**10. Laboratory investigations**

Laboratory evaluation is often performed to assess the prognosis. Leucopenia indicates severe toxicity. Increased aspartate aminotransferase or alanine aminotransferase and metabolic acidosis indicate moderate to severe ingestional poisoning. Electrolyte analysis shows decreased magnesium while potassium may be increased or decreased (Chugh, et al, 1990). Measurement of plasma renin is significant as its level in blood carries a direct relationship with mortality and is raised in direct proportion to the dose of pesticide. The serum level of cortisol is usually found to be decreased in severe poisoning (Chugh, et al, 1989). Chest X-ray may reveal hilar or perihilar congestion if ARDS develops. Electrocardiogram shows various manifestations of cardiac injury (ST depression or elevation, bundle branch block, ventricular tachycardia, ventricular fibrillation) (Jain, et al, 1985; Katira, et al, 1990; Siwach, et al, 1998; Singh, et al, 1989). Wall motion abnormalities, generalised hypokinesia of the left ventricle, decreased ejection fraction and pericardial effusion can be seen in echocardiography (Chugh, 1995).
