• 대한임상독성학회지
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• 제18권1호
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• pp.34-41
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• 2020

Purpose: This study evaluated aggressive hyperbaric oxygen therapy (HBOT) by understanding various exposure routes of acute carbon monoxide (CO) poisoning, the risk factors causing acute cardiovascular, and neurological toxicity caused by poisoning. Methods: A retrospective study was conducted based on the medical records of 417 acute CO poisoning patients who visited the emergency care unit from March 2017 to August 2019. The exposure routes, HBOT performance, age, sex, medical history (hypertension, diabetes mellitus, ischemic heart disease, heart failure), intentionality, loss of consciousness (LOC), intake with alcohol or sedatives, and initial test results (carboxyhemoglobin (COHb), troponin-I, electrocardiography, echocardiography, brain MRI) were examined. Comparative analysis of the clinical information was conducted between the groups that showed acute cardiovascular toxicity and neurological toxicity, and groups that did not. Results: Among 417 patients diagnosed with acute CO poisoning, 201 cases (48.2%) were intentional, and charcoal briquette was the most common route (169 patients (40.5%)). Two hundred sixteen cases (51.8%) were accidental, and fire was the most common route (135 patients (32.4%)). The exposure route was more diverse with accidental poisoning. Three hundred ninety-nine patients were studied for acute cardiovascular toxicity, and 62 patients (15.5%) were confirmed to be positive. The result was statistically significant in intentionality, LOC, combined sedatives, initial COHb, HTN, and IHD. One hundred two patients were studied for acute neurological toxicity, which was observed in 26 patients (25.5%). The result was statistically significant in age and LOC. Conclusion: Active HBOT should be performed to minimize damage to the major organs by identifying the various exposure routes of CO poisoning, risk factors for acute cardiovascular toxicity (intentionality, LOC, combined sedatives, initial COHb, HTN, IHD), and the risk factors for acute neurological toxicity (age, LOC).

• 대한임상독성학회지
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• 제19권1호
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• pp.17-23
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• 2021

Purpose: Alcohol ingestion enhances impulsivity and aggression, and has been proven to have a close relationship with suicide. This study investigates whether alcohol co-ingestion affects the Poisoning Severity Score (PSS) grade in patients with intentional poisoning. Methods: We conducted a retrospective analysis of intentional poisoning patients who visited the emergency department (ED) from January 1 to December 31, 2020. Patients were divided into non-drunken and drunken groups. We collected the data based on the medical records of the patients and serum ethanol level results recorded during initial blood tests at the ED. To grade the PSS, the highest score was assessed through clinical signs and test results during the hospital stay. A comparative analysis was conducted between the two groups. Results: A total of 277 patients were included in the study. 163 (58.8%) were in the non-drunken group, and 114 (41.2%) were in the drunken group. The PSS grade showed a significant difference between the two groups (p=0.002). While grade 1 (mild) was observed more in the non-drunken group, grade 2 (moderate) and grade 3 (severe) were seen more in the drunken group. In an ordinal logistic regression analysis, alcohol co-ingestion (adjusted odds ratio [aOR] 2.557, 95% confidence interval [CI] 1.554-4.208, p<0.001) was considered to be a risk factor for a higher PSS grade. There was no significant correlation between the serum ethanol level and the PSS grade. (p=0.568) Conclusion: Intentional poisoning patients with alcohol co-ingestion had a higher PSS. Hence close observation and aggressive treatment in the ED is warranted in such cases.

• 대한임상독성학회지
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• 제21권2호
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• pp.108-116
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• 2023

Purpose: This study investigated the differences between patients with acute carbon monoxide (CO) poisoning who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a single-center retrospective observational study. Patients with CO poisoning who visited the ED during the period from February 2020 to January 2023 were classified as the COVID-19 pandemic group, and those from February 2019 to January 2020 were classified as the non-pandemic group. Patients' medical records were reviewed, their demographic and clinical characteristics were compared, and the length of stay in ED was checked. The time from admission to the ED to the start of hyperbaric oxygenation (HBO) was defined as the door-to-HBO time, and this parameter was compared between both groups. Results: In total, 672 patients were included in this study. The proportion of intentional poisoning was significantly higher in the COVID-19 pandemic group than in the non-pandemic group (p=0.028). The proportion of intentional poisoning significantly increased in the 20- to 29-year-old age group during the COVID-19 pandemic (p<0.001). In addition, it took longer to initiate HBO in the COVID-19 pandemic group than in the non-pandemic group (p=0.001). Conclusion: These findings suggest that pandemics of infectious diseases, such as COVID-19, increase the proportion of intentional CO poisoning, and it may take longer to initiate HBO after visiting the ED. Efforts will be needed to decrease intentional CO poisoning and length of stay in ED.

• 청정기술
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• 제25권4호
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• pp.296-301
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• 2019

본 연구는 습윤함침법으로 제조하여 400 ℃에서 소성한 Pt/TiO₂ 촉매를 이용하여 NO 피독에 의한 CO 산화반응특성에 대하여 확인하였다. Pt/TiO₂ 촉매의 NO 피독영향을 확인하기 위하여 CO + O₂ 반응 중 NO를 주입하면서 반응활성의 변화를 관찰하였으며, 200 ℃ 이하에서 CO 전환율이 급격하게 저하되는 것을 확인하였다. 또한125 ℃ 이하에서 CO 전환율을 나타내지 않았다. 125 ℃에서 NO의 주입을 차단하더라도 초기 CO 전환율의 회복이 확인되지 않았다. 이에 따라 NO 주입에 따른 다양한 분석을 수행하였다. 먼저, TPD 분석 결과, 촉매에 NO의 선흡착은 CO 흡착을 방해하였으며 흡착된 CO에서 CO₂로의 전환탈착을 억제하는 것을 확인하였다. 다음으로, NO가 선흡착될 경우, 촉매의 산소전달능력을 감소함을 H₂-TPR 분석을 통하여 확인하였다. 또한 FT-IR 분석을 통하여, 촉매의 redox cycle (Pt²⁺→Pt⁰→Pt²⁺)을 방해하는 것을 확인하였다. 따라서 Pt/TiO₂ 촉매에서 NO의 존재는 CO 산화반응에서의 피독 인자으로 작용을 하였으며, NO 피독을 방지하기 위해서는 촉매의 산소전달능력의 증진이 필요하다고 판단되어진다.

• 대한임상독성학회지
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• 제21권2호
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• pp.117-127
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• 2023

Purpose: No consensus currently exists regarding the maximal pressure of hyperbaric oxygen (HBO₂) therapy performed within 24 hours of acute carbon monoxide (CO) poisoning. This study aimed to evaluate the difference in therapeutic effects according to the first HBO₂ pressure (3.0 atmospheres absolute [ATA] vs. 2.8 ATA). Methods: We used prospectively collected registry data on CO poisoning at a tertiary academic hospital in the Republic of Korea. Adult patients with acute CO poisoning treated with HBO₂ within 24 hours after arrival at the emergency department and without the use of additional HBO₂ after 24 hours between January 2007 and February 2022 were included. Data from 595 patients were analyzed using propensity score matching (PSM). Patients with mild (non-intubated) and severe (intubated) poisoning were also compared. Neurocognitive outcomes at 1 month after CO poisoning were evaluated using the Global Deterioration Scale combined with neurological impairment. Results: After PSM, the neurocognitive outcomes at 1-month post-CO exposure were not significantly different between the 2.8 ATA (110 patients) and 3.0 ATA (55 patients) groups (p=1.000). Similarly, there was also no significant difference in outcomes in a subgroup analysis according to poisoning severity in matched patients (165 patients) (mild [non-intubated]: p=0.053; severe [intubated]: p=1.000). Conclusion: Neurocognitive sequelae at 1 month were not significantly different between HBO₂ therapy pressures of 2.8 ATA and 3.0 ATA in patients with acute CO poisoning. In addition, the 1-month neurocognitive sequelae did not differ significantly between intubated and non-intubated patients.

• 대한임상독성학회지
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• 제17권2호
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• pp.86-93
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• 2019

Purpose: The objective was to determine the association between PaCO₂ and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients. Methods: This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 hours later. The baseline characteristics and clinical course during hospitalization were collected and compared. The mean PaCO₂ during the first 6 hours after presentation was calculated. Results: The incidence rates of moderate (30 mmHg< PaCO₂ <35 mmHg) or severe (PaCO₂ ≤30 mmHg) hypocapnia at presentation after acute CO poisoning were 40.7% and 26.8%, respectively. The mean PaCO₂ during the first 6 hours was 33 (31-36.7) mmHg. The incidence of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total ranges of PaCO₂ variables. In multivariate regression analysis, mean PaCO₂ was independently associated with ACVEs (OR 0.798 (95% CI 0.641-0.997)). Conclusion: Mean PaCO₂ during the first 6 hours was associated with increased ACVEs. Given the high incidence of ACVEs and PaCO₂ derangement and the observed association between PaCO₂ and ACVEs, this study suggests that 1) PaCO₂ should be monitored at the acute stage to predict and/or prevent ACVEs; and 2) further study is needed to validate this result and investigate early manipulation of PaCO₂ as treatment.

• 한국에너지공학회:학술대회논문집
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• 한국에너지공학회 2008년도 춘계학술 발표회
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• pp.217-222
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• 2008

In the last five years, 45 people died and 104 were wounded because of carbon monoxide poisoning accident. CO poisoning accident is higher than any other gas accident in the rate of deaths/incidents. Most of these CO poisoning accidents were caused by defective exhaust tube in the old gas boiler and multi-use facility. In this study, the spread of CO gas released from leakage hole of exhaust tube was analyzed by concentration measuring test. CO gas leaked form exhaust tube in a building was highest concentrated near the ceiling. Through these experiments, the reasonable installation location of CO alarm was made certain and suggested.

• 한국가스학회지
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• 제12권4호
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• pp.1-7
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• 2008

최근 5년간 국내 가스사고 중 CO중독사고는 사망 36명, 부상 79명이 발생하였으며, 전체 가스 사고에 비해 인명피해율이 8배나 높게 나타나고 있다. 이러한 CO중독사고의 대부분이 노후 가스보일러 및 다중 가스 사용시설의 배기통 불량에 의한 가스누출사고로 조사되고 있다. 본 연구에서는 실험을 통해 건축물 내 보일러실의 배기통 불량에 의한 CO가스의 누출확산 메커니즘을 해석하였다. 배기통에서 누출된 CO 가스는 건축물 내부의 천정부근에서 가장 높은 농도분포를 보인다. 또한 CO경보기 설치 실험을 통해서 천정부근의 CO경보기가 가장먼저 작동하고, $30{\sim}40$분 경과한 후에 바닥 및 중간에 설치된 경보기가 작동하는 것을 확인하였다. 본 연구를 통해 CO경보기의 적정 설치위치를 확인하였으며, 이 결과를 토대로 건출물내 CO경보기 설치위치를 제안하였다.

• 대한임상독성학회지
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• 제10권2호
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• pp.103-110
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• 2012

Purpose: The aim of this study was to evaluate the cardiovascular manifestations and clinical course in patients with acute carbon monoxide poisoning. Methods: A retrospective study was conducted over a 36 month period on consecutive patients who visited an emergency medical center and were diagnosed with acute carbon monoxide poisoning. A standardized data extraction protocol was performed on the selected patients. Results: A total of 293 patients were selected during the study period. Cardiac manifestations were observed in 35.2% (n=103) of the patients: hypotension in 11 patients (3.8%), ECG abnormalities in 44 patients (15.0%) and cardiac enzyme abnormalities in 103 patients (35.2%). Echo cardiography was performed on 56 patients with cardiac toxicity: 12 patients had abnormal results (5 patients with global hypokinesia and 7 patients with regional wall akinesia). Five patients died within 3 hours after ED admission, and the remaining patients were discharged alive. At 3 months after discharge, none of these patients had died.The SOFA scores in the severe cardiac toxicity group and non-severe cardiac toxicity group at the time of arrival were $2.53{\pm}2.29$ and $2.19{\pm}2.12$, respectively (p=0.860). Conclusion: Cardiovascular manifestations occur after acute CO poisoning at arateof 35.2%. Even those with severe cardiovascular toxicity recovered well within 10 days after admission. Therefore, the importance of cardiac toxicity after acute CO poisoning is not significant in itself in the clinical course, and the short-term prognosis of cardiac toxicity is unlikely to be unfavorable in acute CO poisoning.

• 대한신경과학회지
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• 제36권4호
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• pp.358-362
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• 2018

Delayed anoxic encephalopathy after carbon monoxide (CO) poisoning is characterized by neurological deterioration that occurs after recovery from acute CO intoxication. There has been no established therapy. We report a patient recovered from acute CO intoxication developed various neurological symptoms. After the administration of high dose prednisolone and anticholinesterase inhibitor, the therapeutic effect was remarkable and confirmed by quantitative analysis of diffusion-tensor imaging (DTI). DTI could be used to evaluate the therapeutic effect for delayed anoxic encephalopathy after CO poisoning.