Journal of The Korean Society of Clinical Toxicology

Volume 19(1); June 2021

Systematic review for economic benefit of poison control center: Eunah Han, Hyuna Hwang, Gina Yu, Dong Ryul Ko, Taeyoung Kong, Je Sung You, Minhong Choa, Sung Phil Chung; J Korean Soc Clin Toxicol. 2021;19(1):1-7. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.1

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Purpose: The purpose of this study was to conduct a systematic review to investigate the socio-economic benefits of the poison control center (PCC) and to assess whether telephone counseling at the poison control center affects the frequency of emergency room visits, hospitalization, and length of stay of patients with acute poisoning. Methods: The authors conducted a medical literature search of the PubMed, EMBASE, and Cochrane Library databases. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool. Key results such as the cost-benefit ratio, hospital stay days, unnecessary emergency room visits or hospitalizations, and reduced hospital charges were extracted from the studies. When meta-analysis was possible, it was performed using RevMan software (RevMan version 5.4). Results: Among 299 non-duplicated studies, 19 were relevant to the study questions. The cost-benefit ratios of PCC showed a wide range from 0.76 to 36 (average 6.8) according to the level of the medical expense of each country and whether the study included intentional poisoning. PCC reduced unnecessary visits to healthcare facilities. PCC consultation shortened the length of hospital stay by 1.82 (95% CI, 1.07-2.57) days. Conclusion: The systematic review and meta-analysis support the hypothesis that the PCC operation is cost-beneficial. However, when implementing the PCC concept in Korea in the future, it is necessary to prepare an institutional framework to ensure a costeffective model.

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2022 Annual Report of the Seoul Poison Control Center
Yo Han Shin, Sijin Lee, Su Jin Kim, Young Hoon Yoon, Sung Woo Lee
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 39. CrossRef

Analysis of social factors influencing authenticity of suicide for patient who attempt to suicide in emergency department: Retrospective study based Post-suicidal Care Program data: Jae-Gu Ji, Yang-Weon Kim, Ji-Hun Kang, Yun-Deok Jang; J Korean Soc Clin Toxicol. 2021;19(1):8-16. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.8

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Purpose: This study was conducted to analyze the social factors influencing the 'authenticity of suicidal ideation' based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). Conclusion: The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.

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Effect of Multidisciplinary Program for Relapse Prevention on Abstinence Self-efficacy, Impulsivity and Suicidal Ideation among Patients with Substance Use Disorder
Soyun An, Wanju Park
Journal of Korean Academy of psychiatric and Mental Health Nursing.2023; 32(2): 216. CrossRef

Comparison of Poisoning Severity Score (PSS) according to alcohol co-ingestion in intentional poisoning patients: Min jae Jun, Tae kyu Ahn, Soo Kang; J Korean Soc Clin Toxicol. 2021;19(1):17-23. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.17

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Abstract PDF: Purpose: Alcohol ingestion enhances impulsivity and aggression, and has been proven to have a close relationship with suicide. This study investigates whether alcohol co-ingestion affects the Poisoning Severity Score (PSS) grade in patients with intentional poisoning. Methods: We conducted a retrospective analysis of intentional poisoning patients who visited the emergency department (ED) from January 1 to December 31, 2020. Patients were divided into non-drunken and drunken groups. We collected the data based on the medical records of the patients and serum ethanol level results recorded during initial blood tests at the ED. To grade the PSS, the highest score was assessed through clinical signs and test results during the hospital stay. A comparative analysis was conducted between the two groups. Results: A total of 277 patients were included in the study. 163 (58.8%) were in the non-drunken group, and 114 (41.2%) were in the drunken group. The PSS grade showed a significant difference between the two groups (p=0.002). While grade 1 (mild) was observed more in the non-drunken group, grade 2 (moderate) and grade 3 (severe) were seen more in the drunken group. In an ordinal logistic regression analysis, alcohol co-ingestion (adjusted odds ratio [aOR] 2.557, 95% confidence interval [CI] 1.554-4.208, p<0.001) was considered to be a risk factor for a higher PSS grade. There was no significant correlation between the serum ethanol level and the PSS grade. (p=0.568) Conclusion: Intentional poisoning patients with alcohol co-ingestion had a higher PSS. Hence close observation and aggressive treatment in the ED is warranted in such cases.

Availability of urine toxicologic screening tests in the emergency department: focused on illegal drugs: Se Kyu Lee, Sangchun Choi; J Korean Soc Clin Toxicol. 2021;19(1):24-30. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.24

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Abstract PDF: Purpose: In Korea, it is predicted that the proportion of drug abusers among patients visiting the emergency room will soon increase. Several emergency medical institutions in Korea are conducting field urine screening tests for poisoning. In this study, we investigated the characteristics and usefulness of urine toxicology screening tests. Methods: The medical records of patients with positive results for tetrahydrocannabinol and methamphetamine from urine toxicology screening tests at a tertiary university hospital from August 2016 to August 2019 were reviewed retrospectively. The subjects were classified into positive and false-positive groups, and their clinical characteristics were compared and analyzed. Results: Of the 2,026 patients surveyed, 823 patients (40.6%) tested positive for one or more drugs. Among them, 12 cases (0.6%) were positive for methamphetamine and 40 cases (2.0%) were positive for tetrahydrocannabinol. The positive and the false-positive rates for methamphetamine were 66.7% and 33.3%, respectively. The positive and the false-positive rates for tetrahydrocannabinol were 2.5% and 97.5%, respectively. Conclusion: Methamphetamine showed a relatively low false-positive rate in our study. Therefore, this test seemed to assist in diagnosing methamphetamine poisoning when considered together with the present illness and physical examination results. On the other hand, the high false-positive rate for tetrahydrocannabinol tests indicates that this test was unlikely to assist in diagnosing tetrahydrocannabinol poisoning. However, considering the growing trend of illegal drug abusers in Korea, it may still be useful as a diagnostic tool for identifying drug users.

Laboratory analysis of acute acetaminophen overdose patients in Emergency Medical Centers: including analysis of one toxicological laboratory data: In Chan Kim, Sinae Won, Arum Lee, Haeun Jung, Jeongsun Lee, Bum Jin Oh; J Korean Soc Clin Toxicol. 2021;19(1):31-37. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.31

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Abstract PDF: Purpose: Acetaminophen (APAP) is a widely available drug responsible for a large part of drug-induced hepatotoxicity in developed countries. Although acetaminophen overdose cases in Korea are being continuously reported, there are no reports related to the level of this drug in the patient's blood or of laboratory analysis at emergency departments (ED). This study sought to analyze the acetaminophen overdose cases at a toxicological laboratory and to survey APAP analysis services offered at select EDs. Methods: We analyzed the demographic and analytic data at a toxicological laboratory run by the National Emergency Medical Center (NMC) in 2019-2020. We surveyed the APAP laboratory service in the 38 regional emergency medical centers (EMCs) and 68 local EMCs near the toxicological laboratory. Results: We studied 175 acute poisoning cases (112 women) with positive blood APAP results (mean age 47.0±24.1 years). Suicide attempts comprised 40.0% of the cases and 30.3% APAP overdose events. In the univariate analysis, we observed that patients were significantly younger, with fewer underlying medical diseases. There were a higher number of APAP overdose events, more favorable initial mental status, more toxic quantity intake in the above treatment line group (p<0.05), In multivariate analysis, the toxic amount intake was significantly more frequent in the above treatment line group (p<0.01). Hospital APAP analysis services were available in six EMCs (3/38 regional and 3/68 local). The hospital blood APAP level reporting intervals were shorter than outside-hospital laboratory services (p<0.01, regional 7.0±3.0 vs. 40.6±27.5, local 5.3±3.1 vs. 57.9±45.1 hours). The NMC toxicological laboratory reporting interval was shorter than the other outside-hospital laboratories (p<0.01, regional 5.7±0.6 vs. 50.2±22.7 local 7.5±3.0 vs. 70.5±41.5 hours). Conclusion: Over the treatment line group, toxic amount intake was significantly more frequent. Only six of 106 EMCs have their own APAP analysis service in their hospitals.

Association between defoliant exposure and survival to discharge after out-of-hospital cardiac arrest: Dong Wook Kim, Yu Chan Kye, Jung Youp Lee, Eui Gi Jung, Dong Sung Kim, Hyun Jung Choi, Young Lee; J Korean Soc Clin Toxicol. 2021;19(1):38-43. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.38

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Abstract PDF: Purpose: We investigated the association between defoliant exposure and survival to discharge after out-of-hospital cardiac arrest. Methods: This is a retrospective case-control study based on the cardiopulmonary resuscitation (CPR) registry. The electronic medical records of out-of-hospital cardiac arrest victims from 6/9/2008 to 12/31/2016 were analyzed statistically. The case patients group had a history of defoliant exposure while the control group did not. Among the 401 victims studied, a total of 110 patients were male out-of-hospital cardiac arrest patients. Baseline characteristics and the parameters involved in cardiac arrest were analyzed and compared between the two groups after propensity score matching. The primary outcome was survival to discharge, and secondary outcomes were sustained return of spontaneous circulation (ROSC) and survival to admission. Results: After propensity score matching a total of 50 patients (case=25, control=25) were analyzed. Primary outcome (survival to discharge) was not significantly different between case and control groups [(OR, 1.759; 95% C.I., 0.491-6.309) and (OR, 1.842; 95% C.I., 0.515-6.593), respectively]. In the subgroup analysis, there were also no significant differences between the control group and subgroups in primary and secondary outcomes according to defoliant exposure severity. Conclusion: There is no statistically significant association between defoliant exposure and survival of out-of-hospital cardiac arrest.

Effect of ETCO2 monitoring of poisoning patients with decreased mental state in ED: Yong Hee Kwon, Byung Hak So, Won Jung Jeong; J Korean Soc Clin Toxicol. 2021;19(1):44-50. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.44

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Abstract PDF: Purpose: This study aimed to analyse the effect of End-Tidal Carbon Dioxide (ETCO2) monitoring on patients who had been poisoned and presented in the emergency department with decreased consciousness. Methods: The data of patients over 18 years old presenting with poisoning from 2016 to 2020 was collected from the emergency department. We retrospectively analyzed their medical records, and defined patients with a Glasgow Coma Scale (GCS) score of 9 or less as having decreased consciousness. We divided the patients into two groups, one with ETCO2 monitoring and the other without, and the difference between the two groups was compared. Results: 168 patients participated in this study and 83 (49.4%) of them belonged to the ETCO2 monitoring group. In this group, the interval between arterial blood tests was statistically significantly longer and the rate of intubation was lower. In addition, in the monitoring group, the incidence of pneumonia and the rate of poor prognosis was not significantly higher. Conclusion: Although ETCO2 monitoring does not directly affect the prognosis of poisoned patients with decreased consciousness, it should be actively done as it can help to adequately treat patients while avoiding invasive techniques or unnecessary intubation.

Delayed death after chlorfenapyr poisoning: Jang Young Lee; J Korean Soc Clin Toxicol. 2021;19(1):51-54. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.51

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Chlorfenapyr is a widely used insecticide, that is very lethal if ingested. It exhibits delayed toxicity in which there are few symptoms at first which suddenly worsen after a few days. A 66-year-old female patient ingested about 90 mL of chlorfenapyr liquid hydrating agent (Chlofenapyr 10%) and showed stable vital signs with no specific symptoms and findings other than a mild fever, vomiting, and nausea. From the 3rd day of ingestion, creatine kinase was high, and rhabdomyolysis was suspected. From the 4th day of ingestion, pancreatic enzymes began to gradually increase. A diffusion-weighted image showed a multifocal high signal intensity in the white matter and corpus callosum area. On the 8th day after ingestion, she suffered a high fever and a heart attack and died. Thus, if a patient is suspected of taking chlorfenapyr, he/she needs active treatment and monitoring even if he/she does not exhibit any symptoms.

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A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels
Ming-Jin Chung, Yan-Chiao Mao, Chia-Tien Hsu, Mu-Chi Chung, Tsai-Jung Wang, Tung-Min Yu, Po-Yu Liu, Pin-Kuei Fu, Chia-Ming Hsieh
Medicina.2022; 58(11): 1630. CrossRef

Ciguatera fish poisoning in Korea: a case report: Jeong Ho Kang, Sung Kgun Lee; J Korean Soc Clin Toxicol. 2021;19(1):55-58. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.55

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Abstract PDF: Ciguatera is the commonest syndrome of marine poisoning that is caused by the ingestion of ciguatoxins that accumulate in certain tropical and subtropical finfish. It is endemic throughout the subtropical and tropical regions of the Indo-Pacific and Caribbean and has been rarely reported in Korea. With the expansion of travel, tourism, and the import of fish from the tropics, ciguatera poisoning now affects a diverse population. We report a case of ciguatera in a 70-year-old woman, presenting with general paralysis and coma, which developed after consuming codfish and mackerel in Korea.

Use of succimer as an alternative antidote in copper sulfate poisoning: A case report: Sang Kyoon Han, Sung Wook Park, Young Mo Cho, Il Jae Wang, Byung Kwan Bae, Seok Ran Yeom, Soon Chang Park; J Korean Soc Clin Toxicol. 2021;19(1):59-63. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.59

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Abstract PDF: Copper sulfate is widely used as a fungicide and pesticide. Acute copper sulfate poisoning is rare but potentially lethal in severe cases. Copper sulfate can lead to cellular damage of red blood cells, hepatocytes, and myocytes. Toxic effects include intravascular hemolysis, acute tubular necrosis and, rhabdomyolysis. A 76-year-old man presented with vomiting and epigastric pain. He had ingested a copper-containing fungicide (about 13.5 g of copper sulfate) while attempting suicide 2 hours prior to presentation. From day 3 at the hospital, laboratory findings suggesting intravascular hemolysis were noted with increased serum creatinine level. He was treated with a chelating agent, dimercaptosuccinic acid (succimer). His anemia and acute kidney injury gradually resolved with a 19-day regimen of succimer. Our case suggests that succimer can be used for copper sulfate poisoning when other chelating agents are not available.

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