- Recent 10-Year Experience of One Regional Emergency Center and Recommendation for Hyperbaric Oxygen Therapy (HBOT)
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Jung-Hoon Yoon, Gi-Woon Kim, Yoon-Seok Jung, Cheol-Soo Han, Young-Gi Min, Joon-Pil Cho, Sang-Cheon Choi
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J Korean Soc Clin Toxicol. 2013;11(2):81-88. Published online December 31, 2013
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- 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.
- The Clinical Characteristics and Prognosis after Acute Ingestion of Glacial Acetic Acid
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Gab-Yong Choi, Young-Gi Min, Yoon-Seok Jung, Joon-Pil Cho, Sang-Cheon Choi
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J Korean Soc Clin Toxicol. 2012;10(2):91-96. Published online December 31, 2012
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- Purpose: A retrospective study with a literature review was conducted to identify the clinical characteristics and prognosis after the acute ingestion of glacial acetic acid. Methods: The medical records of 20 patients,who had presented to the emergency department of Ajou University Hospital complaining of the acute ingestion of glacial acetic acid between January 2006 and December 2011, were examined retrospectively. Results: Among the 172 patients admitted for caustics injury, 20 patients ingested glacial acetic acid. The mean age of the patients was $55{pm}23.5$, and the mean volume of the acid was $84.5{pm}71.3$ ml. The clinical features included 1) oral ulcers in 12 patients (63.2%), 2) respiratory difficulties in 11 patients (57.9%), 3) oliguria in 8 patients (42.1%), 4) renal toxicity in 7 patients (36.8%), 5) hepatic failure in 7 patients (36.8%), 6) disseminated intravascular boagulopathyin 7 patients (36.8%), 7) low blood pressure in 8 patients (42.1%), and 8) mental changes in 9 patients (47.4%). Ten patients required endotracheal intubation. Nine patients were admitted to the intensive care unit, and 5 patients expired. Conclusion: The ingestion of glacial acetic acid can cause severe symptoms, such as metabolic acidosis, multiple organ failure and upper airway swelling frequently and has a high mortality rate. Therefore, aggressive treatment, including endotracheal intubation, should be considered at the early stages.
- Veiled Paraquat Poisoning - A Focus on Clinical Characteristics
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Ye-Wan Song, Sang-Cheon Choi, Young-Yeol You, Yeoun-Ho Shin, Eun-Jung Park, Jung-Hwan Ahn, Young-Gi Min, Yoon-Seok Jung
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J Korean Soc Clin Toxicol. 2011;9(1):14-19. Published online June 30, 2011
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- Purpose: Most paraquat poisonings are easily diagnosed by history taking on physical examination, however, some are failed to be diagnosed initially if the poisoning was veiled. The purpose of this study was to explore the clinical characteristics of veiled paraquat poisoning. Methods: We retrospectively reviewed the medical records of patients whose discharge diagnosis was paraquat poisoning in one university teaching hospital between 1 Jan, 2001 and 31 Dec, 2010. Veiled paraquat poisoning was determined when there was a positive urine paraquat kit in patients who did not mention paraquat poisoning in an initial physical examination or had unknown cause of pulmonary fibrosis, acute renal failure, or multi-organ failure. Results: Of the 117 patients with paraquat poisoning during the study period, 6 patients (5.1%) had veiled paraquat poisoning. The clinical characteristics were 1) proteinuria - 6 (100%), 2) increased creatinine - 4 (66.7%), 3) green skin stains - 2 (33.3%), 4) mucosal ulcer - 3 (50%). Blood chemistry results were variable. Conclusion: We should suspect veiled paraquat poisoning for patients who have proteinuria, increased creatinine, green skin stain, mucosal ulcer and vomiting, or if they have rapidly progressing acute renal failure or multi-organ failure with unknown cause, even if patients didn't mention about paraquat poisoning upon the initial physical examination. In cases with the above clinical conditions, a thorough repeated physical examination including history taking and use of urine paraquat kits should be performed.
- Influence of the Werther Effect: An Increase of Intentional Carbon Monoxide Poisoning
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In-Young Heo, Sang-Cheon Choi, Chung-Ah Lee, Jung-Hwan Ahn, Young-Gi Min, Yoon-Seok Jung, Joon-Pil Cho, Jin-Sook Kim
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J Korean Soc Clin Toxicol. 2009;7(2):143-149. Published online December 31, 2009
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- Purpose: Suicide attempts are known to be influenced by mass media reports. The purpose of this study was to evaluate the effects of mass media reporting celebrity suicides on an increase of intentional carbon monoxide (CO) poisoning and suicide attempts. Methods: We retrospectively reviewed the medical records of the consecutive patients who presented with suicide attempts to the Emergency Department of Ajou University Hospital during a 24 month period. We obtained the demographic data, any past history of suicide attempt and the methods of suicide attempts from the medical records of the suicide attempters. Time series analysis was conducted for evaluating the influence of mass media reporting of celebrity suicide on the suicide rates. Results: We finally enrolled 770 patients during the study period. The total number of suicide attempts by CO poisoning was 18 and the average number of suicide attempts by CO was $0.33{pm}0.73$ per week. All of the suicide attempts by CO poisoning occurred after a celebrity committed suicide using CO from burning charcoal. Conclusion: This study showed that celebrity suicide by CO poisoning resulted in the Werther effect, which made the rate of intended CO poisoning increase, and the study provided further evidence for the need to actively restrain mass media reporting of suicide to decrease the Werther effect.
- Clinical Experience with Continuous Renal Replacement Therapy as a Method of Extracorporeal Elimination and as performed by Emergency Room Physicians for Patients with Poisoning
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Jung-Hwan Ahn, Sang-Cheon Choi, Yoon-Seok Jung, Young-Gi Min
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J Korean Soc Clin Toxicol. 2009;7(2):150-155. Published online December 31, 2009
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- Purpose: Extracorporeal elimination of drugs is a critical part of managing poisonings, although the indications and optimal method remain a matter of debate. The aim of this study is to report our clinical experiences with continuous renal replacement therapy (CRRT), as performed by emergency room physicians, as method of extracorporeal drug elimination in patients with poisoning. Methods: This study was a retrospective study of the consecutive patients who underwent CRRT, as performed by an emergency room physician, for acute poisoning. The patient characteristics, the kinds of drugs and the method of extracorporeal elimination were analyzed by reviewing the patients' charts. Results: During eleven months, 26 patients with acute poisoning underwent extracorporeal elimination (2 patients; intermittent hemodialysis, 24 patients; CRRT). The mean time from the decision to performing extracorporeal elimination was $206.0{pm}36.8$ minutes for intermittent hemodialysis, $62.9{pm}8.5$ minutes for continuous venoveno-hemodiafiltration (CVVHDF) and $56.6{pm}6.8$ minutes for charcoal hemoperfusion. For the patients with CRRT, CVVHDF was conducted in 10 patients (3 patients; valproic acid, 2 patients; Lithium, 1 patient; salicylates, 1 patient; methanol) and charcoal hemoperfusion by using CRRT was done in 14 patients (13 patients; paraquat, 1 patient; dapsone). For the 12 patients who required hemodialysis due to severe poisoning, 7 patients underwent CRRT because of their unstable vital signs. Conclusion: CRRT was an effective method of extracorporeal drug elimination in patients with acute poisoning, and especially for the cases with unstable vital sign and for those patients who required an early start of extracorporeal elimination according to the characteristics of the drug. (ED note: the writing of the abstract was not clear. Check it carefully.)
- A Lethal Case of Aute Zipeprol Poisoning Occurring in a Drug Addicted Old Woman
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Doo-Hwan Lee, Sang-Cheon Choi, Jung-Hwan Ahn, Young-Shin Cho, Gi-Woon Kim, Young-Gi Min, Yoon-Seok Jung
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J Korean Soc Clin Toxicol. 2009;7(2):172-175. Published online December 31, 2009
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- Zipeprol dihydrochloride is a non-opioid mucolytic, antitussive agent and it is frequently prescribed for respiratory symptoms such as cough and sputum. The main pharmacologic mechanisms of zipeprol are inhibition of superior laryngeal nerve stimulation and direct antagonism for stimulation of the bronchial receptors, which might have an effect for the drug's mucolytic action. Many cases of drug abuse with zipeprol have occurred world-wide due to the hallucinogenic effect of the drug. In Korea, zipeprol was reported to be the most commonly abused drug among young people for the 1990s. Zipeprol associated death was first reported since 1991 and 69 cases of death related to zipeprol abuse were further reported during 8 years (between 1991 and 1998). In addition to the hallucinogenic effect, dyspnea, extrapyramidal symptoms, seizure, cerebral edema have been reported as the signs and symptoms of toxic zipeprol overdose. However, zipeprol abuse is not common for old age people and non drug abusers. We report here on a fatal case of acute zipeprol poisoning in an eighty five year old drug addicted woman.
- Systemic Complications occurring after Korean Venomous Snake Bite, with focus on Hematologic and Neurologic Complications
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Eun-Jung Park, Sang-Kyu Yoon, Jung-Hwan Ahn, Sang-Cheon Choi, Gi-Woon Kim, Young-Gi Min, Kuk-Jong Lee, Ho-Sung Jung, Yoon-Seok Jung
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J Korean Soc Clin Toxicol. 2009;7(2):90-96. Published online December 31, 2009
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- Purpose: This study explored and evaluated the systemic complications resulting from the bite of Korean venomous snake, focussing on hematologic and neurologic features. Methods: Medical records (demographic data, clinical measurements including laboratory results, severity score, and amount of antidote administration, and hospitalization course) of consecutive patients who presented with snakebites to two university teaching hospital during a 10-year period were retrospectively reviewed. Subgroup analysis was conducted for evaluations of anti-acetylcholine esterase administration in complicated victims. Results: The 170 patients displayed occurrence rates of hematologic and neurologic complications of 12.9% and 20.6%, respectively. Among 22 patients with hematologic complications, isolated thrombocytopenia was evident in eight patients (36.4%), prothrombin time (PT) / activated partial thromboplastin time (aPTT) prolongation in 11 patients (50.0%), and both in three patients (13.6%). The mean time to recovery was $4.5{pm}1.8$ days for isolated thrombocytopenia, and $5.1{pm}1.8$ days for PT and aPTT prolongation. Hematologic complications could occur suddenly 1?4 days after hospitalization. Among 35 patients with neurologic complications, dizziness was evident in 16 patients (45.7%), and diplopia / blurred vision in 19 patients (54.3%). The mean time to recovery was $3.4{pm}0.6$ days in patients receiving anti-acetylcholine esterase and $6.9{pm}1.8$ days in those not receiving anti-acetylcholine esterase (p=0.00). Conclusion: Occurrence rates of hematologic and neurologic complications following venomous snake bite differed as compared to other studies conducted in Korea. Onset of hematologic complications can occur rapidly days after admittance. Anti-acetylcholine esterase administration may be effective in treating neurologic complications.
- Digitalis-like Toxic Symptoms Occurring after Accidental Nerium indicum Poisoning
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Ye-Wan Song, Jung-Hwan Ahn, Chung-Ah Lee, Gi-Woon Kim, Sang-Cheon Choi, Yoon-Seok Jung
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J Korean Soc Clin Toxicol. 2009;7(1):19-22. Published online June 30, 2009
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- Although Nerium indicum poisoning is a globally rare occurrence, Nerium oleander poisoning is known to occur frequently in the Mediterranean regions. To our knowledge, this is the first reported case of accidental Nerium indicum poisoning in Korea. Its poisoning symptoms and signs are similar to that of digitalis poisoning, because of the presence of cardiac glycosides in Nerium indicum. A 16-year-old boy was admitted to the emergency department four hours prior to the accidental ingestion of Nerium indicum petals. The patient complained of nausea, vomiting, and dizziness. His initial vital signs were stable; laboratory blood test results were within normal levels, except for the blood digoxin level (1.5 ng/dL). An electrocardiogram (ECG) analysis showed normal sinus rhythm, progressive PR prolongation and second-degree Morbiz type I AV block. Conservative treatments including activated charcoal administration were conducted, because toxic symptoms and signs were not severe. The patient was admitted to the intensive care unit for close observation. His ECG was converted to normal rhythm after 1 day and the toxic symptoms and signs were completely resolved after 4 days.
- A Case of Acute Hydrogen Sulfide Intoxication Caused Rapid Loss of Consciousness
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Jung-Hwan Ahn, Yoon-Seok Jung
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J Korean Soc Clin Toxicol. 2004;2(2):147-150. Published online December 31, 2004
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- Hydrogen sulfide is a colorless, and malodorous 'rotten eggs' gas that results from the decay of organic material. It is a byproduct of industry and agriculture. The mechanism of its toxicity is primarily related to inhibition of oxidative phosphorylation, which causes a decrease in available cellular energy. Because there is no rapid method of detection that is of clinical diagnostic use, management decisions must be made based on history, clinical presentation, and diagnostic tests that imply hydrogen sulfide's presence. Although there is some anecdotal evidence to suggest that the early use of hyperbaric oxygen is beneficial, supportive care remains the mainstay of therapy. We describe an occupational exposure to hydrogen sulfide gas in 51-year-old man. While cleaning the sewage of pigs. he became unconscious. When he arrived in the emergency department, he had irritability and confused mentality. The typical smell of rotten eggs on clothing and exhaled air were enough to be considered to be exposed to hydrogen sulfide. Hyperbaric oxygen therapy was performed. He had a recovery to normal function.
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KSCT
Korean Society of Clinical Toxicology