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Volume 2(1); 2004
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The Toxic Exposure Patients of Daejon Province by Modified TESS Style
Jung Kyoo Park, Sung Phil Jeong, Seung Hwan Kim, In Sui Yoo, Joon Seok Park, Jin Hyun Yoo, Yeong Mo Yang, Si Kyung Jeong
J Korean Soc Clin Toxicol. 2004;2(1):1-6.   Published online June 30, 2004
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Purpose: A number of reports about the intoxicated patients have been introduced, but there were few multicenter studies. The purpose of this study was to analyse the patients with toxic exposure in the Daejon province. Methods: The patients who were presented to the four academic emergency departments in Daejon with toxic exposure were enrolled from January to June 2003. The collected variables were according to the form which modified from the Toxic Exposure Surveillance System (TESS) of the American Association of Poison Control Centers. Results: The toxic exposure patients were 362 cases which is $0.78\%$ of total patients presented to the emergency department. The most common exposure site was home ($84\%$). Eighteen percent of cases were exposed by two or more substances. The most common substance was the pesticides ($34.8\%$), and the non-prescription drugs ($32.6\%$) was followed. The suicidal attempt was the top reason for exposure ($67.1\%$). The route of exposure other than ingestion was $3.6\%$. Although the most patients left the hospital within a day, the average treatment period was 4.4 days. Thirty-one patients ($8.6\%$) were expired, and 22 among them were exposed to the paraquat. Conclusion: We reported the current status of toxic exposure in Daejon province by modified TESS style.
Cardiovascular Manifestations of Acute Organophosphate and Carbamate Poisoning
Sam-Beom Lee, Jung-Ho Kim, Byung-Soo Do
J Korean Soc Clin Toxicol. 2004;2(1):7-11.   Published online June 30, 2004
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Purpose: We would evaluate the cardiovascular manifestations of the patients with acute organophosphate and carbamate poisoning in the emergency department. Methods: This was retrospectively studied with the review of patient's charts, included total 38 patients were admitted during the past two years in the emergency department of Yeungnam university hospital with the diagnosis of organophosphate or carbamate poisoning. Results: Cardiovascular complications were variously developed in many patients. Electrocardiographic findings were as follows; 4 ($10.5\%$) cardiac arrhythmias included 1 cardiac arrest caused by ventricular fibrillation, 14 ($36.8\%$) sinus tachycardias, 3 ($7.9\%$) sinus bradycardias, and 17 ($44.7\%$) normal sinus rhythms. Conduction disturbances were 23 ($60.5\%$) like as prolonged QTc, 4 ($10.5\%$) ST-T changes, 2 (5.3%) first degree AV block, and 3 ($7.9\%$) right bundle branch block were shown. Other cardiovascular complications were 22 ($57.9\%$) hypertensives, 4 ($10.5\%$) hypotensives, 15 ($39.5\%$) tachycardias, 2 ($5.3\%$) bradycardias, 18 ($47.4\%$) hypoxemics, 12 ($31.6\%$) metabolic acidosis, and 9 ($23.7\%$) pulmonary edemas. Sixteen patients ($42.1\%$) needed ventilatory support because of respiratory paralysis. No patients died in hospital and 36 ($94.7\%$) patients were alive-discharged. Conclusion: Cardiovascular complications are variously in patients with acute organophosphate and carbamate poisoning. Especially, some findings included ventricular arrhythmias, QTc prolongation, hypoxemia, acidosis, and blood pressure changes are known as major precipitating factors to increase the mortality. So, intensive support and aggressive treatment are needed in patients shown various cardiovascular manifestations in the emergency department.
A Case of Electrocardiographic Change Associated with Anaphylaxis
Dong Hoon Lee, Hye Young Jang, Eun Kyung Eo, Koo Young Jung
J Korean Soc Clin Toxicol. 2004;2(1):12-14.   Published online June 30, 2004
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Anaphylaxis is a systemic allergic reaction which can bring fatal results. The common symptoms are erythema, angioedema, urticaria, hypertension and dyspnea. However, in very few cases, ST segment changes in the electrocardiogram can be seen. This is a case of a 51 year old female with normal heart function who showed reversible ST segment depression during anaphylaxis caused by a $H_2$-blocker agent. The cause of ST segment changes during anaphylaxis is thought to be the result of coronary vasospasm mediated by various factors.
Two Cases of Acute Renal Failure due to Rhabdomyolysis Complicating Doxylamine Succinate Intoxication
Jae Kwon Jung, Sung Ho Kim, In Seek Kim, Seon Woong Kim, Dong Wook Ju, Duk Hyun Lee, Jong Kun Kim
J Korean Soc Clin Toxicol. 2004;2(1):15-19.   Published online June 30, 2004
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Doxylamine succinate is an antihistamine used primarily as a sleep-induction. It can be gotten without a doctor's prescription in Korea, so it' s overdoses were frequently encountered. There were several reports that the overdoses of doxylamine might cause rhabdomyolysis, but few cases have been reported that it is related to acute renal failure (ARF). In cases that ARF occur, most of them are not severe enough to require hemodialysis. We experienced two cases of severe rhabdomyolysis complicating ARF after doxylamine overdose and treated with hemodialysis. Clinicians should be aware of the potentially lethal complications of rhabdomyolysis in patients who ingest doxylamine succinate and the needs for prompt intervention and careful assessment of renal function.
Peripheral Neuropathy after Inhalation of Mercury
Hong Jae Chae, Hyoung Jai Lee, Sei Won Oh, Sung Kwan Lee, Jai-Dong Moon
J Korean Soc Clin Toxicol. 2004;2(1):20-22.   Published online June 30, 2004
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Acute mercury inhalation poisoning is a rare cause of acute peripheral neuropathy. A 44-year-old female inhaled the fume from heating mercury to treat her palmar dermatitis. For 4 days, this procedure was done for 2-3 minutes after each meal. She subsequently complained flu like symptoms, such as headache, toothache, myalgia and arthralgia. She was admitted for 9 days and then symptoms disappeared. About 3 weeks after exposure, both knee pain developed and then she could not walk. To treat mercury intoxication, she was referred to our hospital. At that time, initial laboratory data were within normal limits, but blood and urinary mercury level were 5.6 11$mu$g/dl, 132.8 $mu$g/L. After treatment with D-penicillamine for 7 days, blood and urinary mercury level were 3.9 1$mu$g/dl, 177.3 $mu$g/L. During the following 1 month, both leg symptoms remained. Nerve conduction studies were performed, both leg sensory nerve amplitude decreased. These findings were suggestive of peripheral polyneuropathy.
A Case Report of Glacial Acetic Acid Ingestion Complicated with Hepatic Necrosis
Yeon Young Kyong, Mi Jin Lee, Seung Pil Choi, Kyu Nam Park, Won Jae Lee, Se Kyung Kim
J Korean Soc Clin Toxicol. 2004;2(1):23-26.   Published online June 30, 2004
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Caustic ingestion can produce a progressive and fatal injuries to esophagus, stomach and other organs. Reported exposure to acetic acid results injuries to gastrointestinal tract, hemolysis and disseminated intravascular coagulation is general, but causing hepatic necrosis by direct injuries are rare. A 47-year-old man visited our emergency medical center complaining odynophagia and abdominal pain after ingesting glacial acetic acid ($99\%$) with suicidal ideation. At the time of arrival, the patient complained mild abdominal pain but a few hours later the patient complained severe abdominal pain with markedly elevated liver enzymes. The Abdominal Computerized Tomography showed diffuse gastric wall edema and density of wedge shaped hypodense area in right hepatic dome showing focal hepatic necrosis without significant inflammation. This seems likely to be a direct effect of the noxious agent on hepatocyte involving the portal circulation.
Phytolacca Radix Poisoning due to Misidentification as an Arrowroot
Woo-Je Jin, Youngho Jin, Tae-O Jeong, Jae- Baek Lee
J Korean Soc Clin Toxicol. 2004;2(1):27-30.   Published online June 30, 2004
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Phytolaccaceae had been used as a pharmaceutical drugs or food in Korea. Nowadays, it is rarely used due to its toxicity, and then, case reports as to poisoning also are rare. Recently, Authors experienced a case of an occurrence in a group intoxication after ingestion of roots of phytolacca american a misidentifying as arrowroot. We report this case with review of phytolacca radix poisoning.
Hydrogen Sulfide Poisoning
Young-Hee Choi, Byung-Kuk Nam, Hyo-Kyung Kim, Ji-Kang Park, Eun-Seog Hong, Yang-Ho Kim
J Korean Soc Clin Toxicol. 2004;2(1):31-36.   Published online June 30, 2004
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Three workers, field operators in lubricating oil processing of petroleum refinery industry were found unconscious by other worker. One of them who were exposed to an high concentration of H2S was presented with Glasgow Coma Score of 5, severe hypoxemia on arterial blood gas analysis, normal chest radiography, and normal blood pressure. On hospital day 7, his mental state became clear, and neurologic examination showed quadriparesis, profound spasticity, increased tendon reflexes, abnormal Babinski response, and bradykinesia. He was also found to have decreased memory, attention deficits and blunted affect which suggest general cognitive dysfunction, which improved soon. MRI scan showed abnormal signals in both basal ganglia and motor cortex, compatible with clinical findings of motor dysfunction. Neuropsychologic testing showed deficits of cognitive functions. SPECT showed markedly decreased cortical perfusion in frontotemporoparietal area with deep white matter. Another case was recovered completely, but the other expired the next day.
The Cases of Toxicity Caused By Scopolia Japonica Ingestion
Gi Hoon Choi, Hee Cheol Ahn, Moo Eob Ahn, Jae Bong Chung, Sung Eun Kim, Ji Hoon Bae, Jeong Yeol Seo, Jun Hwi Cho, Chan Woo Park, Taek Gun Ok
J Korean Soc Clin Toxicol. 2004;2(1):37-40.   Published online June 30, 2004
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In emergency department, the clinicians occasionally meet some patients with toxicity caused by ingestion of unknown wild edible greens or herbal agents. Due to there was few quantitative or qualitative studies about the mechanism or clinical features of these materials, it' s hard to approach to the patients and start the initial management in emergency department. Authors experienced the case of poisoning by Scopolia Japonica ingestion. We report this case with review of Scopolia Japonica.
The Shock with Bradycardia after Ingestion of Caltha palustris
Chan-Woo Park, Taek-Gun Ok, Jun-Hwi Cho, Dong-Wook Choi, Ae-Young Her, Hee-Young Lee, Yong-Hoon Kim, Byung-Ryul Cho, Sung-Eun Kim, Ki-Hoon Choi, Ji-Hoon Bae, Jeong-Yeul Seo, Jae-Bong Chung
J Korean Soc Clin Toxicol. 2004;2(1):41-44.   Published online June 30, 2004
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With a recent well-being boom, our interest in chemical-free vegetables is also increasing. So, some people are trying to take in wild plants chosen by themselves. However, others often come to their rescue in an emergency department after eating them, caused by their misunderstanding poisonous herbs as edible vegetables. We have ever seen two persons carried into the emergency department with bradycardia and shock incurred by his intake by confusion between Caltha palustris and Ligularia fischeri lately. There were symptoms such as epigastric pain, nausea, vomiting and so on in their cases, and the symptoms of bradycardia and hypotension continued. Owing to sustained bradycardia and hypotension states, we applied a dopamine to a patient, and then the in-patient left the hospital two days later. We presumed the cause of the two symptoms appeared in two cases to be a saponin in Caltha palustris. For that reason, if someone has the bradycardia and hypotension symptoms from an unknown cause after taking in wild plants, they have to consider a toxication by the Caltha palustris. Therefore, this paper focused on the issue that unexpected poisoning would have to be prevented by studying about wild plants much more and informing the toxic risk from the plants.
A case of Diagnosing Paraquat Intoxication on Transferred Patient with Acute Renal Failure
Hyo Wook Gil, Jong Oh Yang, Eun Young Lee, Sae Yong Hong
J Korean Soc Clin Toxicol. 2004;2(1):45-48.   Published online June 30, 2004
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Paraquat, a widely used herbicide, is extremely toxic, causing multiple organ failure in human. Many treatment modality has been used, but now paraquat is very fatal drug. Elimination rate of plasma paraquat seems to be a factor for the survival rate. So early diagnosis and early treatment are very important. Plasma paraquat concentration could be measured by radioimmunoassay. But it is impossible that the test was done at Emergency room and the result was checked immediately. There was relation between plasma paraquat concentrations and urine paraquat concentration. Because of its simplicity and low cost, urine paraquat concentration test is complementary to the plasma concentration measurement. If the patient has psychotic problem or unconscious mental state, and is observed unexplained dyspnea and oral ulcer, urine paraquat test is very important to rule out acute paraquat intoxication. We experienced a patient who was presented as unexplained acute renal failure initially and was diagnosed as paraquat intoxication later.
Two Cases of Sodium Bicarbonate Inhalation Therapy in Chlorine Gas Intoxication
Dong-Hoon Lee, Eun-Kyung Eo
J Korean Soc Clin Toxicol. 2004;2(1):49-53.   Published online June 30, 2004
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A chlorine gas is a common irritant and when exposed, it result in mild occular, oropharyngeal, or respiratory symptoms. In severe case, however, it may result in pulmonary edema, interstitial pneumonia, or respiratory failure. We report the case of 29-year-old and 46-year-old men is accidentally exposed to chlorine gas during cleaning water. The patients complained dyspnea, chest tightness, cough and both eye pain. During hospitalization, they were treated with inhalation of humidified oxygen, beta-adrenergic agonist and $2\%$ sodium bicarbonate. After several days, patients were discharged without respiratory symptoms and complication. In treatment of chlorine gas toxicity the inhalation of sodium bicarbonate is a possible initial therapy can improve respiratory symptoms in spite of lack of evidence.
A case of Hypothermia Resulting from Disulfiram-Ethanol Reaction
Hyun-A Bae, Eun-Kyung Eo
J Korean Soc Clin Toxicol. 2004;2(1):54-57.   Published online June 30, 2004
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Disulfiram (tetraethylthiuram disulphid) is used in the treatment of chronic alcoholism since it causes an unpleasant aversive reaction to alcohol. It works by inactivating hepatic aldehyde dehydrogenase, leading to pronounced rise in the acetaldehyde concentration when ethanol is metabolized. Acetaldehyde causes alcohol sensitivity, which involve vasodilation associated with feeling of hotness and facial flushing, increased heart rate and respiration rates, lowered blood pressure, nausea, headache. One of its metabolites, diethyldithiocarbamate (DDC) can inhibit the enzyme dopamine $eta$-hydroxylase (DBH), this may account for the profound refractory hypotension and hypothermia seen with the disulfiram-ethanol reaction (DER), resulting from norepinephrine depletion. This report is presents the case of a patient we met, who presented with hypothermia caused by the disulfiram-ethanol reaction, and along with a brief review of the subject.
A Case of Serious Caustic Injury after Ingestion of Hydrochloric Acid
Hyun-Joo Park, Hyeon-Gyu Yi, Pum-Soo Kim, Hyung-Keun Roh
J Korean Soc Clin Toxicol. 2004;2(1):58-62.   Published online June 30, 2004
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Acid ingestion can cause not only caustic injury on esophagus and stomach but also fatal outcome through systemic complications. We report the case of a patient who died early after severe caustic injury with strong acid. A 38-year-old man who ingested about 400ml of hydrochloric acid of unknown concentration was transferred to our hospital from a private clinic, in which he was managed with gastric irrigation through a nasogastric tube. He was complaining dyspnea and abdominal pain. Physical examination demonstrated tenderness and rebound tenderness on epigastric region. Severe metabolic acidosis and leukocytosis were noted. Radiological findings suggested perforation of gastrointestinal tract, although the physical signs were not typical. Endoscopy revealed caustic injuries of grade I on esophagus and of grade Ⅲ on stomach, which indicate more severe injury on the stomach than on the esophagus. Exploratory surgery was recommended but unfortunately not permitted by his family. Despite intensive measures, his vital signs deteriorated rapidly and he died 50 hours after the ingestion.
Myopericarditis by an Ingestion of Hydrofluoric acid - A case report
Sun Hyu Kim, Hyun Kim, Ho Jin Ji, Yong Soo Jang, Sung Bum Oh, Kang Hyun Lee, Sung Oh Hwang
J Korean Soc Clin Toxicol. 2004;2(1):63-66.   Published online June 30, 2004
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Hydrofluoric acid (HF), one of the strongest inorganic acids, is used mainly for industrial purpose. Hydrofluoric acid injuries has a potential for both systemic as well as severe local tissue destruction. One of the most serious consequences of severe exposure to HF by any route is marked lowering of serum calcium (hypocalcemia) and other metabolic changes, such as hypomagnesemia and which may result in a fatal outcome if not recognized and treated. promptly cardiotoxicity is not well known except arrhythmias, which are a primary cause of death. We report a case of myopericarditis by ingestion of hydrofluoric acid.

JKSCT : Journal of The Korean Society of Clinical Toxicology