• 대한임상독성학회지
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• 제20권2호
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• pp.82-85
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• 2022

Traditionally, most cases of nicotine poisoning have been due to ingestion of nicotine pesticides. However, the increasing use of electronic cigarettes (e-cigarettes) has resulted in both intentional and unintentional exposure to concentrated liquid nicotine or "e-liquid" leading to an increase in nicotine poisoning cases. However, fatalities following the ingestion of the e-liquid are extremely rare. We report a rare case of cardiac arrest and severe encephalopathy following the intentional ingestion of e-liquid. We present the case of a 20-year-old woman who intentionally ingested liquid nicotine intended for e-cigarette use. She was found in asystole and experienced a return of spontaneous circulation (ROSC) after undergoing approximately 46 mins of cardiopulmonary resuscitation. Her plasma nicotine levels were >500 ng/ml. Despite aggressive supportive care, she was found to have encephalopathy consistent with severe anoxic brain injury on magnetic resonance imaging. In recent times, there have been some reports of deaths following liquid nicotine ingestion. Our case illustrates the potential for fatal nicotine toxicity from ingestion of e-cigarettes.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제33권3호
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• pp.59-66
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• 2022

Objectives: This study aimed to investigate the clinical characteristics of adolescents hospitalized through the emergency room for intentional self-harm or suicide attempts. Methods: This retrospective study used data from the Korean National Hospital Discharge In-depth Injury Survey conducted between 2006 and 2018 for individuals aged 10-24 years. The clinical characteristics of the patients were analyzed and compared across sex and age groups using the Rao-Scott chi-square tests and multiple logistic regression analysis for complex survey data. Results: The most common psychiatric diagnosis was mood disorder (22.0%), and more female patients were diagnosed with it than male patients (p=0.010). The 19-24 years age group was diagnosed with mood disorder the most compared to other younger groups (p=0.012). Male patients used lethal methods more than female patients (p=0.008), and the 19-24 years age group used more drug poisoning and cutting or piercing (p<0.001) for intentional self-harm or suicide attempts than younger groups. Conclusion: Adolescents hospitalized for intentional self-harm or suicide attempts showed significant differences in clinical characteristics across sex and age groups. These findings suggest that measures for preventing self-harm or suicide attempts need to be differentiated according to the sex and age of adolescents.

• 대한임상독성학회지
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• 제18권2호
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• pp.51-56
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• 2020

Purpose: Acute nicotine poisoning by liquid nicotine in electronic cigarettes is becoming an increasing problem worldwide. The current systematic review aimed to determine the harm of acute nicotine poisoning by reviewing published case reports. Methods: An online literature search with PubMed, Embase, Cochrane Library, and KoreaMed database was performed to identify relevant studies addressing acute nicotine poisoning with electronic cigarettes. Two investigators searched the case reports written in English or Korean. Results: Twenty-six cases were included in this study. The routes of intoxication included ingestion in 18 cases, intravenous injection in three cases, subcutaneous injection in two cases, and ocular exposure in two cases. Ten cases had a cardiac arrest, and seven of them died. Seven out of 12 cases with intentional poisoning had a cardiac arrest. Nine children under 18 years were reported, and three of them had a cardiac arrest. Sixteen cases without a cardiac arrest recovered well, except for one case with sudden sensorineural hearing loss. Conclusion: The authors reviewed the risks of electronic cigarette liquid in terms of acute poisoning through a systematic review. The nicotine solution of an e-cigarette can be life-threatening in cases of acute poisoning. Therefore, active emergency treatment with early recognition is necessary. In addition, various management methods and regulations for preventing acute nicotine poisoning, such as restriction of distribution and nicotine concentration, should be considered.

• Clinical and Experimental Emergency Medicine
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• 제5권4호
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• pp.230-239
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• 2018

Objective The suicide rate in South Korea is very high and is expected to increase in coming years. Intoxication is the most common suicide attempt method as well as one of the common reason for presenting to an emergency medical center. We used decision tree modeling analysis to identify predictors of risk for suicide by intentional intoxication. Methods A single-center, retrospective study was conducted at our hospital using a 4-year registry of the institute from January 1, 2013 to December 31, 2016. Demographic factors, such as sex, age, intentionality, therapeutic adherence, alcohol consumption, smoking status, physical disease, cancer, psychiatric disease, and toxicological factors, such as type of intoxicant and poisoning severity score were collected. Candidate risk factors based on the decision tree were used to select variables for multiple logistic regression analysis. Results In total, 4,023 patients with intoxication were enrolled as study participants, with 2,247 (55.9%) identified as cases of intentional intoxication. Reported annual percentages of intentional intoxication among patients were 628/937 (67.0%), 608/1,082 (56.2%), 536/1,017 (52.7), 475/987 (48.1%) from 2013 to 2016. Significant predictors identified based on decision tree analysis were alcohol consumption, old age, psychiatric disease, smoking, and male sex; those identified based on multiple regression analysis were alcohol consumption, smoking, male sex, psychiatric disease, old age, poor therapeutic adherence, and physical disease. Conclusion We identified important predictors of suicide risk by intentional intoxication. A specific and realistic approach to analysis using the decision tree modeling technique is an effective method to determine those groups at risk of suicide by intentional intoxication.

• 대한임상독성학회지
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• 제11권1호
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• pp.9-18
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• 2013

Purpose: Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide stocking and delivery system for emergency antidotes in Korea. We report on a two-year experience of a nationwide stocking and delivery trial for emergency antidotes at emergency departments in Korea. Methods: An expert panel of clinical toxicologists reviewed and made a list of 15 stocked antidote. These antidotes were purchased or imported from other countries and delivered from 14 antidote stocking hospitals nationwide 24 hours per day, seven days per week. Results: From August 1, 2011 to April 30, 2013, 177 patients with acute poisoning, with a median age of 48.5 years, were administered emergency antidotes. The causes of poisoning were intentional in 52.0% and 88.0% were intentional as a suicide attempt. Regarding clinical severity, using the poisoning severity score, 40.7% of patients had severe to fatal poisoning and 39.0% had moderate poisoning according to clinical severity. The most frequent presenting symptom was neurologic deficit, such as altered mentality (62.7%). alerted mentality (62.7%). Emergency antidotes were administered as follows: methylene blue (49 cases), flumazenil (31), N-acetylcysteine (25), glucagon (17), 100% ethanol (15), cyanide antidote kit (12), anti-venin immunoglobulin (5), pyridoxine (4), hydroxocobalamine (2), and deferoxamine (1). The median time interval from antidote request to delivery at the patient's bedside was 95 minutes (interquartile range 58.8-125.8). Conclusion: Findings of this study demonstrated the possibility of successful operation of the nationwide system of emergency antidotes stocking and delivery in Korea.

• Clinical and Experimental Pediatrics
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• 제51권2호
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• pp.116-121
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• 2008

Unintentional injuries are the most important cause of morbidity and mortality in the pediatric population, and the home is the most common site of injury for children in Korea. The most common cause of injury was slip down. Fall down and burn were frequent in infant/toddlers group, automobile and bicycle accident more frequent in preschool children. Findings from the survey could then be used to provide targets for direct educational efforts by medical services and to direct environmental safety modifications tailored to the unique situation of each family. Pediatric toxic ingestions are treated commonly by pediatricians and emergency physicians. Significant injury after these ingestions is infrequent, but identifying the dangerous ingestion is sometimes a difficult task. By performing a detailed history, focused physical examination, and directed laboratory evaluation, an estimation of risk can be developed. According to recent Korean poison papers, there were bimodal peak of age distribution in poisoned children patient on the whole: infant and adolescents group. Various types of materials belonged the classes of drugs, household products, and industrial solvents. Most of the poisoned children patients had been poisoned accidentally, while most cases of adolescents poisoning had been intentional. More than half of the adolescents group had a suicidal purpose in Korea, so an understanding of the demographic factors associated with self-harm poisoning may provide useful information to improve prevention and treatment strategies.

• 대한임상독성학회지
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• 제18권1호
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• pp.34-41
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• 2020

Purpose: This study evaluated aggressive hyperbaric oxygen therapy (HBOT) by understanding various exposure routes of acute carbon monoxide (CO) poisoning, the risk factors causing acute cardiovascular, and neurological toxicity caused by poisoning. Methods: A retrospective study was conducted based on the medical records of 417 acute CO poisoning patients who visited the emergency care unit from March 2017 to August 2019. The exposure routes, HBOT performance, age, sex, medical history (hypertension, diabetes mellitus, ischemic heart disease, heart failure), intentionality, loss of consciousness (LOC), intake with alcohol or sedatives, and initial test results (carboxyhemoglobin (COHb), troponin-I, electrocardiography, echocardiography, brain MRI) were examined. Comparative analysis of the clinical information was conducted between the groups that showed acute cardiovascular toxicity and neurological toxicity, and groups that did not. Results: Among 417 patients diagnosed with acute CO poisoning, 201 cases (48.2%) were intentional, and charcoal briquette was the most common route (169 patients (40.5%)). Two hundred sixteen cases (51.8%) were accidental, and fire was the most common route (135 patients (32.4%)). The exposure route was more diverse with accidental poisoning. Three hundred ninety-nine patients were studied for acute cardiovascular toxicity, and 62 patients (15.5%) were confirmed to be positive. The result was statistically significant in intentionality, LOC, combined sedatives, initial COHb, HTN, and IHD. One hundred two patients were studied for acute neurological toxicity, which was observed in 26 patients (25.5%). The result was statistically significant in age and LOC. Conclusion: Active HBOT should be performed to minimize damage to the major organs by identifying the various exposure routes of CO poisoning, risk factors for acute cardiovascular toxicity (intentionality, LOC, combined sedatives, initial COHb, HTN, IHD), and the risk factors for acute neurological toxicity (age, LOC).

• 정신신체의학
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• 제28권2호
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• pp.116-125
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• 2020

연구목적 자살시도로 응급실에 내원한 환자들 중 음독이 가장 높은 빈도를 보이고 있다. 본 연구에서는 음독 의약품에 따른 자살 시도자들의 특성을 분석하여 향후 임상 진료 현장에서 도움이 될 제언과 자살 예방 정책을 마련하는데 기초자료를 제공하고자 하였다. 방 법 2011년부터 2019년까지 서울 소재 1개 종합 병원 응급실에 음독 자살 시도 후 내원한 환자 574명의 의무기록을 후향적으로 검토하였다. 의무기록을 통해 인구통계학적 정보 및 자살 과거력, 정신건강의학과 과거력, 정신질환 외 기저질환력, 음독 약물의 종류 및 양, 획득 경로, 단일 혹은 혼합 음독여부 등에 대해서 조사 후 카이제곱 검정 및 독립표본 t-검정을 사용하여 통계 분석하였다. 유의한 결과에 대해서는 위험률 산출을 위해 오즈비를 구하였다. 결 과 일반의약품 음독군이 전문의약품 음독군에 비해 연령은 유의하게 낮았으며 국민건강보험 외 비율은 낮고 배우자가 있는 비율은 유의하게 높았다. 전문의약품 음독군은 일반의약품 음독군에 비해 비자발적 응급실 내원, 정신질환력 및 정신질환 외 기저질환력에서 높은 비율을 보였다. 전문의약품 중 벤조디아제핀 음독군은 비음독군에 비해 본인 처방 비율이 높은 반면 졸피뎀 음독군은 타인처방 비율이 높았다. 벤조디아제핀, 졸피뎀, 항우울제 단독 음독군이 복합 음독군에 비해 유의하게 정신질환력이 없는 비율이 높았다. 결 론 일반의약품 판매 규제에 대한 가이드라인이 필요할 것이며 임상 현장에서 자살 고위험군의 특성을 유념한 면담이 필요하다. 또한 자살 위험성이 높은 환자들에게 전문의약품 처방 시 추적 관찰 기간 및 처방 기간, 포장 방식에 대한 적극적인 고려가 필요할 것으로 보인다.

• 대한임상독성학회지
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• 제8권1호
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• pp.46-49
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• 2010

"Stacker 3" is one of the most popular caffeine-containing weight-reduction supplements and it has ephedra-free properties as "Stacker 2 Ephedra-Free" in many countries, including Korea. We describe here a 26-year-old woman who took an acute intentional overdose of "Stacker 3"(approximately 50 capsules, total amount: 25 grams, as caffeine 250 mg/kg) and who had delirium, rhabdomyolysis and acute renal failure. She had to be treated by forced diuresis and urine alkalinization, and she subsequently recovered. This is the first such case report in the medical literature.

• 대한임상독성학회지
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• 제5권1호
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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.