• Journal of The Korean Society of Clinical Toxicology
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• v.21 no.2
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• pp.143-150
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• 2023

Purpose: This study aimed to compare the clinical features of methanol and ethylene glycol poisoning. Methods: This single-center retrospective observational study included patients with toxic alcohol poisoning who visited a regional emergency medical center. Patients with methanol and ethylene glycol poisoning from January 2004 to June 2023 were selected for the study using diagnostic codes. Results: Twenty-two patients with toxic alcohol poisoning visited during the study period, with 11 patients for each category. Compared to methanol poisoning, ethylene glycol poisoning patients were more likely to have consumed alcohol for suicidal purposes (n=4 [36.36%] vs. n=8 [72.73%]) and were more likely to be drowsy (n=0 vs. n=6 [54.55%], p=0.016). The anion gap (25.43±8.35 mmol/L vs. 13.22±6.23 mmol/L, p=0.001) and lactic acid levels (1.785 [1.3-2.785] mmol/L vs. 9.90 [4.20-11.81] mmol/L, p=0.007) were higher in ethylene glycol poisoning patients than in methanol poisoning patients. Among alcohol dehydrogenase blockers, oral ethanol was administered to 10 patients (45.45%) (n=4 [36.36%] vs. n=6 [54.55%]), and intravenous ethanol was administered to six patients (n=4 [36.36%] vs. n=2 [18.18%]). Fomepizole was administered to two patients (9.09%) each, and renal replacement therapy was non-significantly more common in patients with ethylene glycol poisoning (n=8 [72.73%] vs. n=3 [27.27%], p=0.128). Three patients had delays in diagnosis and treatment, and while there were no fatalities, one patient was left with permanent vision damage. Conclusion: Because these are uncommon types of poisoning and the clinical presentation is difficult to recognize early, healthcare providers should be familiar with toxic alcohol types and screen for them to ensure proper diagnosis and treatment.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.29 no.4
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• pp.541-549
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• 2019

Objectives: This study aims to examine patients who developed acute pesticide poisoning while spraying or using pesticide and presented to the emergency department in hospitals in Chungcheongnam-do Province. Based on the findings, this study will provide implications for safety and health management pertaining to the use of pesticides. Methods: Pesticide poisoning data collected by the Chungnam Center for Farmers' Safety and Health from 2014 to 2018 was cross-sectionally analyzed. A total of 331 patients with pesticide poisoning presented to one of hospitals and four of medical centers in the region(Dankuk University Hospital, Gongju and Hongsung, Cheongyang, Cheonan Medical Center). Seventeen of these patients (15 men and two women) developed poisoning while spraying pesticide. The patients' charts were reviewed to collect data on pesticide poisoning, namely currently working in farming-related occupation, means of transportation to the hospital, place of poisoning, symptoms of acute pesticide poisoning, treatment, pesticide used when poisoning occurred, and classification by technical ingredients. Results: Fifteen out of 17 patients who developed poisoning while spraying pesticide were men. Insecticide was used in 35.3% of the cases, and herbicide was used in 29.4% of the cases, which was different from cases of poisoning from ingestion poisoning. The major symptoms were vomiting (35.3%), nausea (29.4%), dizziness (29.4%), and headache (23.5%). A total 11 ingredients were identified in 12 patients, and the most common ingredient was glyphosate, which is an herbicide. Most patients showed a state of mild toxicity, but two patients showed a state of severe toxicity. These patients respectively used glyphosate and paraquat. Conclusions: Our findings can be useful for suggesting the need for a national healthcare system to manage occupational pesticide poisoning among farmers. Further, these findings can be used to increase the awareness of the risk of acute poisoning during pesticide spraying and suggest the need for a safety health education to increase farmers' awareness of pesticide poisoning.

• Korean Journal of Veterinary Service
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• v.35 no.1
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• pp.53-57
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• 2012

This is a case report about rape poisoning in a Hanwoo. Non-protein nitrogen (NPN) compound in rape may cause poisoning in domestic animals. Rape poisoned cattle may show big and rapid breath with opening its mouth, edema and erosion of skin with itching, drooling, dyspnea and indigestion. Besides there can be shown neurological (blindness) and urological (red water) symptoms in some cases. There is no effective therapy for rape poisoning, therefore stopping the rape supplying is basically important. Clinical symptoms and history taking are very important factors in diagnosis of rape poisoning, due to the absence of diagnostic standard of judgment for rape poisoning. A Hanwoo 38 months old cow, in a farm located in Gyeoungbuk province showed typical rape poisoning symptoms such as breath with opening its mouth, drooling, dyspnea and hyperphotosensitivity, and dramatical recovery were occurred after stopping supplying of rape. The cow were diagnosed as the rape poisoning based on observation of clinical symptoms and history taking.

• Journal of agricultural medicine and community health
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• v.33 no.2
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• pp.193-203
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• 2008

Objectives: The aim of this study was to investigate the characteristics of acute poisoning cases admitted to a local emergency department in an urban-rural area. Methods: This retrospective study included all patients with acute poisoning who admitted the emergency department between June 2004 and May 2005. We analyzed the medical records for etiological and demographical characteristics of the acutely poisoned patients. Results: There were 155(1.0%) poisoning cases among 15,457 admitted to the emergency department. Of the admitted cases, 51.0% were female and 49.0% male. The poisoning made a peak in the age range of 30-39 and over 60. The seasonal distribution in poisoning patients suggested a peak in spring(38.1%) and summer(24.5%). The majority of exposures(95.5%) occurred in patient's home, 81.8% were deliberate. The most common agents of acute poisoning in deliberate causes were drugs(p<0.01). All of deliberate cases were suicidal attempts. The most common poisoning cases were pesticides in male, but in female were medications(p<0.01). Overall mortality rate of total cases were 12.9%. The overall mortality rate was higher in male(p<0.05), increasing age(p<0.05) and intentional ingestion(p<0.05), pesticides poisoning(p<0.05). Conclusions: The study forms a foundation for future work on poisoning epidemiology which hopefully will facilitate the allocation of preventive services in order to reduce the incidence as well as morbidity and mortality of toxic exposures.

• 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.3 no.2
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• pp.86-92
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• 2005

Purpose: The main cause of death due to acute organophosphate (OP) poisoning is believed acute respiratory failure caused by cholinergic reactions. Recently, advances in respiratory and intensive care make it possible to maintain the respiratory function of patients with OP poisoning, but the mortality rates remain high. The present study clarified the hemodynamics of patients with acute lethal OP poisoning. The purpose of this study was to analyse the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive care. Methods: We reviewed medical and intensive care records of patients with acute OP poisoning admitted to emergency department and ICU between March 1998 and Aug 2005. We collected patient information regarding poisoning, clinical, and demographic features. Results: During the study period, 67 subjects treated with intensive care and ventilator management in addition to gastric decontamination standard therapy with atropine and 2-PAM. Of 67 patients, 13 died. Kaplan-Meier survival analysis demonstrated a steep decline in the cumulative survival to $86.6\%$ during the first week. Mean arterial pressure < 60 mmHg within the first 24 hours was recognized as a poor prognostic indicators among mechanical ventilated patients. Conclusion: Most OP poisoning-related deaths occurred within the first week of poisoning. Mean arterial pressure lower than 60 mmHg might be the best predictor of poor outcome. We speculated that the refractory hypotension is the leading cause of death in patients with lethal OP poisoning that receiving mechanical ventilation and maximal supportive care.

• Journal of The Korean Society of Clinical Toxicology
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• v.15 no.2
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• pp.86-93
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• 2017

Purpose: Some advanced countries have reported annual statistics for poisoning based on data from poison control centers. This study was conducted to propose a baseline format and statistics of poisoning in Korea from a national representative database. Methods: This study was a retrospective analysis of poisoning patients based on data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2016. Bite or sting injuries were not included. Variables related to poisoning were summarized using a similar format as the National Poison Data System in the United States. Results: A total of 7,820 poisoning patients presented to 23 EDs. Adults ${\geq}20$ years accounted for 84% of the population, while the proportion of intentional poisoning was 59.4%. The most common poisoning substances were therapeutic drugs (45%), gas (21%), pesticides (15%), and artificial toxic substances (13%). Overall, 34.5% of patients were admitted for further treatment. The mortality was 3.2% (248 cases), and the most common causative substances were carbon monoxide, glyphosate, and paraquat, in order. Conclusion: This study showed the recent status of poisoning in Korea. However, a comprehensive poisoning registry based on poison control centers may be required to provide more accurate national statistics in the future.

• Journal of Environmental Health Sciences
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• v.5 no.1
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• pp.25-39
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• 1978

Carbon monoxide poisoning is one of the most serious health problems in Korea. In this review, the author made a intensive reference review on the causes of carbon monoxide poisoning, the patterns of carbon monoxide poisoning and the prospects of CO poisoning. Following findings were induced through the review. 1. Carbon monoxide poisoning is influenced by variable social factors than any other diseases or accidents and is more closely related with the economical and cultural parameters of the community. 2. The increase of risk in the populatlon is expected by National Energy Policy and the hazards of CO poisoning will rather be increasing as long as no radical control measure will be taken. 3. More practical control measure, including extensive public relation service, should be established to eradicate this serious health hazard in Korea.

• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.2
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• pp.57-65
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• 2020

Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). Conclusion: Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

• Journal of Environmental Health Sciences
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• v.46 no.5
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• pp.565-575
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• 2020

Objective: South Korea still lacks systematic national poisoning data collection or a poison control center (PC). The objectives of this study are to provide estimates of poisoning incidents in South Korea and to stress the necessity of a national poisoning surveillance framework managed by a national PC. Method: The number of poisoning incidents was estimated based on the 2018 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Our estimation of poisoning data was classified according to age group, reason for poison exposure, and case management site. Results: Total poisoning cases estimated numbered 326,636, which is tantamount to 631 cases per 100 thousand. Poisoning cases among those younger than five years old accounted for 71.7% in the United States. Fatal poisoning cases were estimated to be 210.63 (95% CI: 199.70-222.15). Non-intentional poisoning cases (250,378 cases, 95% CI: 249,992-250,764, 76.7%) were estimated to be far higher than intentional cases (62,399 cases, 95% CI: 62,207-62,593, 19.1%). Conclusion: Our results can be used to suggest the necessity of producing national poisoning data and establishing a PC despite the uncertainty of estimation.