• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.2
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• pp.91-98
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• 2008

Purpose: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. Methods: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. Results: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: $0.2{\sim}7.4\;mg/L$). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. Conclusion: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.

• Journal of Veterinary Clinics
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• v.30 no.1
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• pp.57-60
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• 2013

Ingestion of grapes or raisins has been reported to the occurrence of acute renal failure (ARF) in dogs, although the mechanism remains undetermined. The prognosis often depends on the severity or clinical course of the disease at the time of presentation and is poor if the dog becomes anuric phase. To explore the characteristics and outcome of ARF caused by grape or raisin poisoning, sequentially collected data, from 2005 to 2008, of the Veterinary Medical Teaching Hospital at the Kangwon National University for clinical evaluation were retrospectively analyzed. Of the 11 clinically affected dogs, 4 cases made a full recovery, 3 died and 4 were euthanized. All but one case (raisin ingestion) had a history of grape exposure, but the exact quantity of fruit ingested was not known. The female dogs accounted for 72.7% (8 cases). Overall, the mean age was 5.3 years (range 0.2-11.3 years), and the mean body weight was 4.1 kg (range 1.4-13 kg). The average duration of hospital stay was 7.1 days (range 2-22 days). Vomiting and anorexia was reported in all dogs. Diarrhea (4 cases), oliguria (5 cases), and anuria (4 cases) with or without isosthenuria were also reported. Five dogs of 11 had mild to moderate anemia, with a decrease in packed cell volume and hemoglobin. All dogs had elevations in serum phosphorous, creatinine, and blood urea nitrogen values, but calcium values were variable; 2 dogs with hypocalcemia, 2 dogs with hypercalcemia, and the remaining 7 cases within reference interval. Dogs (n = 8) with measured on blood gas parameters had metabolic acidosis. In addition, higher serum enzyme activities were observed; amylase in 8 (72.7%) dogs, alkaline phosphatase in 7 (63.6%) dogs, and alanine aminotransferase in 5 (45.5%) dogs. Non-survived dogs revealed lower counts of platelet and lymphocyte subpopulation, as compared to the survived dogs.

• Journal of The Korean Society of Clinical Toxicology
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• v.3 no.1
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• pp.56-59
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• 2005

Blister beetles produce cantharidin, which is toxic to people and animals. Cantharidin has been believed to be an aphrodisiac and an abortifacient based on its tendency to cause marked irritation to the genitourinary system leading to priapism in men and pelvic congestion in women for many years. Cantharidin was used by oriental traditional medicine for more than 2000 years. Typical signs related to cantharidin ingestion are gastrointestinal tract and urinary tract irritation, endotoxemia, shock and myocardial dysfunction. Cantharidin is a severe irritant to epithelial linings (gastrointestinal tract, urinary tract, and skin) and develop systemic inflammatory response syndrome. We report a case of corrosive esophagogastritis and acute renal failure by ingestion of cantharidin.

• Journal of Apiculture
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• v.34 no.4
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• pp.305-313
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• 2019

Honey bees (Apis mellifera) forage in agricultural areas, and are exposed to diverse pesticide poisoning. Toxic effects on Apis mellifera of different groups of pesticides were tested in the laboratory; fungicide (Metconazole), herbicide (Glyphosate), acaricide (Amitraz), organophosphate insecticide(Fenitrothion) and neonicotinoid insecticides(Thiacloprid, Thiamethoxam, Imidacloprid, Acetamiprid, Dinotefuran and Clothianidin). Commercial formulations were serially diluted from the recommended concentration (RC) to 10-6 times to carry out feeding and contact tests. Toxicity was transformed into lethal dose (LD50) and hazard question (HQ). The acute toxicity of pesticides showed similar patterns between feeding and contact tests. But feeding tests showed greater toxic to honey bee than contact test. The organophosphate and nitro-neonicotinoid insecticides were highly toxic with HQ values ranging greater than 1. However, cyano-neonicotinoids of Thiacloprid and Acetamiprid showed low toxicity. Even at the RC, 24 hr mortalities were 18 and 30%. The acaricide (Amitraz) showed intermediate level of toxicity at RC but negligible at the concentration lower than 10-1 times. A fungicide(Metconazole) and herbicide(Glyphosate) showed minimal impacts. The results imply that the selective use of pesticides could help conservation of pollinators in agricultural production systems.

• Tuberculosis and Respiratory Diseases
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• v.68 no.2
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• pp.62-66
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• 2010

Background: Extracorporeal membrane oxygenation (ECMO) during severe acute respiratory failure helps to recover the pulmonary function. This study evaluated our experience with veno-venous ECMO in adult patients with acute respiratory failure. Methods: From January 2007 to July 2009, ECMO was used on 54 patients. Of these 54 patients, 7 were placed on veno-venous ECMO for acute respiratory failure. The indications of ECMO were based on the lung dysfunction measured as a $PaO_2/FiO_2$ ratio <100 mm Hg on $FiO_2$ of 1.0, or an arterial blood gas pH <7.25 due to hypercapnia despite the optimal treatment. $EBS^{(R)}$, $Bio-pump^{(R)}$, and Centrifugal Rotaflow $pump^{(R)}$ were used and all cannulations were performed percutaneously via both femoral veins. When the lung function was improved, an attempt was made to wean on ECMO at moderate ventilator settings followed by decannulation. Results: Five of the 7 patients were male and the mean age was $46.3{\pm}18.3$. The causes of acute respiratory failure were 3 cases of pneumonia, 2 near-drownings, 1 pulmonary hemorrhage due to acute hepatic failure and 1 mercury vapor poisoning. The mean support time of ECMO was $17.3{\pm}13.7$ days. Of the 7 patients implanted with ECMO, 5 patients (71%) were weaned off ECMO and 3 patients (43%) survived to hospital discharge after a mean 89.6 hospital days. Conclusion: The early use of ECMO for acute respiratory failure in adults due to any cause is a good therapeutic option for those unresponsive to the optimal conventional treatments.

• Journal of Environmental Health Sciences
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• v.46 no.5
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• pp.525-531
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• 2020

Objectives: This study was performed to identify the epidemiological features of a food poisoning outbreak in a company cafeteria located in Chungcheongnam-do Province, Korea in June of 2020 and to suggest preventive measures for a similar incidence. Methods: A total of 84 patients with acute gastroenteritis were examined. Environmental samples were obtained from 16 food handlers, six food utensils, 135 preserved foods served over three days and nine menus, and six drinking water samples. These are analyzed to detect viruses and bacteria. Results: Ninety-four out of the 402 people who were served meals (23.4%) predominantly showed symptoms of diarrhea, and the number was over 3 times. Among the 84 patients under investigation, 17 cases (20.2%) were positive for Enteropathogenic E. coli (EPEC) and 18 cases were positive for Clostridium (C.) perfringens (21.4%). Based on the investigation, it was concluded that the main pathogens were EPEC and C. perfringens. For EPEC, it was detected in three of the food service employees and in the preserved food and curry rice. The results of pulsed field gel electrophoresis indicate that all EPEC cases are closely related except for one food service employee. Assuming that isolated EPEC originated from the preserved food, the incubation period is about 25 hours. The origin of the C. perfringens was not determined as it was not detected in the food service employees or environmental samples. Conclusions: This case suggests that food provided in group food service centers must be thoroughly managed. In addition, identifying the pathogens in preserved food is very important for tracing the causes of food poisoning, so food must be preserved in an appropriate condition. To prevent similar food poisoning cases, analyzing cases based on epidemiological investigation and sharing the results is needed.

• Journal of The Korean Society of Clinical Toxicology
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• v.21 no.2
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• pp.135-142
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• 2023

Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status. Methods: This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027-1.844), 1.017 (95% CI, 1.002-1.032), and 0.196 (95% CI, 0.040-0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746-0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652-0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527-0.722). Conclusion: The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.

• Tuberculosis and Respiratory Diseases
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• v.72 no.2
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• pp.177-181
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• 2012

Activated charcoal is an inert substance and it is used in standard therapy in patients with acute intoxication. Charcoal has some side effects such as pulmonary aspiration, gastrointestinal complications, and electrolyte abnormalities. Although aspiration of charcoal is a rare complication, it can cause fatal sequelae. We report a 69-year old man who developed acute respiratory failure associated with charcoal aspiration after management of glyphosate poisoning. The patient was drowsy and suffered severe vomiting during transport to our hospital. On arrival, acute respiratory failure was observed due to charcoal aspiration, but the clinical state was improved with repeated bronchoscopy with a bronchoalveolar lavage (BAL). We presumed that the aspirated charcoal was an important factor in evoking a lung injury. Early bronchoscopy with a BAL might be an effective method for eliminating charcoal from the lung, especially in the case of a large amount of aspiration, and be helpful in decreasing respiratory failure due to charcoal aspiration.

• Journal of Nutrition and Health
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• v.33 no.1
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• pp.33-41
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• 2000

The purpose of this study was to investigate the effects of vitamin E on antioxidative defense system of liver in acute cadmium poisoned rats. Sprague-Dawley male rats weighing 100$\pm$10gm were randomly assigned to one control and three cadmium injected groups. Cadmium injected groups were fed vitamin E free diet(OE-Cd group), 40mg vitamin E per kg diet(40E-Cd group) or 400 mg vitamin E per kg diet(400E-Cd group). Vitamin E level of normal group was 40mg per kg diet. Animals were injected intraperitoneally with 2.0mg Cd$^2$$\^$+//kg bw for 4 days after the rats were fed diets with three different levels of vitamin E for 2 and 4weeks. Activities of superoxide dismutase(SOD), glutathione peroxidase(GSHPx) and glutathione S-transferase(GST) were decreased in cadmium injected groups but those were significantly improved by dietary vitamin I supplementations. Vitamin E contents reduced glutathione(GSH) in the live were decreased in cadmium injected groups, but we., not significantly different among three groups with different levels of vitamin E supplementations. Contents of liver thiobarbituric acid reactive substance (TBARS) of 0E-Cd group were higher than those of 400E-Cd and 400E-Cd groups, but those were markedly alleviated according to vitamin E supplementations. These results indicate that cadmium poisoning in rats causes decreasing antioxidative defense system and increasing peroxidative damage in liver, however can be restored by vitamin E supplements. (Korean J Nutrition 33 (1) : 33-41, 2000)

• Journal of The Korean Society of Clinical Toxicology
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• v.10 no.2
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• pp.91-96
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• 2012

Purpose: A retrospective study with a literature review was conducted to identify the clinical characteristics and prognosis after the acute ingestion of glacial acetic acid. Methods: The medical records of 20 patients,who had presented to the emergency department of Ajou University Hospital complaining of the acute ingestion of glacial acetic acid between January 2006 and December 2011, were examined retrospectively. Results: Among the 172 patients admitted for caustics injury, 20 patients ingested glacial acetic acid. The mean age of the patients was $55{\pm}23.5$, and the mean volume of the acid was $84.5{\pm}71.3$ ml. The clinical features included 1) oral ulcers in 12 patients (63.2%), 2) respiratory difficulties in 11 patients (57.9%), 3) oliguria in 8 patients (42.1%), 4) renal toxicity in 7 patients (36.8%), 5) hepatic failure in 7 patients (36.8%), 6) disseminated intravascular boagulopathyin 7 patients (36.8%), 7) low blood pressure in 8 patients (42.1%), and 8) mental changes in 9 patients (47.4%). Ten patients required endotracheal intubation. Nine patients were admitted to the intensive care unit, and 5 patients expired. Conclusion: The ingestion of glacial acetic acid can cause severe symptoms, such as metabolic acidosis, multiple organ failure and upper airway swelling frequently and has a high mortality rate. Therefore, aggressive treatment, including endotracheal intubation, should be considered at the early stages.