• The Journal of Internal Korean Medicine
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• v.22 no.2
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• pp.245-250
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• 2001

Paraquat is one of the widely used herbicides. But it is fatal, if it is consumed by people. Paraquat poisoning causes acute renal failure, hepatic dysfunction, and progressive respiratory failure. There are no effective antidotes to paraquat. This report is about one case's treatment for acute hepatitis caused by paraquat. The patient was hospitalized in the Department of Internal Medicine, Wonkwang University Oriental Medical Hospital in Chonju. The patient received the following treatments while in an acute stage : Gamdutanggamibang(甘豆湯加味方), which consists of Radix glycyrrhizae(甘草), Semen mungo(綠豆), burned powder of Rhizoma rhei(大黃炒炭末), Succus phyllostachyos(竹瀝), chinese ink(墨汁) and fluid therapy. The patient received Sagunjatanggamibang(四君子湯加味方) while in a chronic stage. The patient improved faster with the above treatments than with the conventional treatment. We hope that this report will help widening the clinical range of oriental medicine, and improve systemic efforts in treating paraquat poisoning cases.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.149-156
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• 2018

Purpose: The purpose of this study was to determine whether hepatotoxicity could be predicted early using biochemical markers in patients with acetaminophen (AAP) poisoning and to assess the usefulness of predictive factors for acute liver injury or hepatotoxicity. Methods: This study was a retrospective observational study involving a medical records review. The participants were patients who were admitted to the emergency department (ED) with AAP overdose at two hospitals over a 10-year period. Demographic data, age, time from ingestion to visit, initial AAP level, initial hepatic aminotransferases, and initial prothrombin time were recorded. Acute liver injury was defined as a peak serum ALT >50 U/L or double the admission value, and hepatotoxicity was defined as a peak ALT >1,000 U/L. Receiver operating characteristic curve analyses were performed to compare the prognostic performance among variables. Results: A total of 97 patients were admitted to the ED with AAP overdose, of whom 26 had acute liver injury and 6 had hepatotoxicity. Acute liver injury was associated with the time interval after taking the drug, and hepatotoxicity was associated with the initial PT and the ALT level. The scoring system proposed by the authors has a significant ability to predict both acute liver injury and hepatotoxicity. Conclusion: To predict the prognosis of AAP poisoning patients, the time interval after taking AAP was important, and initial prothrombin time and ALT level were useful tests. Also a scoring system combining variables may be useful.

• Journal of The Korean Society of Clinical Toxicology
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• v.9 no.1
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• pp.14-19
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• 2011

Purpose: Most paraquat poisonings are easily diagnosed by history taking on physical examination, however, some are failed to be diagnosed initially if the poisoning was veiled. The purpose of this study was to explore the clinical characteristics of veiled paraquat poisoning. Methods: We retrospectively reviewed the medical records of patients whose discharge diagnosis was paraquat poisoning in one university teaching hospital between 1 Jan, 2001 and 31 Dec, 2010. Veiled paraquat poisoning was determined when there was a positive urine paraquat kit in patients who did not mention paraquat poisoning in an initial physical examination or had unknown cause of pulmonary fibrosis, acute renal failure, or multi-organ failure. Results: Of the 117 patients with paraquat poisoning during the study period, 6 patients (5.1%) had veiled paraquat poisoning. The clinical characteristics were 1) proteinuria - 6 (100%), 2) increased creatinine - 4 (66.7%), 3) green skin stains - 2 (33.3%), 4) mucosal ulcer - 3 (50%). Blood chemistry results were variable. Conclusion: We should suspect veiled paraquat poisoning for patients who have proteinuria, increased creatinine, green skin stain, mucosal ulcer and vomiting, or if they have rapidly progressing acute renal failure or multi-organ failure with unknown cause, even if patients didn't mention about paraquat poisoning upon the initial physical examination. In cases with the above clinical conditions, a thorough repeated physical examination including history taking and use of urine paraquat kits should be performed.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.27-35
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• 2007

Purpose: Organophosphate (OP) compounds insecticides are the most commonly associated with serious human toxicity all over the world. The aim of this study was to identify sociocultural factors that contribute to high incidence of pure OP poisoning and prevent OP poisoning in order to reduce the factors responsible for deaths in South Korea. Methods: This is the 38 multi-centers survey and prospective study of pure OP poisoning by structural reporting system and hospital records from August 2005 to July 2006. 238 patients with acute pure OP poisoning were enrolled. We collected patient information regarding poisoning, clinical, and demographic features. Results: The mean age was $55.32{\pm}17.3$ years old. The most frequent site of exposure was their own residence(85.7%). Frequent compounds involving pure OP poisoning were dichlorvos(22.7%), methidathion(8.4%), and phosphamidon(6.7%). Intentional poisoning was 77.9%. The most frequently route of exposure was ingestion(94.5%). The mean arrival time to hospital after poisoning was 12.7 hours and mean hospitalization duration was 12.9 days. 2-PAM was administered to 101 patients in mean doses of 6.3 g/day intravenously. Atropine was administered to 81 patients in mean doses of 74.6 mg/day (maximal 910 mg/day). The presence of lower level of GCS score, respiratory complications, hypotension, acute renal failure, and serious dysrhythmia was associated with serious and fatal poisoning. Overall final mortality in pure OP poisoning was 9.7%(23/238). Conclusion: This study highlights the problem of pure OP poisoning in South Korea as a basic national survey. Futhermore this might help the establishment of strict policies availability of OP and the statistics of OP poison exposure in South Korea.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.43-45
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• 2007

Carbon dioxide is the fourth most abundant gas in the earth's atmosphere, and it is widely used in the chemical industry. Solid carbon dioxide is commonly known as dry ice. At low concentration, carbon dioxide appears to have little toxicological effect. At higher concentrations, however, it can produce an increased respiratory rate, tachycardia, cardiac arrhythmia, loss of consciousness, convulsion, and even death. Management of carbon dioxide poisoning requires the immediate removal of an individual from the toxic environment and administration of oxygen. It is important to know the concentration of carbon dioxide to which a patient has been exposed. We report a case of acute poisoning from solid carbon dioxide in a patient presenting with drowsiness and diminished mental capacity when she arrived in the emergency department. She recovered completely after administration of oxygen with conservative treatment.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.57-60
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• 2007

Cyanide has been well known from antiquity. Cyanide poisoning causes histotoxic hypoxia--inhibition of mitochondrial cytochrome oxidase with disruption of the ability of cells to use oxygen. The mortality rate is 95% within 30 minutes. Acute cyanide poisoning is mostly the result of attempted suicide, and because of the high doses typically employed it usually is lethal within minutes. Also acute cyanide poisoning leads to a very poor prognosis because medical personnel can't detect cyanide intoxication and so many hospital haven't antidote. We report two cases of cyanide poisoning which responded well to treatment with the Taylor cyanide antidote package.

• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.66-74
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• 2022

Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion: The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.

• Journal of The Korean Society of Clinical Toxicology
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• v.21 no.2
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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.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.1
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• pp.49-56
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• 2018

Purpose: Glufosinate ammonium poisoning can cause seizures, even after a symptom-free period. This study was conducted to evaluate the relationship between serum neuron specific enolase (NSE) level and the occurrence of seizures in patients with acute glufosinate ammonium poisoning. Methods: For this retrospective observational study, data from patients diagnosed with acute glufosinate ammonium poisoning were collected between January 2016 and June 2016. Serum NSE was measured within 2 hours of arrival at the emergency department. The patients were divided into a seizure group and a non-seizure group. Results: The seizure group included eight of the 15 total patients (53.3%). The serum NSE level was significantly higher in the seizure group than in the non-seizure group ($32.4{\pm}11.9ng/mL$ vs. $19.5{\pm}5ng/mL$, p=0.019). The amount of glufosinate ingested and initial and peak serum ammonia levels were significantly higher in the seizure group than in the non-seizure group. There was no significant difference in the area under the curve of the serum NSE level or the initial and peak serum ammonia levels in terms of predicting the occurrence of seizures. Conclusion: In acute glufosinate poisoning, initial serum NSE levels may help in prediction of seizures.

• The Korean Journal of Physiology
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• v.1 no.2
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• pp.185-191
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• 1967

In order to evaluate the elimination of CO through the lung comparing with the decrease of CO content in the blood, authors had induced acute CO poisoning on 9 dogs. Arterial CO-Hb saturation, CO concentration, %, in expired gas and eliminated CO amount through the lung were measured at 1,5,10,30,60, and 120 minutes after acute CO poisoning in 6 dogs breathing room air and 3 dogs breathing room air and oxygen alternately. Results obtained are summarized as follows. In room air breathing group, arterial CO-Hb saturation averaged 50.8% , and 53.67 ml of CO was blew off through the lung during 120 minutes and in alternately air and oBygen breathing group, the arterial CO-Hb saturation averaged 65.6% and 95.6 ml of CO was blew off through the lung. The amount of CO eliminated in expired gas for 120 minute was much less than the amount of decreased CO in arterial blood which was calculated with the decreased CO-Hb content in the estimated circulating blood volume. Such difference between the amount of eliminated CO in expired gas and the decreased CO in blood might be attributed to the oxidation of CO to $CO_2$ in the tissues. Concentration of CO in expired gas was markedly increased and the rate of decrease in arterial CO-Hb saturation is enhanced by oxygen breathing. In early period of recovery from acute CO poisoning, neither the CO concentration in expired gas, nor, the rate of CO elimination (unlit 2 minutes after CO poisoning) showed close correlation with the blood CO-Hb saturation level. The reason seemed to be due to irregularly depressed or unevenly stimulated respiration which were induced by acute CO poisoning.