- Clinical Characteristics of Acute Zolpidem Intoxication
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Joo-Hyun Suh, Hyung-Keun Roh, Eun-Kyung Eo, Young-Jin Cheon, Koo-Young Jung
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J Korean Soc Clin Toxicol. 2008;6(2):91-98. Published online December 31, 2008
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- Purpose: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. Methods: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. Results: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: $0.2{sim}7.4;mg/L$). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. Conclusion: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.
- Clinical Implication of Acetylcholinesterase in Acute Organophosphate Poisoning
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Hoon Kim, Seung-Baik Han, Jun-Sig Kim, Mi-Jin Lee, Joon-Seok Park, Woon-Yong Kwon, Eun-Kyung Eo, Bum-Jin Oh, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2008;6(1):25-31. Published online June 30, 2008
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- Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.
- A Case of Amitraz Insecticide Intoxication after Ingestion of Large Amount
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Joo-Hyun Suh, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2008;6(1):52-56. Published online June 30, 2008
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- Amitraz is used as farm-animal insecticide. Its side effects in humans are related to its pharmacological activity on alpha 2-adrenergic receptors. The case describes a previously healthy 46-year-old woman who intentionally ingested approximately 250mL of liquid amitraz. She presented with vomiting, altered mental status, miosis, dry mouth, hypopnea, metabolic and respiratory acidosis, hypotension, hypothermia, polyuria, metabolic acidosis, elevated serum aminotransferase and abdominal distension. Supportive treatments including mechanical ventilation, hydration, dopamine infusion, bicarbonate infusion and gastric decompression resulted in improvement. By hospital day 3, she recovered with resolution of abdominal distension. It is paramount to recognize amitraz poisoning when a pesticide-intoxicated patient presets with signs and symptoms consistent with organophosphate intoxicated patients but with greater alpha 2-adrenergic related symptoms such as decreased bowel motility and xerostomia.
- Clinical Characteristics of Acute Dichlorvos Poisoning in Korea
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Mi-Jin Lee, Joon-Seok Park, Woon-Yong Kwon, Eun-Kyung Eo, Bum-Jin Oh, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2008;6(1):9-15. Published online June 30, 2008
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- Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.
- Clinical Aspects of the Chlorophenoxy Herbicide Intoxicated Patients
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Young-Soon Cho, Ho-Jung Kim, Bum-Jin Oh, Joo-Hyun Suh, Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Mi-Jin Lee, Sung-Woo Lee, Hyung-Keun Roh, Hoon Lim
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J Korean Soc Clin Toxicol. 2007;5(2):112-118. Published online December 31, 2007
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- Purpose: There have been relatively few reports of chlorophenoxy herbicide poisoning. The purpose of this study is to analyze the general characteristics and clinical aspects of the chlorophenoxy herbicide intoxicated patients in Korea. Methods: We prospectively evaluated the chlorophenoxy herbicide intoxicated patients visiting to the 38 emergency medical centers in Korea from the 1 August 2005 to the 31 July 2006. Results: 24 patients were enrolled during the study periods. Their mean age was 55.7 years old. The median amount of the chlorophenoxy herbicide intoxicated is 150 mL. The most frequent location where the patients obtained and took the chlorophenoxy herbicide was their home. Frequent compounds involving chlorophenoxy herbicide poisoning were dicamba(66.7%), MCPP(16.7%), and 2,4-D(12.5%). The most common symptom of the patients was confusion and vomiting. 16 patients(66.7%) intended to suicide. 3 patients out of 24 patients(13.0%) were died. Conclusion: There were 24 patients intoxicated by the chlorophenoxy herbicide during the study periods. The mortality rate was 13.0%. The suicidal attempts and the numbers of death involving chlorophenoxy herbicide were high in Korea.
- The Study of Pyrethroid Intoxication: The basis of Agrichemical Intoxication Survey in 2005
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Ah-Jin Kim, Kyung-Hwan Kim, Joon-Seok Park, Eun-Kyung Eo, Bum-Jin Oh, Mi-Jin Lee, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2007;5(2):99-105. Published online December 31, 2007
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- Purpose: Pyrethroid is an insecticide that produces moderate intoxication in mammals, with neither exposure to skin nor inhalation resulting in severe systemic manifestations. In 2005 we made a nationwide survey of agrichemical human intoxication. The object of this study is to analyze pyrethroid intoxications based on the 2005 survey. Methods: We prospectively collected data from 1 August 2005 to 31 July 2006 by a standard investigation protocol. We analyzed demographic data, exposure data (cause, amount, ingredients), clinical features, and courses. Results: A total of 125 cases of pyrethroid intoxication were surveyed. The mean patient age was $56.78{pm}16.158$ years old, and the mean amount ingested was $121.85{pm}110.732ml$. Patients were classified into four severity groups according to symptoms and mental status: the asymptomatic group (27 patients, 21.6%), the mild symptom group (48, 38.4%), the moderate symptom group (21, 16.8%), and the severe symptom group (7, 5.6%). There were statistically significant differences in mental status, severity, and mean ICU days between two groups. Admission days by severity grade for the asymptomatic, mild, moderate, and severe symptom groups were $5.49{pm}16.051,;3.65{pm}4.143,;4.59{pm}3.335,;and;8.14{pm}7.199days$, respectively (p=0.047). Conclusion: Nationwide surveillance was extremely telling in uncovering a high frequency of agrichemical intoxication in Korea. In pyrethroid intoxication, severity grading can be a useful prognostic tool.
- Characteristics and Prognostic Factors of Carbamate Poisoning in Korea
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Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Bum-Jin Oh, Mi-Jin Lee, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh, Gil-Joon Suh
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J Korean Soc Clin Toxicol. 2007;5(1):1-7. Published online June 30, 2007
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- Purpose: The aim of this study was to evaluate the characteristics and the prognostic factors of carbamate poisoned patients who visited emergency departments. Methods: From August 2005 to July 2006, we investigated the demographic feature, dose of exposure, time of exposure, alcohol intake, route of exposure, reason of exposure, site of exposure, pre-existing medical condition, time from exposure to emergency department (ED), transfer from other hospitals, vital sign at ED arrival, symptom or sign at ED arrival, and result of care of the patients who visited the ED of thirty-eight hospitals in Korea. According to the result of care, we divided the patients into two groups, the survival and the dead. To evaluated the prognostic factors, we calculated the odds ratio of each factor for the survival. Results: Among the sixty-eight patients, fifty-five patients (80.9%) were survival and thirteen patients (19.1%) were dead. The patients in the dead were older than the patients in the survival. The Glasgow coma scale (GCS) of the patients in the dead was lower than the GCS in the survival. The odds ratio of the GCS at ED arrival for the survival was 1.58 (95% CI; 1.23-2.05). Other factors showed no statistical significances. Conclusion: The GCS at emergency department arrival was the prognosis factor of the carbamate poisoned patients who visited emergency departments. If the carbamate poisoned patients showed altered mentalities, they should be provided intensive care, immediately.
- Clinical Aspects of the Organochlorine Intoxicated Patients
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Jun-Ho Cho, Bum-Jin Oh, Joo-Hyun Suh, Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Mi-Jin Lee, Sung-Woo Lee, Hyung-Keun Roh, In-Cheol Park
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J Korean Soc Clin Toxicol. 2007;5(1):15-20. Published online June 30, 2007
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- Purpose: To analyze the general characteristics and clinical aspects of the organochlorine intoxicated patients in Korea. Methods: We prospectively evaluated the organochlorine intoxicated patients visiting to the 38 emergency medical centers in Korea from the 1, Aug. 2005 to the 31, Jul. 2006. Results: There were 38 patients intoxicated by the organochlorine during the study periods. The mean age of patients was 55.1 years old. The mean amount of the organochlorine intoxicated is 246.1 mL. The most frequent place where the patients got and took the organochlorine was their home. Twenty eight patients(73.7%) intended to suicide. Nine patients out of 38 patients(23.7%) were died and they all intended to suicide. Conclusion: There were 38 patients intoxicated by the organochlorine during the study periods. The suicidal attempts and the number of the dead were higher in Korea than the developed countries.
- Organophosphate-Pyrethroid Mixtures Poisoning
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Dae-Young Hong, Kwang-Je Baek, Kyeong-Ryong Lee, Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Bum-Jin Oh, Mi-Jin Lee, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh, Jun-Sig Kim
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J Korean Soc Clin Toxicol. 2007;5(1):21-26. Published online June 30, 2007
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- Purpose: Owing to organophosphate-pyrethroid mixtures are widely used, suicidal or unintentional poisoning is common. But there have been relatively few reports of poisoning. The purpose of this study is to evaluate the difference of the severity and toxicity between organophosphate-pyrethroid mixtures poisoning and single organophosphate poisoning. Methods: From August 2005 to July 2006, 65 patients presented with organophosphate-pyrethroid mixtures poisoning to emergency medical center. Date were gathered by report form it was drawn up. Results: 65 patients were enrolled in 28 hospitals and their mean age was $56.5{pm}16.2$ years old. The most common cause of poisoning was suicide, in 52 cases(80%). Chlorpyrifos-cypermethrin, malathion-esfenvalerate were the most frequent chemicals involved, and the mean ingestion amount was 135.4ml. The most common symptom of the patients was nausea/vomiting, in 16 patients. The average GCS score was 13. The mean ICU stay was $4.4{pm}5.2$ days, and mortality was 3.1%. Conclusion: The severity and toxicity of organophosphate-pyrethroid mixture poisoning were lower than that of single organophosphate poisoning.
- Clinical Characteristics of Acute Pure Organophosphate Compounds Poisoning - 38 Multi-centers Survey in South Korea -
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Mi-Jin Lee, Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Bum-Jin Oh, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2007;5(1):27-35. Published online June 30, 2007
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- 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.
- Epidemiology and Clinical Analysis of Poisoning of Glufosinate Herbicide - Multicenter Study -
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Sung-Woo Lee, Yun-Sik Hong, Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Bum-Jin Oh, Mi-Jin Lee, Joo-Hyun Suh, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2007;5(1):36-42. Published online June 30, 2007
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- Purpose: To assess the epidemiology and the clinical features of Glufosinate herbicide in Korea. Methods: Data was prospectively collected during 1 year since August 2005 from 38 hospital in Korea. We analyzed the epidemiologic characters and clinical manifestations of Glufosinate poisoning. In addition, the characteristics of patients with severe central nervous system toxicity were separately analyzed to find poor prognosis relating factors. Results: During study periods, there were 715 persons of poisoning of herbicides and insecticides. 6.3% (45 persons) of the agricultural chemicals poisoning had Glufosinate poisoning. There were 36 cases of suicide attempts and 7 cases of accidental exposure, The major of poisoning route was oral ingestion (44 cases). 28.9 % of the study patients had not toxic symptoms. The most common symptoms were gastrointestinal symptoms relating surfactant irritation. 67.7% of central nervous symptoms occurred lately. 10 persons showed severe central nervous system toxicity. 4 persons of them showed poor outcomes (1 death, 3 hopeless discharged). Complications of respiratory failure and renal failure related with poor outcome. Conclusion: Majority of patients ingested Glufosinate for suicide attempt. 22.2% of patients with Glufosinate poisoning showed delayed serious central nervous system toxicity. Early supportive care of altered mentality may prevent late respiratory complications and improve the outcomes.
- The Differences of Clinical Aspects in Children and Adolescents Poisoning
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Joo-Hyun Suh, Eun-Kyung Eo
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J Korean Soc Clin Toxicol. 2006;4(1):17-24. Published online June 30, 2006
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To analyze the general characteristics and clinical differences of poisoning in children and adolescents and to take precautions of occasions. Methods: We retrospectively evaluated poisoning children and adolescents (less than 19 years) visiting to the emergency medical center of tertiary hospital in urban area. We collected demographic data, substance exposure data (materials, causes of poisoning and amount), and clinical outcome of poisoning for the past 2 years and 9 months. Results: 189 cases were reported of concerning poisoning in children and adolescents. The age groups were divided into four categories. (1) Infants group:<2 year, (2) Preschool age group: $2{sim}5year$, (3) Children group: $6{sim}12year$ and (4) Adolescents group: $13{sim}18year$. The most vulnerable age group was the infants group. There were two-peaks of age distribution in poisoned patients on the whole. Various types of materials belonged to classes of druqs (56.6%). household products (34.4%) and industrial solvents (9.0%). On adolescents group, the frequency of drug poisoning was significantly high, in comparison with infants, preschool age, and children group (p=0.001). Most of the patient groups had been poisoned accidentally(73.5%), while most cases of adolescents poisoning had been intentional. 63% of the adolescents group had a suicidal purpose. Conclusion: The incidence of poisoning was most highly due to drugs. The cause of poisoning is most commonly accidental. while in adolescent group, intentional poisoning is mostly common. Special cares, like keeping children away from drugs, will be needed to prevent children poisoning, and psychiatric consultation and supportive cares can reduce the adolescents poisoning cases.
- A Fatal Case of Dicamba Intoxication
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Dae-Young Hong, Wook-Hyun Um, Kyoung-Mi Lee, Ji-Hye Kim, Seung-Baik Han, Joo-Hyun Suh, Jun-Sig Kim, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2006;4(1):69-72. Published online June 30, 2006
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- Dicamba is a benzoic acid and classified as a chemically related chlorophenoxy herbicide which is widely used for the control of broad-leaved weeds. While the chlorophenoxy herbicide poisoning is known to be uncommon, its ingestion can result in serious or sometimes fatal outcome. A 65-year-old man ingested about 300 ml of dicamba in a suicidal attempt and three hours later he was admitted hospital, complaining abdominal pain, nausea and vomiting. On admission his vital signs were normal and laboratory findings were not remarkable except metabolic acidosis in arterial blood gas analysis. Shortly after the admission endotracheal tube was inserted due to altered mental state and activated charcoal was given after performing gastric lavage. However, his vital signs became unstable 6hrs after the ingestion and mechanical ventilation was started with administration of inotropic agents. In spite of urine alkalization for rapid elimination of the absorbed dicamba, the metabolic acidosis was aggravated with concomitant rhabdomyolysis and acute renal failure, and he died 24 hrs after the ingestion.
- Severe Liver Toxicity Caused by Amatoxin (Case Series)
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Joo-Hyun Suh, Sung-Jin Kim, Young-Kuk Chung, Woong-Gil Choi, Young-Se Kwon, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2006;4(1):73-77. Published online June 30, 2006
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- Poisoning with mushroom containing amatoxin may be a real medical emergency and is characterized by long incubation time lag, gastrointestinal symptoms, hepatotoxic phase and sometimes death. We report a family of parents and two children who ingested wild mushroom and recovered from varying degrees of hepatotoxicity. After eating cooked wild mushroom and its soup, they all developed abdominal pain, vomiting and diarrhea 11 hours later, Their liver enzymes reached peak level between 48 and 72 hours after the ingestion. Among the family members, 5-year-old girl showed the most severe hepatic toxicity of AST/ALT 14,099/13,176 IU/L. They were all treated with supportive measures including repeated activated charcoal and penicillin G and recovered from the hepatotoxicity between 7 and 28 days after the ingestion. Being based on the shape and a typical course of the amatoxin poisoning, we presume that this wild mushroom belongs to Amanita virosa.
- Parkinsonism after Cyanide Intoxication: A Case Report
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Joo-Hyun Suh, Eun-Kyung Eo
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J Korean Soc Clin Toxicol. 2004;2(2):137-140. Published online December 31, 2004
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- Acute cyanide poisoning is usually the result of attempted suicide which is often lethal within minutes or leads to a very poor prognosis after delayed and inadequate treatment. It affects the cerebral structures with the highest oxygen requirement, such as the basal ganglia, the cerebral cortex. We experienced a-45-year-old man who ingested Potassium Cyanide. He was stuporous. In 25 minutes, respiratory arrest developed and cardiopulmonary resuscitation was done. After return of spontaneous circulation, he admitted to intensive care unit, and conservative treatment was started. The clinical status was improved by degrees, but he couldn't perform daily activity like before. Minimal limitation of movement and memory deficit were left. In magnetic resonance imaging, which taken at the 11th day after admission, there were both basal ganglia and folia of cerebellum abnormality.
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KSCT
Korean Society of Clinical Toxicology