• 대한임상독성학회지
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• 제5권1호
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• pp.74-78
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• 2007

The carbamates are a group of insecticides derived from carbamic acid, with a broad spectrum of uses as agricultural and household garden insecticides. Carbamate insecticides are reversible cholinesterase inhibitors. Their inhibitory action is mediated by reversible carbamylation of acetylcholine, as with the organophosphate insecticides. Carbamates are absorbed by the body through multiple routes, including inhalation, ingestion, and dermal absorption. Although poisoning can result from occupational exposure or accidental ingestion, in most cases there is suicidal intent. This is particularly true in developing countries, where the highest incidence of morbidity and mortality from this cause occurs. Cardiac complications often accompany poisoning by carbamate compounds, which may be serious and often fatal. The extent, frequency, and pathogenesis of cardiac toxicity from carbamate compounds has not been clearly defined. Possible mechanismsinclude sympathetic and parasymphatetic overactivity, hypoxemia, acidosis, electrolyte derangements, and a direct toxic effect of the compounds on the myocardium. Patients with carbamate poisoning should immediately be transferred to an intensive or coronary care unit where appropriate monitoring and resuscitative facilities are available. We here report a case of acute coronary syndrome resulting from acute carbamate ingestionthat resulted in a healthy discharge.

• 대한임상독성학회지
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• 제2권1호
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• pp.7-11
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• 2004

Purpose: We would evaluate the cardiovascular manifestations of the patients with acute organophosphate and carbamate poisoning in the emergency department. Methods: This was retrospectively studied with the review of patient's charts, included total 38 patients were admitted during the past two years in the emergency department of Yeungnam university hospital with the diagnosis of organophosphate or carbamate poisoning. Results: Cardiovascular complications were variously developed in many patients. Electrocardiographic findings were as follows; 4 ($10.5\%$) cardiac arrhythmias included 1 cardiac arrest caused by ventricular fibrillation, 14 ($36.8\%$) sinus tachycardias, 3 ($7.9\%$) sinus bradycardias, and 17 ($44.7\%$) normal sinus rhythms. Conduction disturbances were 23 ($60.5\%$) like as prolonged QTc, 4 ($10.5\%$) ST-T changes, 2 (5.3%) first degree AV block, and 3 ($7.9\%$) right bundle branch block were shown. Other cardiovascular complications were 22 ($57.9\%$) hypertensives, 4 ($10.5\%$) hypotensives, 15 ($39.5\%$) tachycardias, 2 ($5.3\%$) bradycardias, 18 ($47.4\%$) hypoxemics, 12 ($31.6\%$) metabolic acidosis, and 9 ($23.7\%$) pulmonary edemas. Sixteen patients ($42.1\%$) needed ventilatory support because of respiratory paralysis. No patients died in hospital and 36 ($94.7\%$) patients were alive-discharged. Conclusion: Cardiovascular complications are variously in patients with acute organophosphate and carbamate poisoning. Especially, some findings included ventricular arrhythmias, QTc prolongation, hypoxemia, acidosis, and blood pressure changes are known as major precipitating factors to increase the mortality. So, intensive support and aggressive treatment are needed in patients shown various cardiovascular manifestations in the emergency department.

• 대한임상독성학회지
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• 제12권2호
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• pp.77-84
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• 2014

Purpose: Carbamate insecticides are potent cholinesterase inhibitors capable of causing severe cholinergic toxicity. Use of carbamate rather than organophosphate insecticides has been increasing. Compared with organophosphate poisoning, relatively few studies have investigated carbamate-associated acute pancreatitis. We investigated general characteristics and pancreatitis of carbamate poisoning and the predictors, among those readily assessed in the emergency department. Methods: We performed a retrospective review of consecutive patients, aged over 18 years, who were admitted between January 2008 and April 2012 to an emergency department (ED) of an academic tertiary care center for treatment of carbamate poisoning. Patients who exhibited poisoning by any other material, except alcohol, were excluded. After application of exclusion criteria, patients were divided according to carbamate-induced pancreatitis and non-pancreatitis groups. Results: A total of 41 patients were included in this study. Among these 41 patients, the prevalence of acute pancreatitis was 36.6% (15 patients). Initial blood chemistry tests showed a statistically higher glucose level in the pancreatitis group, compared with the non-pancreatitis group (222, IQR 189-284 vs. 137, IQR 122-175 mg/dL, P<0.05). Regarding clinical courses and outcomes, a significantly higher proportion of patients developed pneumonia [10 (66.7%) vs. 6 (23.1%), P<0.05] and had a longer hospital stay (7 days, IQR 6-12 vs. 5 days, IQR 2-11, P<0.05), but no difference in mortality, in the pancreatitis group vs. the non-pancreatitis group. In multivariate analysis, the initial glucose was showing significant association with the presentation of carbamate-induced acute pancreatitis (odds ratio 1.018, 95% confidence interval 1.001-1.035, P<0.05). Conclusion: Carbamate-induced acute pancreatitis is common, but not fatal. Initial serum glucose level is associated with acute pancreatitis.

• 대한임상독성학회지
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• 제18권2호
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• pp.123-129
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• 2020

Purpose: Atropine is an antidote used to relieve muscarinic symptoms in patients with organophosphate and carbamate poisoning. Nutritional support via the enteral nutrition (EN) route might be associated with improved clinical outcomes in critically ill patients. This study examined the administration of nutritional support in patients undergoing atropinization, including methods of supply, outcomes, and complications. Methods: A retrospective observational study was conducted in a tertiary care teaching hospital from 2010 to 2018. Forty-five patients, who were administered with atropine and on mechanical ventilation (MV) due to organophosphate or carbamate poisoning, were enrolled. Results: Nutritional support was initiated on the third day of hospitalization. Thirty-three patients (73.3%) were initially supported using parenteral nutrition (PN). During atropinization, 32 patients (71.1%) received nutritional support via EN (9) or PN (23). There was no obvious reason for not starting EN during atropinization (61.1%). Pneumonia was observed in both patient groups on EN and PN (p=0.049). Patients without nutritional support had a shorter MV duration (p=0.034) than patients with nutritional support. The methods of nutritional support during atropinization did not show differences in the number of hospital days (p=0.711), MV duration (p=0.933), duration of ICU stay (p=0.850), or recovery at discharge (p=0.197). Conclusion: Most patients undergoing atropinization were administered PN without obvious reasons to preclude EN. Nutritional support was not correlated with the treatment outcomes or pneumonia. From these results, it might be possible to choose EN in patients undergoing atropinization, but further studies will be necessary.

• 대한임상독성학회지
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• 제18권2호
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• pp.116-122
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• 2020

Acute respiratory failure is an important risk factor for mortality in patients with acute pesticide poisoning. Therefore, it is necessary to investigate the risk factors to predict respiratory failure in these patients. This study retrospectively investigated the clinical features of respiratory failure among patients with acute pesticide poisoning requiring mechanical ventilation. This study included patients who were admitted with intentional poisoning by pesticide ingestion from January 2017 to December 2019. Paraquat intoxication was excluded. Among 469 patients with acute pesticide poisoning, 398 patients were enrolled in this study. The respiratory failure rate was 30.4%. The rate of respiratory failure according to the type of pesticide was carbamate (75.0%), organophosphate (52.6%), glufosinate (52.1%), glyphosate (23%), pyrethroid (8.9%), and others (17%). The mortality was 25.6% in the respiratory failure group. The risk factors for respiratory failure were old age, low body mass index, and ingestion of more than 300 mL. In conclusion, respiratory failure is a risk factor for mortality in pesticide poisoning. Old age, low body mass index, and ingestion of more than 300 mL are the risk factors for predicting respiratory failure.

• Journal of Preventive Medicine and Public Health
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• 제23권2호
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• pp.194-200
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• 1990

The paraoxonase (E. C. 3.1.1.2) is a major enzyme to detoxicate the organophosphorus and carbamate which are the most widely used as the agricultural spraying insecticides. To investgate the distributions of plasma paraoxonase activity and the factors affecting the enzyme activity, the plasmas of 945 Korean rural population were analysed with the modified Krisch's direct sphectrphotometry method. Three indices of the enzyme activity - basal activity, stimulated activity (by NaCl), % stimulation - were obtained from the analysis. Three indicies suggested unimodal distributions, so we couldn't identify the low activity group risk group to organophosphorus & carbamate insecticides poisoning. There is no significant relation between 3 actvity indicies and sex, age, or history of insecticide use (p>0.05). The basal activity and the stimulated activity have significant relationship and high coefficient of determination with the activities of their parents ($r^2$=0.30, 0.24 ; p<0.05), but the % stimulation does not ($r^2$=0.02 ; p<0.05). These results suggest that the activity of paraoxonase is determined mainly by the genetic factor.

• Toxicological Research
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• 제17권4호
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• pp.287-296
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• 2001

The acute oral LD5O toxicity values of isazofos, pyraclofos, diazinon and methomyl were determined for Japanese quail based on OECD guideline. The $LD_{50}$ of isazofos, pyraclofos and diazinon was 16.26 mg/kg, and 7.11mg/kg body weight In female respectively. And the $LD_{50}$ of each chemical in male was 21.44, 35.64, 8.28 mg/kg body weight respectively. Diazinon was the most susceptible compounds to Japanese quail in both sexes. The $LD_{50}$ of methomyl was 21.24 mg/kg body weights in female, and 28.28 mg/kg body weight in male respectively. Diazinon, isazofos and methomyl were more toxic In the female than male. The symptoms of poisoning were similar in quails administrated with each chemicals. The clinical sign in Japanese quail were ataxia, salivation, diarrhea, ruffled feather and convulsion at dead point. There were severe hemorrhage and catarrhal inflammation from duodenum to ileum In all compounds. In Japanese quail treated with organophosphorus and carbamate compounds, brain acetylcholinesterase was inhibited by 88-96. The recovery was not observed after 5 h in sublethal dose.

• 한국수산과학회지
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• 제28권3호
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• pp.364-372
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• 1995

1993년 진해만 일원의 마비성패독 발생의 원인규명을 위한 모니터링의 일환으로 원인생물의 독생산과 성분조성을 조사하기 위하여 양식장 인근해역의 저서 휴면포자를 발아시켜 분리한 무균주의 독성분을 분석하였다. 분리된 전체주중에서 수정리산 (St. 1) 5주, 욱곡리산 (St. 2) 3주 및 대곡리산 (St. 4) 11주의 독조성 및 독함량을 비교하였을 때, 각 지점별 평균 독량은 약 54-70 fmol/cell 높은 량을 나타내었고, 동일 휴면포자의 clone 분리주 뿐만 아니라 전체 분리주에서 개체별 독함량의 차이가 크게 나타났다. 독조성은 C1/C2 (epiGTX8/GTX8), GTX1/GTX4 및 neoSTX가 주요 구성성분을 이루었고, GTX2/GTX3, GTX5, C4, dcSTX 및 STX성분은 미량 또는 산발적으로 출현하였다. 주요 성분중에서 neoSTX는 $5-54mol\%$로 변동이 컸으나, 전체 분리주의 절반은 출현을 보이지 않아 이 지역에서 조성이 다른 개체군의 출현이 시사되었다 한편, 상대적으로 독성이 강한 GTX1-4 및 neoSTX와 같은 Carbamate군의 성분이 세 정점에서 각각 $57\%,\;54\%$ 및 $67\%$의 높은 평균치를 나타내어 이 지역에서의 높은 독화율과 독화 가능성의 잠재력이 큰 것으로 시사되었다.

• Environmental Analysis Health and Toxicology
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• 제25권4호
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• pp.263-271
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• 2010

Objectives : The records of 447 pesticide poisoning deaths from the National Forensic Service (NFS) headquarters located in Seoul of Korea from 2005 to 2009 were retrospectively reviewed. Methods : The data of each case were analyzed by using the SPSS program. Results : The mean age was $57.8{\pm}14.8$ years and the range was 16-92 years. The numbers of deaths of males and females were 301 and 134, respectively. The largest number of cases occurred in people aged 50-59 years (n=92, 20.6%) followed by the age groups 40-49 years (n=91, 20.4%), 60-69 years (n=88, 19.7%), and 70-79 years (n=75, 16.8%). The total number of deaths among other age groups (10-19, 20-29, 30-39, 80-89, and 90-99 years) was 73, representing only 16.3%. Of all pesticide poisoning deaths, 96.2% were due to suicide, and 28.4% of the total number who died received medical treatment. The mostfrequent site of ingestion was the person's own residence (n=279, 62.4%). The most common classes of pesticide were bipyridylium herbicide (paraquat, 31.1%), organophosphate insecticide (21.7%), and carbamate insecticide (15.4%). The major pesticides having a high proportion of fatalities were paraquat (31.1%), methomyl (11.4%), glyphosate (9.1%), dichlorvos (5.6%), phosphamidon (4.6%), and methidathion (4.0%). Conclusions : This study showed that poisoning deaths due to pesticides are one of the major public health problems in Korea. Enforcement of regulations and safety education to prevent pesticide poisoning should be carried out by the government.

• 대한수의학회지
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• 제48권2호
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• pp.131-137
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• 2008

Pesticides are extensively used for the control of crop pests in agriculture and forestry. Organophosphate (OP) and carbamate pesticides are especially effective for the control of a variety of harmful insects. However, these cholinesterase inhibitors are also dangerous to non-target organisms (wildlife and other animals) because of their high acute toxicity. Most poisonings by pesticides occur as a result of misuse or accidental exposure, but intentional killing of unwanted animals also occurs. At the request of a local autonomous entity, we investigated wild bird poisonings by pesticides from 2003 to 2007. The 207 suspicious samples of pesticide poisoning based on the necropsy were analyzed by GC/NPD, GC/FPD, or GC/MSD. We looked for trends in the identification of pesticides in wild birds thought to have died from poisoning. Pesticides were determined in 59% of the total samples analyzed. Phosphamidon and monochrotophos were the most common pesticides identified, which amounted to 77% of the subtotal. Other OP and carbamate pesticides were also found in various concentrations from dead wild birds. The determined rates of pesticides were as high as 86% and 76% in 2003 and 2006, respectively, during an outbreak of avian influenza in Korea.