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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Hee-Cheol Ahn 7 Articles
A one-year Follow-up Study of Patients Exposed to Chlorine Gas
Hyuk-Sool Kwon, You-Dong Sohn, Hee-Cheol Ahn, Ji-Yun Ahn
J Korean Soc Clin Toxicol. 2008;6(2):99-103.   Published online December 31, 2008
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Purpose: Chlorine gas is a common irritant that usually causes mild respiratory symptoms. One severe symptom, RADS (Reactive Airway Dysfunction Syndrome), is not well known to physicians. We analyzed the clinical features of chlorine gas exposure. Methods: We prospectively collected 25 cases of chlorine gas exposure near our emergency center on January 10th, 2007, and analyzed demographic data, event-to-ER interval, symptoms, and laboratory results based on medical records. Results: Only 2 patients out of 25 were admitted because of severe symptoms, the rest were discharged without complications. Sixty percent of them visited the ER within 12 h of exposure. The most common symptoms were chest discomfort (60%), headache (40%), nausea (40%), throat irritation (26%), and cough (32%). Two out of eight dyspnea cases showed abnormal pulmonary function, but only one case was diagnosed as RADS. Conclusion: Most symptoms after chlorine gas exposure can be treated conservatively. However, patients with chlorine exposure should be followed up long term for delayed complications.
Nicotine Poisoning Using Nicotine Patches
You-Dong Sohn, Jae-Sung Lee, Gu-Hyun Kang, Jung-Tae Choi, Moo-Eob Ahn, Jeong-Youl Seo, Hee-Cheol Ahn
J Korean Soc Clin Toxicol. 2007;5(1):53-56.   Published online June 30, 2007
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Nicotine poisoning arising from the use of nicotine patches is rare. However, because nicotine patches are classified as an OTC drug, the risk of misuse or abuse is increasing. Nicotine poisoning using nicotine patches shows an unusual clinical presentation compared to that from oral ingestion of multiple doses of nicotine. We present a case of misused nicotine patches that cause a nicotine poisoning. A thirty-nine year-old healthy man visited the ER with complaints of an intermittent cramping abdominal pain with nausea and vomiting. Upon physical examination, there were no specific findings except increased bowel sounds, and the patient's initial laboratory findings were also unremarkable except for an increased bilirubin level. CT revealed a mild degree of fatty liver. The patient's symptoms did not improve any further with conservative management. During his ED stay, we meticulously took his history again, and we discovered that he had used nicotine patches for three days, six days before admission, and had misused the nicotine patches as NSAID patches. The patient's diagnosis of nicotine poisoning was confirmed by a urine cotinine level ten times the normal value. After a 12-hour stay in the ED, his symptoms disappeared without any specific management.
Two Cases of Rhododendron Brachycarpum Intoxication
Taek-Geun Ohk, Yoon-Seong Kim, Chan-Woo Park, Joong-Bum Moon, Bong-Ki Lee, Byung-Yeul Cho, Yong-Hoon Kim, Seong-Eun Kim, Ki-Hoon Choi, Jeong-Yeul Seo, Hee-Cheol Ahn, Moo-Wob Ahn, Jun-Hwi Cho
J Korean Soc Clin Toxicol. 2006;4(2):143-146.   Published online December 31, 2006
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Historically, the common folk have made use of various wild herbs for both food and medicinal purposes. However, the misuse of these wild herbs can lead to adverse consequences, including severe poisoning in some cases. In cases of poisoning from wild herbs, patients can exhibit a variety of symptoms depending on the herbs involved, which in addition to gastrointestinal symptoms may include hemodynamic alteration and abnormal neurologic signs. In the present case, two patients were admitted to the emergency room with symptoms of toxicity after consuming Rhododendron brachycarpum liquor. Rhododendron brachycarpum and other wild herbs contain the toxic material grayanotoxin. Because of its serious toxic symptoms, great caution must be exercised in using rhododendrons for food and medicinal purposes.
A Patient Presenting with Abnormal Behavior after Wild Plant Ingestion
Taek-Geun Ohk, Yoon-Seong Kim, Chan-Woo Park, Joong-Bum Moon, Ki-Hoon Choi, Jeong-Yeul Seo, Hee-Cheol Ahn, Moo-Wob Ahn, Jun-Hwi Cho
J Korean Soc Clin Toxicol. 2006;4(1):48-51.   Published online June 30, 2006
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With well-being boom recently, the common people, but not experts, are increasingly taking in them directly by picking wild herbs. However, only experts can distinguish between edible vegetables and poisonous herbs from the wild herbs. Especially, it is not even easy for experts to distinguish them only by looking into buds in spring without flowers or fruit. So, sometimes many patients are being carried into the emergency room by the toxic symptom after taking by misunderstanding the poisonous herbs as edible vegetables. For herb intoxication as well as drug intoxication, what kinds of vegetables patients took in, and when and how much they took in them are important information for curing. Of course, in the case of intoxicating in the wild herbs, the patients can have a lot of symptoms and sings-hemodynamic alteration and abnormal neurologic sign as well as gastrointestinal symptoms-according to the kinds of herbs which they took in. Therefore, it is difficult to find the kinds of herbs which they took in through the specific symptoms. Recently we experienced a case with showing typical anticholinergic symptoms after ingestion of Scopolia japonica. As a result, the publicity activities about the wild plants needs because if the person without their previous knowledge take in the poisonous herbs, serious side effects can be produced..
The Fatal Paraquat Poisoning Through Skin Abrasion -Case Report-
Sung-Eun Kim, Jun-Hwi Cho, Seung-Whan Cheon, Seung-Young Lee, Ki-Hoon Choi, Ji-Hoon Bae, Jeong-Yeul Seo, Hee-Cheol Ahn, Moo-Eob Ahn, Taek-Gun Ok, Chan-Woo Park
J Korean Soc Clin Toxicol. 2005;3(2):122-125.   Published online December 31, 2005
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Paraquat, is a widely used for its great effect as a herbicide. But the mortality rate by paraquat intoxication is known to be very high. It is thought to act by changing form to superoxide and peroxide free radical. Almost paraquat intoxication is through ingestion. A few intoxication of paraquat is through skin absorption. But there was no known death case through skin absorption. We experienced a case of a expired patient by paraquat intoxication through skin abrasion and scratching wound. A 75-year-old man was visited emergency room after motorcycle accident during transporting paraquat. He has multiple abrasion and scratching wound on extremities, and pelvic bone fracture. There was no evidence of ingestion of paraquat. But serum/urine gramoxone level was all positive. In spite of wound irrigation and hemoperfusion, his condition was been gone form bed to worse. 2 days after, multiple organ failure and the respiratory arrest were developed and he was expired. Paraquat intoxication through skin wound is extremely dangerous and death by that could possibly happen
The Clinical Aspects of Wild Plant Poisoning
Taek-Gun Ok, Chan-Woo Park, Jun-Hwi Cho, Seung-Whan Cheon, Seung-Young Lee, Sung-Eun Kim, Ki-Hoon Choi, Ji-Hoon Bae, Jeong-Yeul Seo, Hee-Cheol Ahn, Moo-Eob Ahn, Byung-Ryul Cho, Yong-Hoon Kim
J Korean Soc Clin Toxicol. 2005;3(2):79-85.   Published online December 31, 2005
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Purpose: With the recent boom in 'eating healthy', many adults are interested in dieting to prevent future diseases. However only well trained experts can distinguish between what are edible vegetables and herbs from their poisonous look-alikes. In cases where a patient unknowingly ingests a poisonous herb, is caught off guard by the poisonous side effects that occur because of their lack of knowledge of what they have ingested. This paper will focus on the need to educate the public about the risks involved with ingesting wild vegetables and herbs and study the emergency diagnosis and treatment of poisoned patients that enter the emergency room. Method: This study was done in the spring of 2004 (from March to May) in the Kangwon Young-Seo districts of Korea. 15 subjects used in this study, entered the emergency room showing signs of toxic symptoms. Data was collected by examining subject's records. Additional data was collected by collaborating with physicians in the hospital that diagnosed and treated the subjects. Identifying the poisonous vegetable or herb is the first step to proper diagnosis and treatment. Subjects admitted to the emergency room, underwent a battery of tests: laboratory examination, ECG, radiological exam and etc. Results: The demographics of the study encompassed subjects with the average age of $50{pm}19$ years old. There were 10 men and 5 women. Common symptoms of this study included; gastrointestinal symptoms such as nausea, vomiting, epigastric pain and so on. In the case of Caltha palustris ingestion, additional symptoms were present; bradycardia and hypotension which lasted for a long time. While cases that ingested Scopolia parviflora had little effect on vital signs but manic episodes lasted for about three days. Veratrum patulum ingestion showed signs of bradycardia and hypotension but contrary to Caltha palustris recovery was shorten by treating with dopamine. However, dizziness, headache and paresthesia of the extremities continued for a long time. Finally Sium ninsi ingestion showed visual disturbance, paresthesia of the extremities, dizziness as their initial symptoms. Conclusion: The risks involved with ingesting wild plants without the proper knowledge can lead to serious side effects and steps need to be taken to educate the public. In addition, all emergency physicians need to have a working knowledge of the symptoms and signs associated with ingesting toxic wild plants and need to treat accordingly.
The Clinical Investigation of Drug Intoxication in the North-Youngseo District of Kangwon Province
Taek-Gun Ok, Jun-Hwi Cho, Chan-Woo Park, Sung-Eun Kim, Ki-Hoon Choi, Ji-Hoon Bae, Jeong-Yeul Seo, Jae-Bong Chung, Hee-Cheol Ahn, Moo-Eob Ahn, Ki-Cheol You
J Korean Soc Clin Toxicol. 2004;2(2):83-89.   Published online December 31, 2004
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Acute poisoning is one of the diseases which need the most fastest emergency measures at the very beginning. However, at present, The Korea doesn't manage the toxication all over the country, and in particular, there is no guide to medical cure paying due regard to the traits of each area. This paper focused on the issue that the necessary data in preparing the facilities for the treatment of the poisoned patients and materials for medical treatment including antidote would have to be collected, after finding the special features of the symptoms by searching the present conditions of the poisoning in small towns next to farm villages in the North area of Youngseo, Kangwon province. This study was based on the questionnaires from 111 patients who were carried into the emergency room by the poisoning in two university hospitals of the North area of Youngseo, Kangwon, for one year, 2002. Upon investigation, the patients(111) visiting emergency room by the acute poisoning during the research period was found to be 0.37 percent of all patients(30,085) visiting emergency room. Among them, the most high percentage was given in their twenties and thirties at the rate of $39.6\%$, and the ratio($40.5\%$) of the poisoned patients after their fifties was much higher than a research($10\%$) of other areas. Many poisoned patients came to their rescue in an emergency room generally in spring and in winter, from 7 a.m. to 3 p.m. Agricultural chemical of the toxic materials had a majority at a ratio of $57.7\%$, and paraquat of the agricultural chemicals was found to have a lot of toxicity by $31.7\%$. As the trace of the toxication, the oral poisoning was common by $89.2\%$, and $55.9\%$ in the case of operating gastric lavage and nasogastric irrigation, but only $14.4\%$ for prescribing antidote. The mortality of the acute poisoned patients was $17.2\%$, and the toxication by paraquat held a majority. As a result, the acute poisoning of the North area in Youngseo, Kangwon had both of the characteristics of the rural and the city, and the patients over their fifties by the population aging had more attack of the disease than other regions. Also, with the high ratio of the toxication by the agricultural chemicals, especially, the lethal agricultural chemical was used frequently. Therefore, these dangerous situations need to find the ways to cope with.

JKSCT : Journal of The Korean Society of Clinical Toxicology