Cholinesterase, Serum

Blood
Optimal Result: 1801 - 3637 IU/L.

Cholinesterases, including acetylcholinesterase and pseudocholinesterase, play critical roles in maintaining the proper functioning of the nervous system. Acetylcholinesterase aids in the transmission of nerve signals by breaking down acetylcholine, which facilitates communication across nerve endings. Reduced acetylcholinesterase activity can lead to an accumulation of acetylcholine at nerve endings, causing excessive nerve stimulation in various tissues and organs. On the other hand, pseudocholinesterase is primarily involved in the processing and metabolism of certain drugs.

Two main reasons for conducting cholinesterase tests are:

→ Organophosphate pesticide exposure: These pesticides can hinder the activity of cholinesterase and pseudocholinesterase. Exposure can lead to severe symptoms in cases of acute poisoning or gradually develop with chronic exposure. Monitoring the levels of red blood cell acetylcholinesterase and serum pseudocholinesterase is crucial for detecting poisoning and monitoring individuals exposed to these chemicals, such as agricultural workers or those handling industrial chemicals.

→ Inherited pseudocholinesterase deficiency: Some individuals inherit a deficiency in the pseudocholinesterase enzyme due to genetic variations. This enzyme is essential for deactivating succinylcholine, a commonly used muscle relaxant during surgeries. Individuals with low levels or defective pseudocholinesterase may experience prolonged effects of the drug, leading to extended muscle paralysis and apnea following anesthesia. Pre-surgical pseudocholinesterase testing is essential for individuals with a family history of prolonged apnea after succinylcholine use to assess the risk of drug-related complications.

Cholinesterase testing serves two primary purposes:

→ Detecting and diagnosing exposure to or poisoning by organophosphate pesticides. It's also employed for monitoring individuals at a higher risk of exposure to these compounds, notably those working in agricultural and chemical industries. Tests typically involve examining levels of red blood cell acetylcholinesterase (AChE) and serum pseudocholinesterase (PChE).

→ Conducted before a surgical procedure, it assesses the susceptibility of individuals with a history of post-operative paralysis following the administration of succinylcholine, a common muscle relaxant used in anesthesia. Pseudocholinesterase testing is standard in such cases, often accompanied by a dibucaine inhibition test to evaluate the enzyme's diminished activity.

What does it mean if your Cholinesterase, Serum result is too low?

Decreased pseudocholinesterase levels may be due to:

- Chronic infection

- Chronic malnutrition

- Heart attack

- Liver damage

- Metastasis

- Obstructive jaundice

- Poisoning from organophosphates (chemicals found in some pesticides)

- Inflammation that accompanies some diseases

Smaller decreases may be due to:

- Pregnancy

- Use of birth control pills

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In the context of monitoring for occupational pesticide exposure:

 → AChE and PChE activity can drop to approximately 80% of normal before symptoms emerge and to 40% before they become severe, making regular testing crucial for those regularly exposed to these compounds.

→ Significantly reduced cholinesterase activity levels typically signal excessive organophosphate absorption. While PChE activity may recover within days to weeks, AChE activity can remain depressed for one to three months. Plasma and RBC activities respond differently post-exposure due to variations in their production sites and regeneration rates.

In the case of testing for acute pesticide exposure/poisoning:

→ Pseudocholinesterase deficiency in 3% of individuals can lead to prolonged effects from succinylcholine. Pre-surgery evaluation is necessary for patients with a history of prolonged apnea post-drug use.

→ The dibucaine inhibition test aids in characterizing drug sensitivity, with lower test results indicating a higher risk.

Moreover, reduced cholinesterase levels can be linked to chronic liver disease, malnutrition, pregnancy, renal disease, shock, and certain cancers.

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