• 대한임상독성학회지
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• 제10권1호
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• pp.22-32
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• 2012

Purpose: The purpose of this study was to examine the occurrence of toxic exposure cases in Korean emergency centers using a toxic exposure surveillance system-based report form and to provide guidelines for the prevention and treatment of toxic exposures. Methods: We retrospectively reviewed the medical records of toxic exposure patients who had visited emergency centers from January 2009 to December 2009. Epidemiology data points for the toxic exposure cases included age, gender, type of exposure, number and kind of substances involved, reason and route of poison exposure, management of the patients in the emergency departments, and the clinical outcome. Results: A total of 3,501 patients from 12 emergency departments were enrolled in the study. 50.0% of the total exposure patients were male and 63.0% of the total cases were fatal. Acute intoxication occurred in 91.3% of the total patients and suicidal intent was the most common (43.3%) reason for exposure. The most common route of exposure was ingestion (75.9%). Of the total cases, pesticides were involved in 26.3%, sedatives/hypnotics/antipsychotics were involved in 22.0%, and bites and envenomations were involved in 15.7%. Conclusion: We provided a database of patients who were admitted to emergency departments after poisoning incidents. We recommend that toxicology professionals develop a classification scheme for toxicants which is adequate for Korean domestic circumstances and initiate a toxic surveillance system for all types of exposures. With support of a psychiatric surveillance system for suicidal patients and establishment of social mediation for pesticide poisoning, major reductions in poison exposures can be achieved.

• 대한임상독성학회지
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• 제17권2호
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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.

• 대한임상독성학회지
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• 제17권2호
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• pp.118-125
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• 2019

Purpose: Non-benzodiazepine hypnotic drugs (including zolpidem) are associated with an increased risk of suicide and suicidal ideation. Considering the wide usage of zolpidem, this drug should be considered a possible etiology for stupor or coma in any patient exposed to this drug. However, there are no reports on zolpidem blood levels in emergency department patients in Korea. We therefore reviewed the analyzed data of a toxicology laboratory at one university affiliated hospital. Methods: The sex, age, chief symptoms, suspiciousness of poisoning, and presumption of poison were analyzed from January 2018 to June 2019. The detection frequency and level of zolpidem in the patient blood were compared to the mental changes presented, which is the main consequence of zolpidem. Results: A total of 229 toxicological analyses, requested to a toxicological laboratory at one university affiliated hospital, were reviewed. Among 229 patients, the mean age was 54.3±20.7 years old with 113 women and 116 men. 8.7% of patients have psychiatric illness and 39.7% were poisoned intentionally. The chief symptoms detected were: mental change 55.0%, gastrointestinal 14.4%, cardiovascular 10.5%, focal neurological 7.4%, respiratory 3.5%, none 8.7%, and unknown 0.4%. A request for detailed reports revealed that causative poisons were specified only in 20.1% cases. Zolpidem was detected in 22.3% cases (51/229), with median blood level 1.26 mg/L (interquartile 0.1, 5.06 mg/L) and urine 0.90 mg/L (interquartile 0.11, 5.6 mg/L). Furthermore, zolpidem was more frequently detected in toxicology analysis of patients where mental change was the primary symptom, as compared to other symptoms (32.5% vs. 9.7%, p<0.01). Conclusion: This study reported the blood level of zolpidem in suspected poisoning patients admitted to the emergency department.

• 한국산업보건학회지
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• 제33권2호
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• pp.215-229
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• 2023

Objectives: To validate the effectiveness of a real-time chemical exposure monitoring system developed by KOSHA (Korea Occupational Safety and Health Agency), we applied the system to a workplace in the electronics industry for 153 days. Methods: The monitoring system consisted of a PID chemical sensor, a LTE communication equipment, and a web-based platform. To monitor chemical exposure, four sets of sensors were placed in two manufacturing tasks - inspection and jig cleaning - which used TCE as a degreasing agent. We reviewed previous reports of work environment measurements and conducted a new work environment measurement on one day during the period. The PID sensor systems detected the chemical exposure levels in the workplace every second and transmitted it to the platform. Daily average and maximum chemical exposure levels were also recorded. Results: We compared the results from the real-time monitoring system and the work environment measurement by traditional methods. Generally, the data from the real-time monitoring system showed a higher level because the sensors were closer to the chemical source. We found that 28% of jig cleaning task data exceeded the STEL. Peak exposure levels of sensor data were useful for understanding the characteristics of the task's chemical use. Limitations and implications were reviewed for the adoption of the system for preventing poisoning caused by chemical substances. Conclusions: We found that the real-time chemical exposure monitoring system was an efficient tool for preventing occupational diseases caused by chemical exposure, such as acute poisoning. Further research is needed to improve the reliability and applicability of the system. We also believe that forming a social consensus around the system is essential.

• 한국환경보건학회지
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• 제21권3호
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• pp.1-15
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• 1995

Tolerance to toxic effects of cadmium(Cd), including lethality has been shown following pretreatment with cadmium and zinc. This study was designed to determine if tolerance also develops to Cd-induced hepatotoxicity and renal toxicity. Three groups of rats(A, B, C), each consisting of 52 rats, were studied and each group was divided into three subgroups(1,2,3), 28 rats for each subgroup. Rats were subcutaneously pretreated with saline(A), $CdCl_2$(0.5 mg/kg, B), and $ZnCl_2$(13.0 mg/kg, C) during time periods of 5 days. At the end of the period, rats were challenged with $CdCl_2$(3.0 and 6.0 mg/kg) by intraperitoneal injection. As for the cadmium levels in rat tissues after 1,3,5,6 days of pretreatments, it was highest in the liver. Then kidney, heart, blood and muscle followed it in that order. After 24, 48 and 96 hours of intraperitoneal injection by challenge doses the concentration of cadmium in liver and kidney increased proportionally to the increase of challenge dosage. However metallothioneins in liver and kidney were increased by the pretreatment of cadmium and zinc. These data indicate the liver is a major target-organ of acute Cd poisoning, and suggest that cadmium induced hepatic injury, via release of Cd-MT, may play an important role in the nephrotoxicity observed in response to short-term exposure to cadmium. This result suggest that increasing cadmium concentrations, gradually accumulating in liver and kidney as the result of the pretreatment, served to induce the synthesis of metallothionein, thus making them resistant to the challenge from cadmium.

• 대한임상검사과학회지
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• 제45권3호
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• pp.91-95
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• 2013

It is important to check the types of drugs when treating acute drug intoxication. This study researches the clinical characteristics and types of patients hospitalized in emergency medical center for drug addiction in 2009 and 2010. By applying a drug addiction selecting kit, it studied the flexibility and clinical efficiency during diagnosis and treatment. The study result shows, among the drugs causing addiction, Sedative accounts for 34.4%, Herdicide 23.5%, Analgesic 17.2%, Insectide 7.8% and else 17.2%. Sedative showed the highest proportion both in 2009 and 2010. Among the drug addicted patients, 39 cases did not know that the drugs are poisonous and among them, the drug addiction selecting kit was positive in 32 cases (82.0%). In 42 cases where addiction was suspicious, 25 cases (59.5%) were positive in the drug addiction selecting kit. In 57 cases of using drug addiction selecting kits, the cases in which benzodiazepine was positive, were 30 and the most frequently cases were as follows; Tricyclic Antidepressants (TCA) 13 cases, Amphetamines 3 cases, barbiturate 3 cases, and piate 3 cases. In the district using drug addiction kit meaningfully had Flumazenil injection much greater impact than the one not using the kit. This proves the efficiency of the kit (p<0.05). The uses of drug addiction selecting kits are for acute drug intoxicated patients and for providing objective and scientific information when emergency medical doctor are checking unchecked poisoning drugs. It is considered that drug addiction selecting kits would give help when treating the early stage of drug addicted patients in emergency medical treatment.

• Applied Microscopy
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• 제36권2호
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• pp.57-72
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• 2006

본 연구는 급성 납 독성에 대한 활성탄의 방어효과를 알아보기 위하여 시도되었다. 30g 내외의 생쥐를 대상으로 대조군, 납(60mg/kg)투여군, 납 투여후 활성탄(40mg/kg)투여군으로 구분하여 구강투여 한 후 신장 손상억제 효과를 알아보기 위하여 생화학적 및 조직학적 실험을 실시하였다. 혈액 중 blood urea nitrogen(BUN) 그리고 creatinine (Cre)의 활성도는 활성탄 투여군이 납 투여군보다 감소되었다. 전자현미경적 관찰 결과, 신장의 근위세뇨관에서 납 투여군은 미세융모의 소실이 나타나고, 핵이 함입되어 불규칙해졌으며, 미토콘드리아는 팽대되고, 그 수가 감소하였다. rER의 수조가 확장되고 공포화 현상이 관찰되었으며 리보솜의 탈락이 관찰되었다. 활성탄 투여군은 핵은 거의 원형의 상태이고, 다수의 미토콘드리아가 관찰되었으며, rER은 리보솜이 부착된 상태로 관찰되었다. 이상과 같은 결과, 활성탄이 납 중독된 생쥐에서 납을 흡착시킴으로서 손상된 신장에 보호 효과가 있는 것으로 사료된다.

• 한국농공학회논문집
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• 제62권1호
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• pp.105-115
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• 2020

With the decrease of the agricultural population in Korea, the workers who is vulnerable to labor are increasing in agricultural industry because of aging, feminization of population. They are exposed in poor working environment with higher temperature and concentrations of dust, gas. Higher concentration of harmful gas and dust can cause chronic and acute disease to workers depending on exposure intensity and frequency. In order to improve the working environment in the livestock facilities, It is important to secure monitoring data of the thermal environment and the concentration of harmful gases and fine dust. Multi-point measurement was performed to analyze the regional environmental conditions in the pig rooms. When analyzing the working environment, video monitoring was conducted to analyze the concentration changes of ammonia, hydrogen sulfide and fine dust according to worker movement and work type. Ammonia and hydrogen sulfide monitoring result showed 1.5~2 times higher concentrations than other work when working in the pigs living zone, and 2~4 times higher than other work when working to increase the activity of pigs. In the case of fine dust, the result was 1.3 times higher than the worker's exposure standard in a specific work. The concentrations of gases and dusts from pig farms are not of concern for acute poisoning in normal work, but there is a risk of chronic respiratory disease if they are continuously exposed. Accordingly, there is a need for development of work environment monitoring device tailored to workers and preparation of alternatives.

• 대한임상독성학회지
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• 제13권1호
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• pp.36-39
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• 2015

Copper sulfate is a copper compound used widely in the chemical and agriculture industries. Most intoxication occurs in developing countries of Southeast Asia particularly India, but rarely occurs in Western countries. The early symptoms of intoxication are nausea, vomiting, diarrhea, and abdominal cramps, and the most distinguishable clue is bluish vomiting. The clinical signs of copper sulfate intoxication can vary according to the amount ingested. A 75-year old man came to our emergency room because he had taken approximately 250 ml copper sulfate per oral. His Glasgow Coma Scale (GCS) score was 14 and vital signs were blood pressure 173/111 mmHg, pulse rate 24 bpm, respiration rate 24 bpm, and body temperature $36.1^{\circ}$ .... Arterial blood gas analysis (ABGa) showed mild hypoxemia and just improved after 2 L/min oxygen supply via nasal cannula. Other laboratory tests and chest CT scan showed no clinical significance. Three hours later, the patient's mental status showed sudden deterioration (GCS 11), and ABGa showed hypercarbia. He was arrested and his spontaneous circulation returned after 8 minutes CPR. However, 22 minutes later, he was arrested again and returned after 3 minutes CPR. The family did not want additional resuscitation, so that he died 5 hours after ED visit. In my knowledge, early deaths are the consequence of shock, while late mortality is related to renal and hepatic failure. However, as this case shows, consideration of early definite airway preservation is reasonable in a case of supposed copper sulfate intoxication, because the patients can show rapid deterioration even when serious clinical manifestation are not presented initially.

• 대한임상독성학회지
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• 제2권1호
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• pp.20-22
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• 2004

Acute mercury inhalation poisoning is a rare cause of acute peripheral neuropathy. A 44-year-old female inhaled the fume from heating mercury to treat her palmar dermatitis. For 4 days, this procedure was done for 2-3 minutes after each meal. She subsequently complained flu like symptoms, such as headache, toothache, myalgia and arthralgia. She was admitted for 9 days and then symptoms disappeared. About 3 weeks after exposure, both knee pain developed and then she could not walk. To treat mercury intoxication, she was referred to our hospital. At that time, initial laboratory data were within normal limits, but blood and urinary mercury level were 5.6 11$\mu$g/dl, 132.8 $\mu$g/L. After treatment with D-penicillamine for 7 days, blood and urinary mercury level were 3.9 1$\mu$g/dl, 177.3 $\mu$g/L. During the following 1 month, both leg symptoms remained. Nerve conduction studies were performed, both leg sensory nerve amplitude decreased. These findings were suggestive of peripheral polyneuropathy.