• Journal of Veterinary Clinics
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• v.20 no.3
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• pp.406-409
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• 2003

We found seventeen dairy cattle with the abnormal signs in cardiovascular and gastrointestinal systems after feeding of the yew foilage. Among them three cattle were dead due to yew poisoning. Among the remaining fourteen dairy cattle, four cattle showed similar symptoms as did dead cattle. Although the remaining ten dairy cattle did not show any abnormal signs, we conducted a therapy of forced magnesium sulfate infusion because the yew consumption might have been occurred in all cattle. As a result of the therapy, we could not found further signs of yew poisoning. The performance of the therapy and the treatment procedures adapted by the therapy could be concluded as follows: The cardioselective toxicity and inhibition of peristaltic activity by the taxine in yew foilage might be involved in the symptoms of acute poisoning as anorexia, dullness, muscle tremor, dyspnea, and sudden death. We also performed the dose response relationship of taxine to the range of clinical symptoms and examined recovery performances. Through the autopsy of the cattle, we could confirm the presence of yew foilages that might have caused the poisoning in the gastrointestinal tract. However, we could not identify further abnormalities in other organs. In this case report, we demonstrated that practice of the forced magnesium sulfate infusion in yew poisoning was helpful for the attenuating the taxine poisoning by blocking the further proceeding of the toxic effect.

• Journal of The Korean Society of Clinical Toxicology
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• v.4 no.1
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• pp.1-6
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• 2006

Purpose: Hemoperfusion is an effective modality of extracorporeal elimination of toxins in acutely poisoned patients. We evaluated the effect of hemoperfusion on plasma concentration of toxins in patients exposed to certain pesticides. Methods: Eleven patients who were acutely exposed to pesticides participated in our study. We measured plasma pesticide concentration from the whole blood obtained by arterial and venous sources by gas chromatography. Results: The plasma concentrations of only 3 patients was measured. Methidation clearance by hemoperfusion was 82.2%, fenitrothion was 23%, and endosulfan was 0% Conclusion: Measurement of plasma organophosphate concentration is not a practical application. Our results suggest that hemoperfusion is applicable in patients with pesticide intoxication according to clinical status.

• Journal of The Korean Society of Clinical Toxicology
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• v.14 no.2
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• pp.92-99
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• 2016

Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were "poisoning" and "benzodiazepine" or "sedatives-hypnotics" from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non-TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.2
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• pp.103-110
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• 2015

Purpose: The purpose of this study is to evaluate the effectiveness and the adverse events of high dose insulin/euglycemia therapy in acute calcium channel blocker (CCB) poisoning. Methods: We developed a systematic search strategy and applied it to 4 electronic reference databases. We searched medical journals as well as the bibliographies of relevant articles. All forms of literature relevant to human use of high dose insulin for acute CCB poisoning were included. The literature search was conducted by two investigators in August, 2015 with publication language restricted to English and Korean. Case reports were divided between CCB overdose alone and multi-drug overdose including CCB. The effect and adverse event of high dose insulin and clinical outcome of each case were analyzed. Results: Among 55 searched studies, 20 studies were included. A prospective study, a retrospective study, a systematic review study, and 17 case reports were identified. Case reports consisted of 11 CCB alone and 12 multidrug overdose cases including CCB. Although most cases described significant clinical improvements, one of them showed no beneficial effect. Several adverse events including hypoglycemia and hypokalemia were reported. No significant sequalae from adverse events was reported. Conclusion: Although there were many case reports demonstrating successful use of high dose insulin for CCB poisoning, the effect cannot be estimated due to a possibility of publication bias. Therefore, high dose insulin/euglycemia therapy might be considered adjunctive therapy in cases of CCB intoxication refractory for standard therapy.

• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.1
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• pp.18-25
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• 2020

Purpose: We studied the impact of arterial oxygen tension (PaO₂) on the long term neurologic outcome in patients with acute carbon monoxide poisoning. Methods: The study population included 311 patients who presented to emergency department with acute CO poisoning from January 2015 to January 2018. These patients underwent arterial blood gas testing at the time of presentation. The baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was the long term neurologic status. Results: The normoxia group was significantly older and it had a higher incidence of diffusion weighted MRI abnormality, and this group needed multiple HBO sessions compared to the group with moderate or severe hyperoxia. Also, the incidence of altered mentality at discharge was higher in the normoxia group than that of the moderate hyperoxia group. The incidence of a poor long term neurologic outcome was 11.3%. The incidence of a poor long term neurologic outcome decreased as the PaO₂ increased. The PaO₂ was significantly lower in patients with a poor long term neurologic outcome than that of the patients with a good outcome 198 (165.2 to 231.1) mmHg in the good outcome group vs. 154 (119-162) mmHg in poor outcome, p<0.001). In multivariate logistic regression analysis, PaO₂ was selected as an independent factor of the poor long-term neurologic outcome (OR 0.981 (95% CI: 0.968 to 0.995)) Conclusion: Higher PaO₂ was independently associated with a lower incidence of a poor long-term neurologic outcome.

• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.2
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• pp.86-93
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• 2019

Purpose: The objective was to determine the association between PaCO₂ and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients. Methods: This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 hours later. The baseline characteristics and clinical course during hospitalization were collected and compared. The mean PaCO₂ during the first 6 hours after presentation was calculated. Results: The incidence rates of moderate (30 mmHg< PaCO₂ <35 mmHg) or severe (PaCO₂ ≤30 mmHg) hypocapnia at presentation after acute CO poisoning were 40.7% and 26.8%, respectively. The mean PaCO₂ during the first 6 hours was 33 (31-36.7) mmHg. The incidence of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total ranges of PaCO₂ variables. In multivariate regression analysis, mean PaCO₂ was independently associated with ACVEs (OR 0.798 (95% CI 0.641-0.997)). Conclusion: Mean PaCO₂ during the first 6 hours was associated with increased ACVEs. Given the high incidence of ACVEs and PaCO₂ derangement and the observed association between PaCO₂ and ACVEs, this study suggests that 1) PaCO₂ should be monitored at the acute stage to predict and/or prevent ACVEs; and 2) further study is needed to validate this result and investigate early manipulation of PaCO₂ as treatment.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.75-85
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• 2018

Purpose: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). Methods: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. Results: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was $4.4{\pm}6.7\;hours$. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. Conclusion: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS>2 and PSSsum>5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.

• 월간산업보건
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• s.343
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• pp.13-17
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• 2016

• Korean Journal of Veterinary Research
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• v.16 no.1
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• pp.97-103
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• 1976

In order to clarify the histopathological changes resulting from nitrate poisoning, rabbits were experimentally poisoned by the oral administration of $KNO_3$ or $NaNO_2$ and examined clinically and histopathologically. In addition, the quantitative changes of glycogen level in hepatic cells were histochemically observed. The results obtained were summarized as follows: 1. Clinical symptoms observed from the acute cases which died within 2 hours after the administration were severe cyanosis of visible mucosa, frequent urination, and dyspnea. However, in chronic cases administrated daily with $KNO_3$ for 43, 50 and 74 days respectively, no marked symptoms were observed. 2. Macroscopic changes observed in acute cases were severe methemoglobinemia, cloudy swelling of hepatic cells, hemorrhage and hyperemia of gastric mucosa, and hyperemia of other organs. In chronic cases there were marked hyperemia, dark-red coloring and increasing of consistency in liver and kidney, and swelling of spleen. 3. Microscopic changes observed in acute cases were hemorrhage and hyperemia of various organs, cloudy swelling and centrilobular necrosis of hepatic cells and necrosis of convoluted tubular epithelium in kidney. In chronic cases there were round cell infiltration of the interlobular connective tissue and epithelial proliferation of interlobular bile ducts in the liver, and necrosis of the convoluted tubular epithelium and proliferation of interstitial connective tissue in kidney, thickening of alveolar septa of lungs, activated hemopoiesis of bone marrow, and myeloid metaplasia of sqlenic pulp. 4. Glycogen storage in liver cells was decreased in acute cases, on the contrary, increased in chronic cases.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.102-107
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• 2018

Purpose: This study examined the association between smoking and delayed neuropsychological sequelae (DNS) in acute carbon monoxide (CO) poisoning. Methods: Patients admitted to the medical center emergency department from March 2016 to March 2017 because of CO poisoning were examined retrospectively. The patients were divided into two groups: DNS and Non-DNS group. Multiple factors were analyzed to explain DNS, which was assessed by motor disturbances, cognitive impairment, dysphagia, Parkinson-like syndromes, epilepsy, and emotional lability in CO poisoning. Results: A total of 120 patients were included. The factors related to DNS were smoking (pack-years) (p=0.002) and initial carbon monoxide-hemoglobin level (p=0.015). On the other hand, after multivariate logistic regression analysis, smoking (Odds ratio 1.07; 95% CI, 1.02-1.13; p=0.004) was the only factor associated with DNS. Conclusion: Smoking is a very reliable factor for predicting the occurrence of DNS. A history of smoking in patients who suffer from CO intoxication is important. If a patient smokes, treatment should be started actively and as soon as possible.