• Korean Journal of Clinical Pharmacy
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• v.23 no.1
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• pp.57-64
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• 2013

Purpose: Drug can be hazardous for people if misused although they are useful for their indication. In urgent incidences such as overdose, proper treatment for intoxication can save patients' lives. In emergent case regarding drug overdose, pharmacists should know how to provide correct information including antidote to other healthcare providers. However, in Korea, there is neither regular class nor education material regarding detoxification. Therefore, the object of our study is to investigate the perception of pharmacists about it. Method: We surveyed hospital pharmacists by means of self-reporting questionnaire in order to investigate the pharmacists' perception of detoxification treatments from May $12^{th}$ 2012 to August $10^{th}$ 2012. The questionnaire comprised of demographic information, interest in detoxification treatment (inquiry from patients and education about antidote), knowledge of antidote, effective drug search route and perception of the need for education and stocking materials about antidotes). Results: It included total 281 hospital pharmacists from 30 hospitals in S. Korea. Of them, only 16.7% have been questioned about drug overdose from patient or representative and 35% have learned about antidotes in case of drug overdose through education program of Korean association of hospital pharmacist or university. About 98% thought that education and stocking materials about frequently overdosed drug and antidotes are helpful for patients in emergent case. Also, the percentage of correct answer of each questions about antidotes were higher in educated group ($p{\leq}0.001$). The more work years are, the percentage of correct answer of each questions are higher ($p{\leq}0.001$). Conclusion: In conclusion, it will be helpful for reducing damage by drug overdose that pharmacists take regular education about antidote for all pharmacist and pharmacy student. In addition, preparing and keeping booklet for Korean Style-antidote in pharmacy is needed currently for protecting public health.

• Journal of Preventive Veterinary Medicine
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• v.42 no.4
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• pp.182-185
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• 2018

This study examined the overdose toxicity of Super-Neophensan, containing florfenicol and acetaminophen, upon pigs. SNP-3.0 (n=10) was administered at the dosage level of 3 kg/ton feed for 7 consecutive days, which is 3 times the recommended dose based on the guidelines of the manufacturer, and the control group (CON) (n=10) was administered the normal diet without the drug. The body weight, weight gain and feed efficiency in SNP-3.0 treated with the drug for 14 days post-administration showed no significant differences compared with those in CON. In hematological and blood biochemical analyses, all parameters were not affected by over-dosage of the drug. In the same way, there were no significant differences between SNP-3.0 and CON on markers for liver and kidney functions. As no adverse effects were observed with the drug in an overdose oral toxicity test, this study suggests that the drug was identified as a safe agent in pigs administered with three times the recommended dose.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.2
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• pp.95-102
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• 2015

Purpose: Drug overdose is easily found in the emergency department (ED). Sedative-hypnotics overdose causes the aspiration pneumonia in patients with decreased mental status. The purpose of this study was to investigate the risk factors of aspiration pneumonia in patients poisoned with sedative-hypnotics. Methods: One hundred seventy eight patients who were poisoned with sedative-hypnotics and who visited ED between 2009 and 2015 were included. This study was conducted retrospectively, with collection of data by review of medical records. We collected the data concerning the characteristics of patients and classified them into two groups based on the development of aspiration pneumonia. Logistic regression analysis was performed to investigate the factors for the development of aspiration pneumonia. Results: Thirty five patients had an aspiration pneumonia during their hospital stay in 178 patients. The age, amount of ingestion, Glasgow Coma Scale (GCS) score at admission, a history of hypertension and diabetes mellitus, and the hypotension at admission were significantly different between two groups in univariate analysis. The age, amount of ingestion and GCS score at admission were associated with the development of aspiration pneumonia in the multivariate logistic regression analysis (OR 1.028 (95%CI, 1.002-1.056, p=0.037), 1.026 (95%CI, 1.004-1.043, p=0.001), 0.737 (95%CI, 0.683-0.915, p=0.002)). All patients with aspiration pneumonia were discharged without a sequelae. Conclusion: The development of aspiration pneumonia in the patients of sedative-hypnotics overdose is associated with old age, amount of drug ingestion, and GCS score at admission.

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.2
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• pp.142-145
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• 2008

Lamotrigine is a newer anti-epileptic drug for adjunctive treatment of refractory epilepsy, partial seizures, generalized tonic-clonic seizures, and bipolar disorder. Lamotrigine overdose causes serious central nervous and cardiovascular problems, but reports are uncommon. Few lamotrigine overdoses have been described because anti-epileptic drug use is limited and usually used with combination of other anti-epileptic drugs. In addition, most patients visit emergency departments with multi-drug overdoses, so few cases of lamotrigine poisoning alone exist. We had a female patient visit our emergency department a couple of hours after a lamotrigine overdose treated with intravenous hydration and urine alkalization by NaHCO3. She recovered successfully without any evidence of renal injury. However, she developed profound rhabdomyolysis, a previously unreported complication of this medication. We suggest that serial creatine kinase levels should be measured after lamotrigine poisoning.

• Journal of The Korean Society of Clinical Toxicology
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• v.14 no.1
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• pp.26-32
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• 2016

Purpose: Aspiration pneumonia is an important complication of drug intoxication with decreased mental status. The purpose of the study is to investigate the risk factors of aspiration pneumonia in the patients of benzodiazepine overdose with or without co-ingestion of other drugs. Methods: A retrospective chart review of patients who visited the emergency department between January 2012 and December 2014 was conducted. Demographic data, time from ingestion to visit, initial vital signs, symptoms, mental status, medical history, laboratory results, chest radiological findings and co-ingested medications were recorded. Multiple logistic analyses were performed to verify the association between variables and the development of aspiration pneumonia. Results: A total of 249 patients presented to the emergency department with benzodiazepine overdose. Aspiration pneumonia had developed in 24 patients (9.6%). Univariate analysis revealed time from ingestion to visit was longer, Glasgow coma scale score was lower, hypoxia was presented, leukocytosis was shown, types of ingested drugs was high, less activated charcoal was applied and tricyclic antidepressants was taken in patients that developed aspiration pneumonia. Time from ingestion to visit (odds ratio (OR) 1.121, 95% confidence interval (CI), 1.057-1.189, p=0.000), GCS score (OR 0.724. 95% CI, 0.624-0.839, p=0.000), oxygen saturation (OR 0.895, 95% CI, 0.835-0.959, p=0.002), and co-ingestion of TCA (OR 4.595, 95% CI, 1.169-18.063, p=0.029) were identified as risk factors of morbidity of aspiration pneumonia upon multiple logistic regression analysis. Conclusion: Time from ingestion to visit, low GCS score, low oxygen saturation and co-ingestion of TCA were risk factors of the development of aspiration pneumonia in benzodiazepine overdose patients.

• Journal of The Korean Society of Clinical Toxicology
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• v.9 no.2
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• pp.71-76
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• 2011

Purpose: The Rumack-Matthew nomogram cannot be applied in managing overdose by extended release (ER) preparation acetaminophen (AAP). This study analyzed the clinical characteristics of ER preparation AAP overdose in order to develop a treatment recommendation. Methods: We retrospectively reviewed the medical records of patients presented to the emergency department as a result of AAP overdose from Jan 2008 to Dec 2010. Only those patients who ingested an ER preparation of AAP were included in the study. Their blood AAP concentrations were measured at 4 and 8 hours after ingestion. Clinical variables related to AAP intoxication were analyzed. Results: Of the total 108 AAP overdose patients identified during the 3-year period, 20 suffered specifically with ER preparation AAP overdose. The mean estimated ingestion amount was 167.5 mg/kg. Treatments including gastric lavage, activated charcoal, and N-acetyl cysteine (NAC) were performed on 10, 14, and 11 patients, respectively. Hepatotoxicity was diagnosed in only one patient who was then successfully treated with NAC. In another case, blood AAP concentration continued to increase until at least 11-hours after ingestion. Conclusion: This study suggested that blood AAP concentrations associated with ingestion of ER formulations of AAP, may increase in an extended manner. Therefore, multiple sampling and longer periods between samples assessing AAP blood concentration may be required for incidences of extended release overdose.

• Journal of The Korean Society of Clinical Toxicology
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• v.19 no.1
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• pp.31-37
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• 2021

Purpose: Acetaminophen (APAP) is a widely available drug responsible for a large part of drug-induced hepatotoxicity in developed countries. Although acetaminophen overdose cases in Korea are being continuously reported, there are no reports related to the level of this drug in the patient's blood or of laboratory analysis at emergency departments (ED). This study sought to analyze the acetaminophen overdose cases at a toxicological laboratory and to survey APAP analysis services offered at select EDs. Methods: We analyzed the demographic and analytic data at a toxicological laboratory run by the National Emergency Medical Center (NMC) in 2019-2020. We surveyed the APAP laboratory service in the 38 regional emergency medical centers (EMCs) and 68 local EMCs near the toxicological laboratory. Results: We studied 175 acute poisoning cases (112 women) with positive blood APAP results (mean age 47.0±24.1 years). Suicide attempts comprised 40.0% of the cases and 30.3% APAP overdose events. In the univariate analysis, we observed that patients were significantly younger, with fewer underlying medical diseases. There were a higher number of APAP overdose events, more favorable initial mental status, more toxic quantity intake in the above treatment line group (p<0.05), In multivariate analysis, the toxic amount intake was significantly more frequent in the above treatment line group (p<0.01). Hospital APAP analysis services were available in six EMCs (3/38 regional and 3/68 local). The hospital blood APAP level reporting intervals were shorter than outside-hospital laboratory services (p<0.01, regional 7.0±3.0 vs. 40.6±27.5, local 5.3±3.1 vs. 57.9±45.1 hours). The NMC toxicological laboratory reporting interval was shorter than the other outside-hospital laboratories (p<0.01, regional 5.7±0.6 vs. 50.2±22.7 local 7.5±3.0 vs. 70.5±41.5 hours). Conclusion: Over the treatment line group, toxic amount intake was significantly more frequent. Only six of 106 EMCs have their own APAP analysis service in their hospitals.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.165-171
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• 2018

An overdose of antihypertensive agents, such calcium channel blockers (CCBs) and angiotensin II receptor blocker (ARBs), and the antihyperglycemic agent, metformin, leads to hypotension and lactic acidosis, respectively. A 40-year-old hypertensive and diabetic man with hyperlipidemia and a weight of 110 kg presented to the emergency room with vomiting, dizziness, and hypotension following an attempted drug overdose suicide with combined CCBs, ARBs, 3-hydroxy-3-methylglutaryl-coemzyme A reductase inhibitors, and metformins. A conventional medical treatment initially administered proved ineffective. The treatment was then changed to simultaneous extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), which was effective. This shows that simultaneous ECMO and CRRT can be an effective treatment protocol in cases of ineffective conventional medical therapy for hypotension and lactic acidosis due to an overdose of antihypertensive agents and metformin, respectively.

• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.1
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• pp.1-7
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• 2022

Purpose: In patients with acute drug overdose, identification of drugs ingested is crucial to make a precise diagnosis. In most cases, the diagnoses are made on the medical history and physical examination findings. This study was undertaken to determine the concordance of diagnosis made on the basis of patient history by comparing it with urine toxicology analysis. Methods: This was a retrospective study of drug intoxicated patients over 18 years old who presented to the emergency center from 2017 to 2019. Specimens from urine were tested using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-TMS). The test results were compared with information obtained from patients. Diagnostic concordances for drug detection in intoxicated patients were calculated. Logistic regression analysis was used to examine the association between clinical characteristics and diagnostic discrepancy. Results: Totally, 370 patients were included in the analysis. Overall, 66 types of drugs were detected by UPLC-TMS. The drugs detected most frequently were zolpidem (104, 27.8%), citalopram (70, 18.7%), and paracetamol (66, 17.6%). The mean diagnostic concordance of patients was 52.7%. There were statistically significant diagnostic discrepancies in patients with underlying depression and patients intoxicated with multiple types of drugs. Conclusion: In ED patients with acute drug overdose, the diagnoses made on history alone were often inaccurate. It is essential to perform urine toxicology tests such as UPLC-TMS as a confirmatory instrument to improve accuracy in evaluating patients with drug intoxication.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.4
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• pp.233-239
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• 2013

Drug intoxication in children and adolescents is not uncommon in Korea. But the tendency of intoxication is changing with some factors, such as national surveillance system, Naderism and increasing concern among physicians. But the death rate of intoxication among adolescents is increasing in spite of decreasing total death rate of intoxication among children and adolescents. Therefore the physician must be concerned about the basic management of intoxication and figure out the common toxic substance among children and adolescents.