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Open Access Publications from the University of California

Pitfalls to Avoid while Interpreting Cholinesterase Activity Levels in Cholinesterase Inhibitor Pesticides Poisoning


The cholinesterase activity (AcCh) assay finds an important place in the diagnosis of acute poisoning by cholinesterase inhibitor pesticides, allowing the indication and the efficacy evaluation of antidote treatment with atropine and oximes. AcCh is also a biomarker of effect in occupational exposure to cholinesterase inhibitor pesticides. However, some factors may disrupt AcCh levels and distort the interpretation of the assay results. Hence, the present review aimed to summarize the factors and the variations that may have an impact on the interpretation of AcCh. Indeed, butyrylcholinesterase and acetylcholinesterase are subject to wide physiological individual variations, such as to age, weight and height. Genetic and pathological state may also be factors influencing AcCh levels. The consumption of drugs and daily exposure to some toxicants may also disrupt the AcCh levels, either by direct action on the enzyme or by disrupting its synthesis. In addition, analytical variations and interferences are to be considered while interpreting the results. These variations could induce an underestimation or an overestimation of the cholinesterase activity levels and could lead to diagnostic errors. To conclude, the dosage of cholinesterase activity constitutes an important biomarker of effect in clinical and occupational toxicology. Its interpretation has to be done delicately, taking into consideration all the factors and variations that may influence it.

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