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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Volume 11(2); 2013
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Recent 10-Year Experience of One Regional Emergency Center and Recommendation for Hyperbaric Oxygen Therapy (HBOT)
Jung-Hoon Yoon, Gi-Woon Kim, Yoon-Seok Jung, Cheol-Soo Han, Young-Gi Min, Joon-Pil Cho, Sang-Cheon Choi
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 Feature and Prognostic Factor of Glyphosate Intoxication Patients
Hee Min Eun, Jin Hui Paik, Joo Hyun Suh, Jin Hee Jung, Eun Kyung Eo, Hyung-Keun Roh
J Korean Soc Clin Toxicol. 2013;11(2):89-95.   Published online December 31, 2013
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Purpose: Glyphosate is widely used and its toxic exposures are not rare. Occasionally, glyphosate intoxication can lead to death. The aim of this study is to analyze clinical findings and fatality in glyphosate intoxication. Methods: Clinical data on acute glyphosate intoxication were prospectively collected at 28 hospitals nationwide between August 2005 and July 2006. The patients' clinical symptoms and characteristics of fatalities were investigated and statistical analysis was performed. Results: Among 105 patients who were finally included, gastrointestinal symptoms(59%) were the most common. A significant difference in the amount ingested was observed between patients with higher systolic blood pressure and those with systolic blood pressure less than or equal to 80 mmHg (p<0.001). The more the patients ingested, the more aggravated their mental status became (p=0.004). Seven patients(6.7%) died, and all of them had ingested greater than or equal to 200 ml. Patients who died had ingested greater amounts than the survivors (p<0.001), and their mental status was worse (p<0.001), and systolic blood pressure was lower (p<0.001). According to the result of logistic regression analysis, relative risk was 24.1-fold higher in the 'poor' mental status group compared with 'good'. Conclusion: Patients who ingested large amounts of glyphosate showed poor mental status and lower blood pressure. Statistical difference in amount ingested, mental status, and systolic blood pressure was observed between survivors and patients who died. Ingested amounts and mental status were the most important factor of the prognosis of glyphosate intoxication.
Bibliometric Analysis of the Journal of the Korean Society of Clinical Toxicology
Jin Hyuck Lee, Tae Ho Lim, Won Hee Kim, Chang Sun Kim, Jae Hoon Oh, Hyung Goo Kang, Hyuk Joong Choi, Bo Seung Kang
J Korean Soc Clin Toxicol. 2013;11(2):96-100.   Published online December 31, 2013
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Purpose: The purpose of this study was to examine the research characteristics and the trend of the Journal of the Korean Society of Clinical Toxicology by bibliometric analysis. Methods: This study was a retrospective quantitative literature review of the publications. We collected data from the internet homepage of the Korean Society of Clinical Toxicology. Among 228 publications, a total of 225 articles were included in this analysis. The data were analyzed from different perspectives, including article types, study design, number of authors, type of toxic material, and the top five ranking prolific authors and the affiliated organization were identified. Results: A total of 225 articles were analyzed; 98(43.6%) were original articles, 115(51.1%) were case reports, and 12(5.3%) were reviews. Among the original articles, nine were prospective studies and 89 were retrospective studies, which were assorted according to study design; there were two(2.0%) cross sectional studies, 93(94.9%) cohort studies, and three(3.1%) etc. The median number of authors per article was five and the top five ranking authors and affiliated organizations published 31.1% and 32.8% of total articles, respectively. The most abundant topic was pesticides, followed by natural poisons and poisons encountered in the work place. Conclusion: Since its foundation, the Journal of the Korean Society of Clinical Toxicology has published 19 issues and 228 articles and has played a key role in development of toxicology research in Korea. However, low ratio of original articles and a decrease in the number of recent articles indicates that greater effort is needed in clinical research. In addition, further interest of many experts and various institutions is necessary.
Correlation between the Portable X-ray and the Radiation Exposure dose in the Emergency Department: Cohort Study
Yu Jung Kim, Hee Cheol Ahn, You Dong Sohn, Ji Yoon Ahn, Seung Min Park, Won Woong Lee, Young Hwan Lee
J Korean Soc Clin Toxicol. 2013;11(2):101-105.   Published online December 31, 2013
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Purpose: This study was conducted in order to determine the relationship between the number of portable X-rays and the radiation exposure dose for emergency medical service providers working in the emergency department (ED). Methods: A prospective study was conducted from February 15, 2013 to May 15, 2013 in the ED in an urban hospital. Six residents, seven emergency medical technicians (EMT), and 24 nurses were enrolled. They wore a personal radiation dosimeter on their upper chest while working in the ED, and they stayed away from the portable X-ray unit at a distance of at least 1.8 m when the X-ray beam was generated. Results: The total number of portable x-rays was 2089. The average total radiation exposure dose of emergency medical service providers was $0.504{pm}0.037$ mSv, and it was highest in the EMT group, 0.85(0.58-1.08) mSv. The average of the total number of portable X-rays was highest in the doctor group, 728.5(657.25-809). The relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant(-0.186, p=0.269). Conclusion: Under the condition of staying away from the portable X-ray unit at a distance of least 1.8 m, the relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant.
Analysis of the Impact on Community Health after Accidental Leak of Hydrofluoric Acid
Young Gab Kim, Ju Taek Lee, Sang Hyun Park, Chan Hee Lee, Michael Sung Choe, Dong Wook Je, Chang Jae Lee, Taei Ko, Hye Jung Jo
J Korean Soc Clin Toxicol. 2013;11(2):106-113.   Published online December 31, 2013
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Purpose: The purpose of this study is to verify the influence of a massive hydrofluoric acid spill on community health through patients who claimed to have been exposed. Methods: We analyzed 2459 patients who visited our emergency department with the claim of exposure to hydrofluoric acid, and retrospective analyses were performed. We analyzed changes in numbers of visitors per day from the day of the accidental hydrofluoric acid spill, symptoms presented by the 1924 patients, and general characteristics. Comparisons of symptoms and hematologic characteristics were made between the initially set evacuation zone(1.3 km radius parameters from the spill) and the outer zone. Results: A total of 2,459 patients who claimed exposure visited our ED from 27 September 2012 to 23 October 2012, and there was a significant increase in the number of visiting patients from day 8 of the hydrofluoric acid spill. The most common complaints were a sore throat, 729(37.9%) and no specific symptom with health concern, 547 (28.4%). Statistically significant findings were pulmonary symptoms (p=0.001), nasal symptoms (p=0.001), diarrhea (p=0.023), and skin symptoms (p=0.007). In hematologic study, a statistically significant difference was observed in white blood cell count (p=0.018), creatine phosphokinase (p<0.001), erythrocyte sediment rate (p=0.013), and phosphorus (p<0.001). Conclusion: A significant increase in the number of patients was observed one week after the accidental spill of hydrofluoric acid. The most frequent symptoms were sore throat, headache, cough, and sputum. Statistically significant increase in creatine phosphokinase level and decrease in phosphorus level were noted in patients within the evacuation zone.
Measurement of Volume of a Swallow for Liquid Swallowing in Healthy Young Adults
Su Ik Kim, Ji Hun Kang, Dong Ik Lee, Jeong Ryul Jo, Hyung Jun Kim, Jae Baek Lee, Young Ho Jin, Tae Oh Jeong, Jae Chol Yoon
J Korean Soc Clin Toxicol. 2013;11(2):114-118.   Published online December 31, 2013
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Purpose: The aim of this study is to estimate one mouthful volume in a single swallow and average volume per swallow (AVS) in multiple swallows in the situation of toxic liquid poisoning. Methods: Thirty five men and 35 women were included in this study. Each subject was asked to drink one swallow and three consecutive swallows from bottle containing water and a bottle containing saline separately. We calculated one mouthful volume in a single swallow and AVS in three swallows. One mouthful volume and AVS were compared according to sex and content, respectively. One mouthful volume of water and saline was then compared with AVS of each. Results: Sixty seven adults(34 men; $26.9{pm}3.2$ years, 33 women; $25.6{pm}2.4$ years) completed the study. Men had larger one mouthful volume of water($49.1{pm}19.9$ ml vs $39.7{pm}10.2$ ml, p=0.02) and saline($20.7{pm}10.9$ ml vs $14.0{pm}4.6$ ml, p=0.004) and AVS of water($28.5{pm}11.9$ ml vs $21.5{pm}5.9$ ml, p=0.004) and saline($11.9{pm}6.3$ ml vs $7.9{pm}2.0$ ml, p=0.001) than women. One mouthful volume and AVS of saline swallow were lower than those of water swallow. AVS of three consecutive swallows was lower than one mouthful volume in water and saline swallow. Conclusion: We suggest that one mouthful volume in a single swallow is 21 ml in men and 14 ml in women and AVS in multiple swallows is 12 ml in men and 8 ml in women. AVS in multiple swallows is two-threefold lower than reference values(20~30 ml) commonly used in poisoning study.
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.
A Case of Seizures after Zolpidem Withdrawal
Hyung Jun Moon, Jung Won Lee, Byeong Dae Yoo
J Korean Soc Clin Toxicol. 2013;11(2):127-129.   Published online December 31, 2013
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The imidazopyridine, zolpidem, a non-benzodiazepine hypnotic drug, is widely-prescribed for insomnia. It is regarded as a good alternative to benzodiazepine because of the reduced possibility for abuse and development of dependence. However, more recently, due to the reduced possibility for abuse and development of dependence, it is regarded as a good alternative to benzodiazepine. adverse effects of zolpidem have been recognized. The objective of this report is to provide information on the potential for occurrence of benzodiazepine-like withdrawal seizure in patients who chronically take zolpidem continually. We present and discuss a case of seizure after sudden interruption of the protracted use of an abusively high dose of zolpidem. Zolpidem may not be the ideal drug for longterm pharmacotherapeutic management of insomnia. Clinicians should administer zolpidem at a low-dose for a short period of time for prevention of drug abuse and dependence and the potential for occurrence of benzodiazepine- like withdrawal seizure.
Three Cases with Manic Symptoms and Cognitive Dysfunction after Wild Plant Ingestion
Doo Hyun Lee, Gi Joong Kim, Ga Eul Kim, Dae Jin Chung, Jun Yeol Lee, Joon Ho Bae, Yoon Seong Kim, Chan Woo Park, Hui Young Lee, Jun Hwi Cho
J Korean Soc Clin Toxicol. 2013;11(2):130-132.   Published online December 31, 2013
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Distinguishing wild plants in spring from ingestible plants is difficult. Differentiation of budding plants from other plants is particularly difficult. Many people want to find edible plants for health during the spring season. Scopolia japonica can cause symptoms of mania. The author experienced three cases of poisoning by Scopolia japonica. We reported on the cases with literature reviews.
Four Cases of Phytolacca Esculenta Van Houtte Intoxication due to Misidentification as a Ginseng
Jun Ho Bae, Ga Eul Kim, Gi Joong Kim, Doo Hyun Lee, Jun Yeol Lee, Dae Jin Jeong, Yoon Seong Kim, Chan Woo Park, Hui Young Lee, Jun Hwi Cho
J Korean Soc Clin Toxicol. 2013;11(2):133-135.   Published online December 31, 2013
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Poisoning by Phytolacca esculenta commonly occurs by misidentification as other edible plants. The root of Phytolacca esculenta is similar to other roots, such as kudzu, balloon flower, codonopsis lanceolata, and ginseng. The author experienced four cases of Phytolacca esculenta intoxication due to misidentification as a ginseng. We report on these cases with a review of the literature.

JKSCT : Journal of The Korean Society of Clinical Toxicology