingthisreaction.Inthesecases,thetestforpseudocholinesteraseisusuallyused.Asecondtest,referredtoasa
dibucaineinhibitiontest,maybedonetohelpdeterminetheextenttowhichtheactivityoftheenzymeisdecreased.
Whenisitordered?
Peoplewhoworkwithorganophosphatecompoundsinthefarmingorchemicalindustriesmayberoutinelymonitoredto
assessanyadverseexposure,oncebaselinelevelshavebeenestablished.Cholinesterasetestingcanalsobeusedto
assessanyacuteexposuretothesecompounds,whichcancauseneuromusculardamage.Toxicitycanfollowarapid
absorptionofthecompoundinthelungs,skin,orgastrointestinaltract.Thesymptomsoftoxicityarevarieddependingonthe
compound,quantity,andthesiteofexposure.Earlysymptomsmayinclude:
Headache,dizziness
Nausea
Excessivetearingintheeyes,sweatingand/orsalivation
Astheeffectsofthepoisoningworsen,someadditionalsymptomsmayappear:
Vomiting,diarrhea
More
5/30/2014 Cholinesterase Tests: The Test
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Darkorblurredvisionduetoconstrictedpupils
Muscleweakness,twitching,lackofcoordination
Slowedbreathingleadingtorespiratoryfailure,requiringlifesavingventilation
Inseriouscases,seizures,coma,anddeath
Preoperativescreeningforpseudocholinesteraseactivityisadvisedifapersonoracloserelativehasexperienced
prolongedparalysisandapneaaftertheuseofsuccinylcholineforanesthesiaduringanoperation.
Whatdoesthetestresultmean?
Inmonitoringforoccupationalpesticideexposure
Followingexposuretoorganophosphatecompounds,AChEandPChEactivitycan
falltoabout80%ofnormalbeforeanysymptomsoccuranddropto40%ofnormalbeforethesymptomsbecomesevere.
Thosewhoareregularlyexposedtothesecompoundsmaybemonitoredfortoxicexposurebyestablishingabaseline
activitylevelandthentestingonaregularbasistowatchforasignificantreductiononactivityofacetylcholinesteraseor
pseudocholinesterase.
Intestingforacutepesticideexposure/poisoning
Significantlydecreasedcholinesteraseactivitylevelsusuallyindicateexcessiveabsorptionoforganophosphatecompounds.
PseudocholinesteraseandRBCacetylcholinesteraseactivityareusuallydecreasedwithinafewminutestohoursafter
exposure.Pseudocholinesteraseactivitymayregenerateinafewdaystoweeks,whileacetylcholinesteraseactivitywill
remainlowforaslongasonetothreemonths.BothplasmaandRBCactivitiesareimmediatelyaffectedbypesticide
exposurebut,uponremovalfromexposure,AChEandPChEregenerateatdifferentratessinceAChEisproducedinblood
cells,whichhavealifespanof120days,whereasPChEisproducedintheliver,withahalflifeofabouttwoweeks.
Intestingforsuccinylcholinesensitivity
About3%ofpeoplehavelowactivitylevelsofpseudocholinesteraseduetoaninheriteddeficiencyandwillhaveprolonged
effectsfromthemusclerelaxantsuccinylcholine.Totalquantitativepseudocholinesteraselevelswillbeevaluatedpriorto
surgeryforpatientswithahistoryorfamilyhistoryofprolongedapneaafteruseofthisdrug.Lowactivitylevelsof
pseudocholinesteraselevelsindicatethatthesepeoplemaybeatincreasedriskofexperiencingprolongedeffectsofthe
musclerelaxant.Asecondtest,thedibucaineinhibitiontest,mayalsobeperformedtohelpcharacterizethedegreeofa
person'ssensitivitytothedrug.Thelowertheresultfromadibucaineinhibitiontest,thegreatertheriskofdrugsensitivity.
Reducedcholinesteraselevelscanalsobecausedbychronicliverdiseaseandmalnutrition.Totalcholinesteraseactivity
canbeloweredinanumberofotherconditions,includingpregnancy,renaldisease,shock,andsomecancers.
IsthereanythingelseIshouldknow?
Ifsomeoneunexpectedlyhasprolongedapneaaftersurgery,testingforsuccinylcholinesensitivitymaybeperformed
however,thesampleshouldbeobtainedafter24to48hourshaveelapsedfollowingthesurgerytoavoidinterferencebyany
drugsgivenduringthesurgerythatcouldaffecttheresults.
DrugscalledcholinesteraseinhibitorsmayhaveamoderatebenefitinthosewithearlydiagnosedAlzheimer'sdisease.
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