Journal of The Korean Society of Clinical Toxicology

Eui Jung Lee

4 Articles

Continuous Control of Acetaminophen Poisoning after Implementation of Regulation for Ease Access of Acetaminophen: Cohort Study from Emergency Department Based in-depth Injury Surveillance: Seung Jik Jo, Hyun Young Gang, Si Jin Lee, Gyu Hyun Bae, Eui Jung Lee, Kap Su Han, Su Jin Kim, Sung Woo Lee; J Korean Soc Clin Toxicol. 2020;18(2):57-65. Published online December 31, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.2.57

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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.

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Analysis of 2011-2020 intentional drug poisoning in children and adolescents
Jin Seok Park, Jin Seong Cho, Jae-Hyug Woo, Jae Ho Jang, Woo Sung Choi, Yong Su Lim, Jea Yeon Choi
Pediatric Emergency Medicine Journal.2023; 10(4): 132. CrossRef

Extracorporeal Life Support in Acute Poisoning: Si Jin Lee, Gap Su Han, Eui Jung Lee, Do Hyun Kim, Kyoung Yae Park, Ji Young Lee, Su Jin Kim, Sung Woo Lee; J Korean Soc Clin Toxicol. 2018;16(2):86-92. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.86

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Abstract PDF: Purpose: Cardiovascular or respiratory complications of acute intoxication are the most common causes of mortality. Advanced cardiac life support (ACLS) or specific antidotes help manage these cardiac or respiratory complications in acute intoxication. On the other hand, some cases do not respond to ACLS or antidotes and they require some special treatment, such as extracorporeal life support (ECLS). ECLS will provide the chance of recovery from acute intoxication. This study examined the optimal timing of ECLS in acute intoxication cases. Methods: This paper is a brief report of a case series about ECLS in acute poisoning. The cases of ECLS were reviewed and the effects of ECLS on the blood pressure and serum lactate level of the patients were analyzed. Results: A total of four cases were reviewed; three of them were antihypertensive agent-induced shock, and one was respiratory failure after the inhalation of acid. The time range of ECLS application was 4.8-23.5 hours after toxic exposure. The causes of ECLS implementation were one for recurrent cardiac arrest, two for shock that did not respond to ACLS, and one for respiratory failure that did not respond to mechanical ventilator support. Three patients showed an improvement in blood pressure and serum lactate level and were discharged alive. In case 1, ECLS was stared at 23.5 hours post toxic exposure; the patient died due to refractory shock and multiple organ failure. Conclusion: The specific management of ECLS should be considered when a patient with acute intoxication does not recovery from shock or respiratory failure despite ACLS, antidote therapies, or mechanical ventilator support. ECLS improved the hemodynamic and ventilator condition in complicated poisoned patients. The early application of ECLS may improve the tissue perfusion state and outcomes of these patients before the toxic damage becomes irreversible.

Changes in Toxicological Characteristics after Sales of Nonprescription Drugs in Convenience Stores: Chang Yeong Kim, Eui Jung Lee, Sung Woo Lee, Su Jin Kim, Kap Su Han; J Korean Soc Clin Toxicol. 2018;16(1):42-48. Published online June 30, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.1.42

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Abstract PDF: Purpose: On November 15, 2012, sales of OTC (Over-The-Counter) drugs began at convenience stores, which changed the accessibility of some drugs. As a result, the exposure and access patterns of these drugs could have changed. In this study, we reviewed the changes in the characteristics of drug poisoning patients because of the reposition of nonprescription drugs according to the revised Pharmaceutical Affairs Act. Methods: A retrospective study was conducted to evaluate changes in characteristics of drug poisoning patients between 2008 and 2016. A registry was developed by an emergency medical center in a local tertiary teaching hospital, and patients who visited the center were enrolled in this registry. We compared two periods, from 2008 to 2012 (Pre OTC) and from 2013 to 2016 (Post OTC), for type of intoxicant, time from poisoning to visiting the emergency center, intention, psychiatric history, previous suicidal attempt, alcohol status, and emergency room outcomes. The primary outcome was the number of patients who took acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Secondary outcomes were ICU admission rate, mortality rate, and number of patients who visited the ER when the pharmacy was closed after taking acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Results: Among 1,564 patients, 945 and 619 patients visited the emergency room during pre and post OTC periods. The number of patients with acetaminophen and NSAIDs poisoning decreased from 9.2% to 6.1% (p=0.016). The ICU admission rate and mortality rate in the emergency room did not show significant results in the relevant patient groups, and so was the number of patients visiting ER when the pharmacy was closed taking acetaminophen and NSAIDs. Conclusion: Despite the sales of nonprescription drugs at convenience stores, the number of acetaminophen and NSAIDs poisoning patients decreased.

Changes of Poison Data Characteristics Collected from Telephone Response in 1339 and 119: Discrepancy in Characteristics of Post-toxin Exposure Data Obtained through Telephone Counselling Provided by 1339 and 119: Kwang Hoon Park, Jong Su Park, Sung-Woo Lee, Su-Jin Kim, Kap Su Han, Eui Jung Lee; J Korean Soc Clin Toxicol. 2017;15(2):116-121. Published online December 31, 2017; DOI: https://doi.org/10.22537/jksct.2017.15.2.116

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Abstract PDF: Purpose: The aim of this study was to compare the toxicologic profiles and outcome of poisoned patients by comparing the data obtained through telephone counselling, each provided by emergency medical information center (1339) and emergency dispatch center (119). Methods: We analyzed the telephone-based poison exposure data before and after Seoul 1339 merged to 119. We compared the Seoul 1339 call response data in 2008 with Seoul and Busan 119 call response data between 2014 and 2016. We analyzed the changes in the trend and quality of data obtained, as well as the quality of service provided by each center before and after this reallocation, by comparing the data each obtained through telephone counselling. Results: The data was collected for a total of 2260 toxin exposure related calls made to Seoul 1339 in 2009, and 1657 calls to 119 in Seoul and Busan between 2014 and 2016. Significant difference was observed for age, sex, and reason for exposure to toxic substance between the two groups. Conclusion: After the integration of 1339 with 119, 119 focused on role of field dispatch and hospital transfer, lacking the consulting on drug poisoning. Moreover, data on exposure to toxic substances at the pre-hospital stage indicate that drug information and counseling are missing or unknown. In addition, first aid or follow-up instructions are not provided. Thus, systematic approach and management are required.

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