Journal of The Korean Society of Clinical Toxicology

Volume 23(1); June 2025

Original Articles

Narcotics and Psychostimulants in Acute Overdose-Suspected Patients in Emergency Departments in Korea: Analysis of Toxicological Laboratory Data: Yoonsoo Kim, Jiwon Lee, Suncheun Kim, Arum Lee, Misuk Kim, Yun Hee Kim, Jung-In Ko, Bum-Jin Oh; J Korean Soc Clin Toxicol. 2025;23(1):1-9. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00007

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Abstract PDF: Purpose: Narcotic use and associated overdose deaths pose a serious public health threat worldwide. The use of psychostimulants, amphetamines and their derivatives, methamphetamine, ecstasy, or 3,4-methylenedioxy-methamphetamine (MDMA) is a significant challenge to the emergency department (ED). Although cases of illicit psychostimulant use have been reported in Korea, no reports with confirmative laboratory analyses have been reported. The objective of this study was to present data on ED patients who have used psychostimulants.
Methods
We used the 2019–2022 toxicological laboratory database of the National Medical Center, which includes data from six nationwide toxicological laboratories that support suspected acute poisoning patients in the ED. We analyzed demographics (age and sex), presenting mental status, and ethanol co-ingestion. The psychostimulant group was compared with the narcotic group, which contained patients who consumed narcotic drugs but not psychostimulants.
Results
Among 4,366 patients, narcotic drugs were detected in 2,239 patients (51.3%): 2,176 in the narcotic group, one who used cannabis, and 60 in the psychostimulant group. Psychostimulant cases were reported from 2019 to 2022 (13, 11, 25, and 11 each year). The psychostimulant group was younger (39.3±14.3 vs. 55.3±21.5 years), contained more female patients (45.0% vs. 21.1%), and had poorer mental status than the narcotic group (p<0.01). The cases of psychostimulant use were treated in 26 hospitals throughout Korea.
Conclusion
This is the first study reporting results from confirmative analyses of narcotic drug use in ED patients. Psychostimulant-related ED visits were observed throughout Korea.

Development and Validation of a Virtual Patient Simulator for the Management of Acute Poisoning: An Assessment of Face and Content Validity: Ki Yong Kwon, Ji-Hoon Kim, Hyo Joon Kim; J Korean Soc Clin Toxicol. 2025;23(1):10-18. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00009

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Abstract PDF: Purpose: This study describes the development of a virtual reality simulator to train medical staff responsible for acute poisoning in early diagnosis and treatment and presents an evaluation of its face and content validity.
Methods
Five clinical toxicology experts identified calcium channel blocker poisoning, neuroleptic malignant syndrome, ethylene glycol poisoning, methemoglobinemia, and organophosphate poisoning as the focus of scenario development. A three-dimensional virtual reality environment was created using a video game engine, with interaction taking place via a head-mounted display and hand controllers. Emergency physicians assessed the simulator, and a questionnaire survey was conducted to evaluate its face and content validity using a 10-point scale. The collected data were descriptively analyzed.
Results
Eighteen emergency physicians with an average age of 43.9 years old with 11.3 years of experience, evaluated the simulator. Thirteen (72.2%) had no prior experience with immersive virtual reality. The simulator’s realism and ease of operation were highly rated, averaging 9 points. The initial diagnosis and treatment training effectiveness, educational content clarity, and feedback were given scores of 10 points in some scenarios. The simulator’s usefulness as a training tool was rated 9 points. The lowest score (8 points) was given for clarity of interaction in four scenarios. Positive feedback highlighted the value of experiencing rare poisoning cases and receiving feedback on treatment.
Conclusion
A virtual patient simulator with five scenarios was developed to train medical staff responsible for cases of acute poisoning in the initial diagnosis and treatment. Emergency physicians evaluated the simulator as realistic and stated that it would be effective in education.

Characteristics of Acute Toxic Alcohol Poisoning Patients in the Emergency Department: A Toxicological Laboratory Analysis of Ethylene Glycol and Methanol: Min Kyung Park, Emergency Vulnerable Area Regional Cooperation Team, Arum Lee, Misuk Kim, Yun Hee Kim, Jung-in Ko, Bum Jin Oh; J Korean Soc Clin Toxicol. 2025;23(1):19-27. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00006

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Abstract PDF: Purpose: Toxic alcohol exposures are rare yet remain an ongoing and potentially lethal poisoning problem in Korea. Few studies have characterized the epidemiological features and blood substance levels in acutely intoxicated patients presenting to emergency departments (EDs). The objective of this study was to describe the characteristics of intoxicated patients for whom toxicological analyses were requested.
Methods
We reviewed demographic and analytical data from a toxicological laboratory operated by the National Medical Center between 2018 and 2022. In total, 1,244 cases from 35 EDs were analyzed.
Results
Of the analyzed cases, 108 cases (63 patients) tested positive for toxic alcohols, including methanol (MeOH), ethylene glycol (EG), and isopropyl alcohol. Sixty patients had a single toxic alcohol detected: 17 with MeOH and 43 with EG. Clinical features included a median age of 42 years, 63.3% male, 100% acute exposure events, 66.7% suicide attempts, and 50.0% ethanol co-ingestion. Median ingestion amounts were 255 mL (MeOH) and 365 mL (EG). Significant differences between MeOH and EG groups included ingestion of an unknown substance (41.2% vs. 69.8%, p=0.04), initial blood pH (7.33 vs. 7.20, p<0.01), and multiple substance ingestion (52.9% vs. 81.4%, p=0.03). Median blood concentrations were 255 mg/dL (MeOH) and 12 mg/dL (EG). Follow-up analyses occurred in 9 MeOH patients (52.9%, 15 tests) and 15 EG patients (34.9%, 30 tests).
Conclusion
This study presents the first confirmatory analytical data on toxic alcohol poisoning among ED patients in Korea, emphasizing ongoing cases around Seoul.

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