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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Kyoung Soo Lim 4 Articles
Clinical Analysis of Patients with Cardiotoxicity Caused by Himalayan Mad Honey
Sung Ho Kim, Dong Woo Seo, Seung Mok Ryoo, Won Young Kim, Bum Jin Oh, Kyoung Soo Lim, Chang Hwan Sohn
J Korean Soc Clin Toxicol. 2013;11(2):119-126.   Published online December 31, 2013
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Purpose: The aim of this study was to evaluate the clinical characteristics and outcome of patients who presented to the emergency department (ED) with cardiotoxicity caused by ingestion of Himalayan mad honey. Methods: Medical records of 12 patients who presented to the ED from January 1, 2005 to December 31, 2012 with cardiotoxicity caused by ingestion of Himalayan mad honey were retrospectively reviewed. Results: The mean age of patients was 54.5 years and 58.3% were men. The median amount of mad honey ingested was 30.0 cc, and the mean time from ingestion to onset of symptoms was 39.4 minutes. All patients had hypotension and bradycardia upon arrival in the ED. The initial electrocardiogram showed sinus bradycardia in seven patients, junctional bradycardia in four patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eight patients were treated with intravenous normal saline solution and atropine sulfate in a dose ranging from 0.5 to 2.0 mg. Blood pressure and pulse rate returned to normal limits within 24 hours in all patients. Conclusion: Our study showed that all patients with cardiotoxicity caused by ingestion of Himalayan mad honey had severe hypotension, bradycardia, and bradyarrythmias, including sinus bradycardia and junctional bradycardia and all patients responded well to conservative treatment, including intravenous normal saline solution and intravenous atropine sulfate.
The Experiences of the Emergency Antidote Stock and Delivery Service by the Korean Poison Information Center
So Young Park, Bum Jin Oh, Chang Hwan Sohn, Ru Bi Jeong, Kyoung Soo Lim, Won Kim, Seung Mok Ryoo
J Korean Soc Clin Toxicol. 2013;11(1):9-18.   Published online June 30, 2013
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Purpose: Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide stocking and delivery system for emergency antidotes in Korea. We report on a two-year experience of a nationwide stocking and delivery trial for emergency antidotes at emergency departments in Korea. Methods: An expert panel of clinical toxicologists reviewed and made a list of 15 stocked antidote. These antidotes were purchased or imported from other countries and delivered from 14 antidote stocking hospitals nationwide 24 hours per day, seven days per week. Results: From August 1, 2011 to April 30, 2013, 177 patients with acute poisoning, with a median age of 48.5 years, were administered emergency antidotes. The causes of poisoning were intentional in 52.0% and 88.0% were intentional as a suicide attempt. Regarding clinical severity, using the poisoning severity score, 40.7% of patients had severe to fatal poisoning and 39.0% had moderate poisoning according to clinical severity. The most frequent presenting symptom was neurologic deficit, such as altered mentality (62.7%). alerted mentality (62.7%). Emergency antidotes were administered as follows: methylene blue (49 cases), flumazenil (31), N-acetylcysteine (25), glucagon (17), 100% ethanol (15), cyanide antidote kit (12), anti-venin immunoglobulin (5), pyridoxine (4), hydroxocobalamine (2), and deferoxamine (1). The median time interval from antidote request to delivery at the patient's bedside was 95 minutes (interquartile range 58.8-125.8). Conclusion: Findings of this study demonstrated the possibility of successful operation of the nationwide system of emergency antidotes stocking and delivery in Korea.
Recent Epidemiologic Features of Carbon Monoxide Poisoning in Korea: A Single Center Retrospective Cohort Study
Byung Ho Choi, Jin Jeon, Seung Mok Ryoo, Dong Woo Seo, Won Young Kim, Bum Jin Oh, Kyoung Soo Lim, Chang Hwa Sohn
J Korean Soc Clin Toxicol. 2012;10(2):80-85.   Published online December 31, 2012
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Purpose: The aim of this study was to describe the epidemiologic characteristics of adult patients with carbon monoxide poisoning who presented to the emergency department in recent years. Methods: This was a retrospective cohort study on adult consecutive patients with carbon monoxide (CO) poisoning who presented to the emergency department of a tertiary care university-affiliated hospital from January 1, 2008 to December 31, 2011. Results: A total of 91 patients were included in this study; there were 56(61.5%) unintentional and 35(38.5%) intentional poisonings. For the unintentional CO poisonings, the principal sources of exposure to CO were fire (39.3%), charcoal (17.9%), briquette charcoal (7.1%), wood burning boiler (7.1%), gas boiler (5.4%), automobile heater (3.6%), briquette boiler (3.6%), firewood (3.6%), and other items (12.5%). For the intentional CO poisonings, the sources were ignition charcoal (60.0%), briquette (31.4%), charcoal (5.7%) and butane gas (2.9%). For the unintentional CO poisonings, the places of poisoning were the home (58.9%), workplace (10.7%), public accommodation (8.9%), tent (8.9%), automobile (3.6%) and parking place (1.8%). For the intentional CO poisonings, the places of poisoning were the home (77.1%), public accommodation (11.4%) and automobile (11.4%). The proportion of intentional CO poisonings among total poisonings has increased significantly in recent years; 0.0% in 2008, 3.3% in 2009, 5.5% in 2010, and 29.7% in 2011. Conclusion: This study showed that in recent years in Korea, the source of CO has diversified broadly and intentional CO poisonings from burning ignition charcoal or briquettes has increased. Prevention efforts should consider these factors.
Appropriateness of Labelling Practice for Pesticides in Korea
Bum Jin Oh, Hyung-Keun Roh, Won Kim, Gyu Chong Cho, Yoo Dong Shon, Hui Dong Kang, Kyoung Soo Lim
J Korean Soc Clin Toxicol. 2005;3(2):71-78.   Published online December 31, 2005
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Purpose: The morbidity of pesticides are largely related with accidental ingestion in human. The four principal ideals of clarity, completeness, conformity and consistency of label are important to make a correct usage and prevent unnecessary health risk. The aim of this study is to evaluate the appropriateness of pesticides labelling practice in Korea. Methods: The photographic label images of pesticide products were gathered through visiting thirteen manufacturers that produce pesticide products in Korea. We scored labelling practice by guidelines of Food and Agriculture Organization of the United Nations in 1995. Results: From August 2005 to November 2005, we gathered 1,296 label images of pesticide and $58.3{\%}$ (755/1,296) of images were scored by check lists for reviewing label content. The average score of four check list categories was $71.9{pm}2.2$. Each categorical score were $91.7{pm}0.9$ for the information appearing on the label, $31.3{pm}0.0$ for safety precaution, $77.7{pm}2.0$ for instructions for use, $87.0{pm}8.7$ for general configurations. In safety precaution, the sentence of keeping locked up the product and two mandatory safety pictograms were missed in all label images. In general configurations category, there was score difference in product package types between bottle and bag container ($85.1{pm}9.0$ vs. $90.3{pm}7.2$, p < 0.01). Conclusion: Although there was no comparable previous data, the score of safety precaution was lowest than other categories because the two mandatory safety pictograms and locked up warning sentence were missed. In general configurations, the colour contrast was more inappropriate in the labels on bottle than bag container.

JKSCT : Journal of The Korean Society of Clinical Toxicology