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Low cholinesterase level in the blood

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Low cholinesterase level in the blood
Last update: 15/10/2024

What is a low cholinesterase level in the blood called?

  • Cholinesterase low

What is the normal cholinesterase level in the blood?

If you need to know which are the cholinesterase reference ranges or you require more information about the role of cholinesterase in the blood, you can visit normal cholinesterase level in the blood

What does a low total cholinesterase level in the blood mean?

A low level of cholinesterase in the blood may be due to three main reasons:

  • Possible insecticide poisoning: Organophosphorus pesticides (e.g., parathion, sarin, tetraethyl pyrophosphate) and carbamates can cause a decrease in serum cholinesterase levels.
  • Perioperative management prior to anesthesia: The cholinesterase test is used to detect a genetic disorder that can be dangerous during surgery when muscle relaxants like succinylcholine (suxamethonium) are administered.
  • Liver disorders: Conditions such as cirrhosis or hepatitis can cause a drop in cholinesterase levels.

A low cholinesterase blood level means:

  • Moderate cholinesterase decrease (< 8 U/ml in adults):

    The significance of a low cholinesterase level depends on the reason for the test:

    • Insecticide poisoning: Mild poisoning can cause symptoms like fatigue, dizziness, headache, nausea, or diarrhea. Moderate poisoning may result in chest pain or difficulty walking, while severe poisoning can lead to respiratory problems, cramps, or loss of consciousness.
    • Prior to anesthesia: A low value may indicate a genetic disorder (often inherited). A further test, called the dibucain inhibition test, can provide additional information about this condition.
    • Liver disease: A decrease of around 30–50% may indicate acute hepatitis, while a decrease of 50–70% may suggest advanced cirrhosis or liver cancer with metastasis.

Which factors can reduce the total cholinesterase level in the blood?

Some particular health situation or drugs may reduce your cholinesterase level in the blood:

  • Caffeine
  • Pregnancy
  • Organophosphorus pesticide poisoning
  • Malnutrition
  • Menstruation
  • Drugs
    • Antiarrhythmic agents
      • Atropine
      • Quinidine
    • Antiasthmatic drugs
      • Theophylline
    • Antineoplastics
      • Cyclophosphamide
    • Oral Contraceptives
    • Drugs for acid related disorders
      • Ranitidine
    • Sex hormones
      • Estrogens
    • Acetylcholinesterase inhibitors
      • Physostigmine
      • Neostigmine
      • Pyridostigmine
    • Opiate
      • Codeine
      • Morphine
    • Vitamin K

Which diseases can reduce your total cholinesterase level in the blood?

The following diseases can explain a cholinesterase level in the blood lower than normal:

What can I do to increase the total cholinesterase level in the blood?

If cholinesterase levels are low, it is important to investigate the underlying causes in order to address them. If the low levels are due to pesticide poisoning, future exposure to these substances should be avoided.

There are also many drugs that can interfere with cholinesterase levels in the blood. Please consult your doctor to determine if any medications you are taking may affect your cholinesterase levels.

Where can I find more information about cholinesterase level in the blood?

You can visit our pages about:

Which values are considered a low cholinesterase level in the blood?

The following values are considered to be above the normal range:

IMPORTANT: These levels are expressed in U/ml. They are an example of a healthy man of about 45 years old with no known disease and not taking any medication. The ranges can be different depending on the laboratory or on your personal circumstances.

Cholinesterase
Moderate cholinesterase decrease
7.9 U/ml7.8 U/ml7.7 U/ml7.6 U/ml7.5 U/ml7.4 U/ml7.3 U/ml7.2 U/ml
7.1 U/ml7 U/ml6.9 U/ml6.8 U/ml6.7 U/ml6.6 U/ml6.5 U/ml6.4 U/ml
6.3 U/ml6.2 U/ml6.1 U/ml6 U/ml5.9 U/ml5.8 U/ml5.7 U/ml5.6 U/ml
5.5 U/ml5.4 U/ml5.3 U/ml5.2 U/ml5.1 U/ml5 U/ml4.9 U/ml4.8 U/ml
4.7 U/ml4.6 U/ml4.5 U/ml4.4 U/ml4.3 U/ml4.2 U/ml4.1 U/ml4 U/ml
3.9 U/ml3.8 U/ml3.7 U/ml3.6 U/ml3.5 U/ml3.4 U/ml3.3 U/ml3.2 U/ml
3.1 U/ml3 U/ml2.9 U/ml2.8 U/ml2.7 U/ml2.6 U/ml2.5 U/ml2.4 U/ml
2.3 U/ml2.2 U/ml2.1 U/ml2 U/ml1.9 U/ml1.8 U/ml1.7 U/ml1.6 U/ml
1.5 U/ml1.4 U/ml1.3 U/ml1.2 U/ml1.1 U/ml1 U/ml0.9 U/ml0.8 U/ml
0.7 U/ml0.6 U/ml0.5 U/ml0.4 U/ml0.3 U/ml0.2 U/ml0.1 U/ml0 U/ml
Medically reviewed by Javier Muga Bustamante Ph.D. on 15/10/2024

Bibliography

  • Tietz. Fundamentals of Clinical Chemistry. Carl A. Burtis, Edward R. Ashwood, David E. Bruns, Barbara G. Sawyer. WB Saunders Company, 2008. Pag 328. ISBN: 978-0-7216-3865-2.
  • Thomas L. Cholinesterase. In: Thomas L, ed. Clinical laboratory diagnostics. Use and assessment of clinical laboratory results. Frankfurt/Main:TH-Books Verlagsgesellschaft, 1998:65-71

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