• 대한임상독성학회지
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• 제1권1호
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• pp.6-11
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• 2003

Various forms of dialytic techniques are available for detoxification. Hemodialysis, hemoperfusion and hemofiltration (hemodialfiltration) are the main treatment modalities. Because these modalities are rather invasive and expensive, it must be decided in balance of the risk and benefit to the patient. The prime consideration in the decision is based on the clinical features of poisoning; hemodialysis or hemoperfusion should be considered in general if the patient's condition progressively deteriorates despite intensive supportive therapy. The hemodialysis technique relies on passage of the toxic agent through a semipermeable membrane so that it can equilibrate with the dialysate and subsequently removed. It needs a blood pump to pass blood next to a dialysis membrane, which allows agents permeable to the membrane to pass through and reach equilibrium. Solute (or drug) removal by dialysis has numerous determinants such as solute size, its lipid solubility, the degree to which it is protein bound, its volume of distribution etc. The technique of hemoperfusion is similar to hemodialysis except there is no dialysis membrane or dialysate involved in the procedure. The patient's blood is pumped through a perfusion cartridge, where it is in direct contact with adsorptive material (usually activated charcoal) that has a coating material such as cellulose. This method can be used successfully with lipid-soluble compounds and with higher-molecular-weight compounds than for hemodialysis. Protein binding does not significantly interfere with removal by hemoperfusion. In conclusion, hemodialysis, hemoperfusion and hemofiltration can be used effectively as adjuncts to the management of severely intoxicated patients.

• 대한임상독성학회지
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• 제2권2호
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• pp.96-100
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• 2004

Purpose: This study was to investigate the effects of ethanol in ingested patients by analyzing data from a single institution's registry, Methods: We conducted a prospective study of 50 patients who has ingested drugs with/without ethanol came to emergency department from January 2004 to May 2004. Only patients over 18 years of age were included. Clinical characteristics, general and specific treatment, laboratory finding, complication, and clinical outcomes were obtained from protocol. Patients were divided into two groups: drug ingested with alcohol (ethanol group, n=18), and ingested without alcohol (non-ethanol group, n=32). Results: The age, the amout of ingestion, the time to treatment, the systolic blood pressure, the diastolic blood pressure and the shock duration were not different between two groups. The AST level with the ethanol group was higher than with the non-ethanol group ($230.94\pm518.88$ U/L vs $43.22\pm63.39$ U/L, p=0.002). The ALT level with the ethanol group was higher than with the non-ethanol group ($97.06\pm152.98$ U/L vs $32.75\pm43.10$ U/L, p=0.001). The lactic acid level with the ethanol group was higher than with the non-ethanol group ($7.40\pm6.33$ mmol/L vs $3.77\pm3.10$ mmol/L, p=0.001). The hospital stay duration and the admission rate were not different between two groups. Conlusions: The ethanol increased the levels of serum AST, ALT and lactic acid in intoxicated patients. But the ethanol dose not increase admission rate and duration of admission stay in intoxicated patients.

• 한국도서관정보학회지
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• 제26권
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• pp.131-168
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• 1997

The future of a country is influenced by the youth. Sound fostering of the youth is important for the country's future. Because of mechanization, industrialization and urbanization of our society, many social problems, such as confusion of the sense of value, dehumanization, money worshi n.0, ppings, juvenile delinquency are increasing. For the solution of problems of juvenile crime and dehumanization, bibliotherapy should be practiced in juvenile reformatories, schools and societies. The purpose of this study is to investigate the effectiveness and value of reading. And also the characteristics, brief history, principles and procedures of bibliotherapy are examined. In addition, the book catalog suitable for bibliotherapy is considered. The results of the study are as follows. (1) In order to solve the problem of dehumanization, and the confusion of the sense of value among young adults, we should enrich and cultivate the characters of young adults through the bibliotherapy. So, bibliotherapy for the treatment of human nature of juveniles should be practiced in the juvenile reformatories, schools and societies. (2) The values of reading in the past were inspiration, information and recreation. But, in recent times, the interest in therapeutic value of reading is increasing. (3) Bibliotherapy is a kind of psychotherapy using selected reading materials. A n.0, pplication scopes of bibliotherapy are very wides, including mental medicine, alcoholic poisoning, drug addiction, juvenile delinquency, counselling and education for school life, etc. (4) The principles of bibliotherapy consist of identification, catharsis, insight and it has self therapeutic principles through the reading. The procedures of bibliotherapy is similar to any other kind of psychotherapy: the participant's statement, diagnosis, treatment, continuous recognition of remedial value. (5) The well suited reading materials for bibliotherapy are literature and biography. Literature and biography are familiar to everyone, because they describe the mentalities, emotions and life styles of human beings. (6) The standard reading lists for bibliotherapy for the proper guidance of juvenile delinquency should be prepared for the solution of developmental tasks, such as, drinking, smoking, friendship, family, love, money, marriage, pregnancy, violence, etc. Finally, Bibliotherapy should be introduced to our school settings and corrections institutions for the proper guidance and prevention of the malpractice of the youths. In addition, we should be endeavor to develop the standard reading lists for bibliotherapy and case study.

• 대한임상독성학회지
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• 제10권2호
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• pp.111-117
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• 2012

Purpose: In Korea, few studies have examined the acute toxicity of anti-obesity drugs. The purpose of this study is to analyze the general characteristics and clinical aspect of acute anti-obesity drug intoxication. Methods: We retrospectively investigated patients admitted to the emergency department after anti-obesity drug intoxication between March, 2004 and February, 2012. The medical records of these patients were reviewed for demographic data, toxicologic history, time elapsed to presentation, clinical symptoms and signs, treatment, and outcome. Results: There were a total of 18 anti-obesity intoxication cases during the study period; of 16 which were included in our study. The purchasing route of the anti-obesity drug was mainly through a doctor's prescription (68.8%), however, some were obtained through the internet and the pharmacies. The mean time to The most commonly ingested antiobesity drug was sibutramine (31.3%) and many of the cases (62.5%) were multi-drug ingestions. The most common clinical manifestations were gastrointestinal symptoms (94%), but, CNS symptoms (75%) and cardiovascular symptoms (75%) were almost equally present. 13 patients (81%) were discharged after clearance of toxic symptoms and signs with a mean observational period of 7.0 hours. 3 patients were admitted for observation and treatment; of which 1 patient died due to fatal complications. Conclusion: Most anti-obesity intoxications show mild toxicity and a nonfatal clinical course. However, the recent trend toward prescribing psychostimulant anti-obesity medication, which can be fatal after an acute overdose, calls physicians' attention to treating of anti-obesity intoxications.

• 한국산업보건학회지
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• 제18권1호
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• pp.32-40
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• 2008

Methyl bromide has been used as a representative fumigant for quarantine, and several poisoning cases have occurred recently by this chemical in Korea. The purpose of this study is to evaluate workers' exposures to airborne methyl bromide in the importing and exporting plant products quarantine companies. Air samples were collected 400/200 mg Anasorb 747TM and were analyzed by gas chromatograph /flame ionization detector according to the Occupational Safety and Health Agency (OSHA) Method PV2040. Geometric mean (GM) and arithmetic mean (AM) of total 27 workers' exposure concentrations to airborne methyl bromide were 1.12 ppm and 0.24 ppm, respectively. Two exposures(12.1 ppm and 12 ppm as 8hr-TWA) of total 27 workers' exposures exceeded the Korean standard (5 ppm) of Ministry Labor, while 4 exposures (15%) exceeded the Threshold Limit Value (TLV) (1 ppm) of American Conference of Governmental Industrial Hygienists (ACGIH). Seven samples (11%) of total 63 short-term air samples exceeded the OSHA Permissible Exposure Limit (PEL) 20 ppm (Ceiling). The opening (management) task in wood fumigation by tent showed the highest short-term exposure concentrations (AM: 18.6 ppm, GM: 0.58 ppm, maximum: 340.7 ppm). The maximum level in treatment task of the same process was 2.01 ppm. Methyl bromide concentrations in opening operation was significantly higher than that in treatment operation (p<0.05). In conclusion, the GM of workers' 8hr-TWA exposures to airborne methyl chloride in the importing/exporting plant quarantine industry was estimated below the ACGIH TLV (1 ppm). However, opening task in the fumigation of wood being covered with tent or fumigation of pant products in container showed the levels exceeding ACGIH TLV (1 ppm), and opening task in the fumigation of wood being covered with tent showed the level exceeding the Korean standard of Ministry of Labor (5 ppm).

• 대한임상독성학회지
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• 제11권2호
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• pp.81-88
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• 2013

Purpose: The aim of this study is to investigate current status, indications, and complications of hyperbaric oxygen therapy. Methods: A retrospective investigation of patients who underwent hyperbaric oxygen therapy at a university medical center from September 2004 to August 2013 was conducted based on patients' medical records and results of an email survey for 99 emergency centers. Results: During the study period, a total of 233 patients underwent hyperbaric oxygen therapy. Indications for hyperbaric oxygen treatment of illness or injury were as follows: 1) 151 cases of acute carbon monoxide poisoning(65.4%), 2) flap wound management, including 42 cases(18.2%), 3) skin care transplanted, including 23 cases(10.4%), 4) Burger's disease, including 5 five cases(2.1%), respectively. Total application time$^*$ frequency was 1,088 and total time was 1,239 hours. Among 233 patients who underwent hyperbaric oxygen therapy, 32 patients(13.7%) had complications: 1) otalgia in 21 cases(9.0%), 2) mastoiditis?in six cases(2.6%), 3) hemotympanum in five cases(2.1%), respectively. There were only 8 emergency centers that currently had an operational hyperbaric oxygen chamber in 77 emergency centers(10.4%). Conclusion: Indications identified through this study showed difference from current indications worldwide. It seems necessary that physicians' perception regarding application of hyperbaric oxygen therapy for more indications be changed and improved. A hyperbaric chamber capable of providing respiratory assistance and intensive care is also needed. A good network for sharing treatment experiences and a specialized team for administration of hyperbaric oxygen therapy is also required.

• 한국임상약학회지
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• 제23권1호
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• pp.57-64
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• 2013

Purpose: Drug can be hazardous for people if misused although they are useful for their indication. In urgent incidences such as overdose, proper treatment for intoxication can save patients' lives. In emergent case regarding drug overdose, pharmacists should know how to provide correct information including antidote to other healthcare providers. However, in Korea, there is neither regular class nor education material regarding detoxification. Therefore, the object of our study is to investigate the perception of pharmacists about it. Method: We surveyed hospital pharmacists by means of self-reporting questionnaire in order to investigate the pharmacists' perception of detoxification treatments from May $12^{th}$ 2012 to August $10^{th}$ 2012. The questionnaire comprised of demographic information, interest in detoxification treatment (inquiry from patients and education about antidote), knowledge of antidote, effective drug search route and perception of the need for education and stocking materials about antidotes). Results: It included total 281 hospital pharmacists from 30 hospitals in S. Korea. Of them, only 16.7% have been questioned about drug overdose from patient or representative and 35% have learned about antidotes in case of drug overdose through education program of Korean association of hospital pharmacist or university. About 98% thought that education and stocking materials about frequently overdosed drug and antidotes are helpful for patients in emergent case. Also, the percentage of correct answer of each questions about antidotes were higher in educated group ($p{\leq}0.001$). The more work years are, the percentage of correct answer of each questions are higher ($p{\leq}0.001$). Conclusion: In conclusion, it will be helpful for reducing damage by drug overdose that pharmacists take regular education about antidote for all pharmacist and pharmacy student. In addition, preparing and keeping booklet for Korean Style-antidote in pharmacy is needed currently for protecting public health.

• 대한임상독성학회지
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• 제6권2호
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• pp.130-133
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• 2008

In South Korea, attempted suicide by paraquat (PQ) intoxication is fairly common, and is lethal by pulmonary fibrosis and hypoxemia. However, the treatment of PQ poisoning is primarily supportive management. To increase the survival rate associated with PQ intoxication, many treatments have been developed. Here, we treated a case of PQ intoxication with steroid pulse therapy. A 23-year-old man was admitted to the hospital because of PQ intoxication. He drank two mouthfuls of Gramoxon (24% commercial paraquat). His vital signs were stable, but he had a throat infection, and navy blue urine in the sodium dithionite test. Standard treatment, including gastric lavage with activated charcoal was performed, and emergent hemoperfusion with a charcoal filter was initiated 11 h after PQ ingestion. Pharmacotherapy was initiated 18 h after PQ ingestion with the administration of 5 mg dexamethasone. On day 10, chest PA showed pulmonary fibrosis. Therefore, we initiated steroid pulse therapy, with 1g methylprednisolone in 100 mL of D5W administered over 1 h repeated daily for 3 days, and 1 g cyclophosphamide in 100 mL of D5W administered over 1 h daily for 2 days. On day 15, dexamethasone therapy was initiated. On day 30, pulmonary fibrosis was improved. Thus, if pulmonary fibrosis becomes exacerbated after dexamethasone therapy during the subacute stage, pulse therapy with methylprednisolone and cyclophosphamide could be helpful.

• 대한임상독성학회지
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• 제16권2호
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• pp.108-115
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• 2018

Purpose: Glehnia littoralis has been reported to have several pharmacological properties but no in vivo reports describing the protective effects of this plant on${\alpha}$-amanitin-induced hepatotoxicity have been published. ${\alpha}$-Amanitin is a peptide found in several mushroom species that accounts for the majority of severe mushroom poisonings leading to severe hepatonecrosis. In our previous in vitro study, we found that ${\alpha}$-amanitin induced oxidative stress, which may contribute to its severe hepatotoxicity. The aim of this study was to investigate whether Glehnia littoralis acetate extract (GLEA) has protective antioxidant effects on ${\alpha}$-amanitin-induced hepatotoxicity in a murine model. Methods: Swiss mice (n=40 in all groups) were divided into four groups (n=10/group). Three hours after giving ${\alpha}$-amanitin (0.6 mg/kg, i.p.) to the mice, they were administered silibinin (50 mg/kg/d, i.p.) or Glehnia littoralis ethyl acetate extract (100 mg/kg/d, oral) therapies once a day for 3 days. After 72 hours of treatment, each subject was killed, cardiac blood was aspirated for hepatic aminotransferase measurement, and liver specimens were harvested to evaluate the extent of hepatonecrosis. The degree of hepatonecrosis was assessed by a pathologist blinded to the treatment group and divided into 4 categories according to the grade of hepatonecrosis. Results: GLEA significantly improved the beneficial functional parameters in ${\alpha}$-amanitin-induced hepatotoxicity. In the histopathological evaluation, the toxicity that was generated with ${\alpha}$-amanitin was significantly reduced by GLEA, showing a possible hepatoprotective effect. Conclusion: In this murine model, Glehnia littoralis was effective in limiting hepatic injury after ${\alpha}$-amanitin poisoning. Increases of aminotransferases and degrees of hepatonecrosis were attenuated by this antidotal therapy.

• 대한임상독성학회지
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• 제20권1호
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• pp.8-14
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• 2022

Purpose: This study was undertaken to investigate how sedative-hypnotics affect the occurrence and severity of the patient's symptoms. In addition, we conducted a study to determine the type of patients who reacted severely and required hospitalization; patients were accordingly classified as hospitalized patients and patients discharged from the emergency room. Methods: From January 2017 to December 2019, we investigated the demographics, drug information, history, laboratory tests, and severity of patients who visited our emergency department and were diagnosed with benzodiazepine, zolpidem, and doxylamine succinate overdose. We further compared details of hospitalized patients and discharged patients. Results: Subjects who had overdosed and visited the ED included 120 for benzodiazepine, 147 for zolpidem, and 27 for doxylamine succinate. Comparisons between the three groups revealed differences in their early diagnosis, psychiatric history, and sleep disturbance. Differences between groups were also determined for mental state, poisoning history, treatment received in the intensive care unit, and intubation and ventilator support. In cases of benzodiazepine overdose, we obtained a high hospitalization rate (40.0%), admission to the intensive care unit (24.2%), and intubation rate (18.3%). Comparisons between hospitalized patients and discharged groups showed differences in transferred patients, early diagnosis, and mental state. Conclusion: Patients poisoned by sedative-hypnotics are increasing every year. In cases of benzodiazepine and zolpidem, the hospitalization rates were high, and benzodiazepine overdose resulted in hospitalization, intensive care unit admission, and pneumonia in a majority of cases. Therefore, active treatment and quick decisions in the emergency room are greatly required.