• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.26 no.4
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• pp.389-395
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• 2016

Objectives: Acute methanol poisonings known to be typical occupational diseases occurring in developing countries broke out in sub-contract manufacturers in the early 2016. The present paper attempted to identify underlying causes which hide under apparent findings, and suggest alternative policies to prevent recurrence of similar intoxication Methods: We evaluated occupational health and safety characteristics of workers in micro-enterprises similar to workplaces with methanol poisoning by in depth-interview of employers, workers, and labor inspectors, and literature review. Results: The common findings of workplaces with methanol poisoning were addressed; First, the victims were illegal agency workers. Second, the workplaces were sub-contract micro-manufacturers with less than 5 employees. Investigators found that local ventilations did not work, while most of workers did not wear any proper personal respiratory protective equipment in the workplace. In addition, periodic environmental monitoring and medical check-ups were not done. However, these apparent findings do not appear to be root causes of methanol poisoning. Our in depth-analysis clarified a root cause; micro-enterprises with less than 5 employees are exempted with essential regulations of OSH Act, and employers do not know about OSH Act. Conclusions: We suggest occupational health policies to prevent recurrence of similar intoxication; First, government should introduce programs so that all employers should know about employers' responsibilities in OSH Act from the start of business. Second, even manufacturers with less than 5 employees should not be exempted with essential regulations of OSH Act. Finally, employers should take responsibilities for health and safety of all the workers including agency workers working in workplaces.

• Journal of The Korean Society of Clinical Toxicology
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• v.7 no.1
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• pp.32-37
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• 2009

Formic acid or formate is a common industrial compound used in the production of ensilage, disinfectants, decalcifying agents and mainly as a precursor in industrial chemical synthesis. It is also a well-known toxic metabolite produced in methanol poisoning. Thus, formate is a potential source of both accidental and deliberate poisoning. Very few reports have been published thus far, on the toxicology of direct formic acid poisoning. Here, we report a case of a 74-year-old man without a history of depression, who ingested about 30 gm of formic acid. The patient presented with profound high anion gap metabolic acidosis, acute renal failure and esophageal stricture. The patient was successfully treated with hemodialysis and supportive measures. But permanent esophageal stricture was complicated by formic acid burns in the gastrointestinal tract. We discuss the pathophysiology and treatment of this case.

• Journal of The Korean Society of Clinical Toxicology
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• v.15 no.2
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• pp.79-85
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• 2017

Purpose: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. Methods: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. Results: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. Conclusion: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.

• Journal of The Korean Society of Clinical Toxicology
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• v.7 no.2
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• pp.150-155
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• 2009

Purpose: Extracorporeal elimination of drugs is a critical part of managing poisonings, although the indications and optimal method remain a matter of debate. The aim of this study is to report our clinical experiences with continuous renal replacement therapy (CRRT), as performed by emergency room physicians, as method of extracorporeal drug elimination in patients with poisoning. Methods: This study was a retrospective study of the consecutive patients who underwent CRRT, as performed by an emergency room physician, for acute poisoning. The patient characteristics, the kinds of drugs and the method of extracorporeal elimination were analyzed by reviewing the patients' charts. Results: During eleven months, 26 patients with acute poisoning underwent extracorporeal elimination (2 patients; intermittent hemodialysis, 24 patients; CRRT). The mean time from the decision to performing extracorporeal elimination was $206.0{\pm}36.8$ minutes for intermittent hemodialysis, $62.9{\pm}8.5$ minutes for continuous venoveno-hemodiafiltration (CVVHDF) and $56.6{\pm}6.8$ minutes for charcoal hemoperfusion. For the patients with CRRT, CVVHDF was conducted in 10 patients (3 patients; valproic acid, 2 patients; Lithium, 1 patient; salicylates, 1 patient; methanol) and charcoal hemoperfusion by using CRRT was done in 14 patients (13 patients; paraquat, 1 patient; dapsone). For the 12 patients who required hemodialysis due to severe poisoning, 7 patients underwent CRRT because of their unstable vital signs. Conclusion: CRRT was an effective method of extracorporeal drug elimination in patients with acute poisoning, and especially for the cases with unstable vital sign and for those patients who required an early start of extracorporeal elimination according to the characteristics of the drug. (ED note: the writing of the abstract was not clear. Check it carefully.)

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.28 no.2
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• pp.230-239
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• 2018

Objective: The purpose of this study is to identify the kinds and exposure levels of health hazards in the metalworking process in relation to acute poisoning accidents caused by methanol in 2016. Methods: The number of industries, workplaces, exposed workers, regional distribution, and exposure level of health hazards in metalworking process were investigated based on employee exposure assessment database provided by KOSHA (the Korea Occupational Safety and Health Agency), which was collected from workplace hazard evaluation programs in Korea. Exposure metrics for methanol were assessed by RCR (risk characterization ratio). Results: The numbers of processes, workplaces, and exposed workers of metalworking, which include CNC (computer numerical control) were 25, 14,405, and 169,102 respectively. The numbers of samples of chemical hazards including methanol were 91,325, and it was found that workers in metalworking were exposed to 249 kinds of chemical hazards. There were 16 kinds of special controlled substances including beryllium. It is estimated that the number of workplaces involving CNC process was 2,537, and the number of exposed workers was 27,976. In CNC process, the total number of workplaces handling methanol was 36, and 298 workers were estimated to be exposed. There was no exceeded that surpassed the OEL and 49% of samples were below the limit of detection. Methanol exposure concentrations in Gyeonggido Province were statistically significantly higher than in other areas (p <0.0001). Conclusions: In the metalworking process including CNC, there is exposure to a wide variety of health hazards. There was no sample exceeding the OEL for methanol. Therefore, it is necessary to recognize the limits of the employee exposure assessment system and urgently improve measures to prevent the occurrence of events like methanol poisoning.

• YAKHAK HOEJI
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• v.46 no.2
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• pp.93-97
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• 2002

Methidathion is one of the organophosphorus pesticides commonly used for stamping out harmful pests in farming areas. This paper presents a fatality due to methidathion intoxication and describes the distribution of methidathion in postmortem blood and tissues obtained at autopsy. Qualitative identification of methidathion was achieved by TLC, GC and GC/MS, and quantitative analysis was performed by GC with thermionic specific detector (TSD). The analytes in postmortem specimens were extracted by liquid-liquid extraction (LLE) with ethylether. After the ethylether layer was evaporated, the residue was partitioned into hexane and acetonitrile, and the acetonitrile layer was used for analysis. Tissue specimens were homogenized with 4% perchloric acid and applied for LLE. After extraction, the extracts were reconstituted 100 $\mu\textrm{g}$ pyraclofos (IS, 100 $\mu\textrm{g}$/ml in methanol) for GC and GC/MS analysis. On analysis of postmortem specimens, methidathion was identified and quantitated. The methidathion concentrations were 2.0 $\mu$l/ml in blood, 24.4 $\mu\textrm{g}$/g in liver, 13.9 $\mu\textrm{g}$/g in lung, 21.8 $\mu\textrm{g}$/g in kidney, respectively.

• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.2
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• pp.47-57
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• 2019

Purpose: Osmolar gap (OG) has been used for decades to screen for toxic alcohol levels. However, its reliability may vary due to several reasons. We validated the estimated ethanol concentration formula for patients with suspected poisoning and who visited the emergency department. We examined discrepancies in the ethanol level and patient characteristics by applying this formula when it was used to screen for intoxication due to toxic levels of alcohol. Methods: We retrospectively reviewed 153 emergency department cases to determine the measured levels of toxic ethanol ingestion and we calculated alcohol ingestion using a formula based on serum osmolality. Those patients who were subjected to simultaneous measurements of osmolality, sodium, urea, glucose, and ethanol were included in this study. Patients with exposure to other toxic alcohols (methanol, ethylene glycol, or isopropanol) or poisons that affect osmolality were excluded. OG (the measured-calculated serum osmolality) was used to determine the calculated ethanol concentration. Results: Among the 153 included cases, 114 had normal OGs (OG≤14 mOsm/kg), and 39 cases had elevated OGs (OG>14). The mean difference between the measured and estimated (calculated ethanol using OG) ethanol concentration was -9.8 mg/dL. The 95% limits of agreement were -121.1 and 101.5 mg/dL, and the correlation coefficient R was 0.7037. For the four subgroups stratified by comorbidities and poisoning, the correlation coefficients R were 0.692, 0.588, 0.835, and 0.412, respectively, and the mean differences in measurement between the measured and calculated ethanol levels were -2.4 mg/dL, -48.8 mg/dL, 9.4 mg/dL, and -4.7 mg/dL, respectively. The equation plots had wide limits of agreement. Conclusion: We found that there were some discrepancies between OGs and the calculated ethanol concentrations. Addition of a correction factor for unmeasured osmoles to the equation of the calculated serum osmolality would help mitigate these discrepancies.