Journal of The Korean Society of Clinical Toxicology

Volume 4(1); 2006

The Effect of Hemoperfusion on Plasma Concentration of Toxins in Acute Pesticide Poisoned Patients: Hyo-Wook Gil, Jong-Oh Yang, Eun-Yong Lee, Sae-Yong Hong; J Korean Soc Clin Toxicol. 2006;4(1):1-6. Published online June 30, 2006

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Abstract PDF: Purpose: Hemoperfusion is an effective modality of extracorporeal elimination of toxins in acutely poisoned patients. We evaluated the effect of hemoperfusion on plasma concentration of toxins in patients exposed to certain pesticides. Methods: Eleven patients who were acutely exposed to pesticides participated in our study. We measured plasma pesticide concentration from the whole blood obtained by arterial and venous sources by gas chromatography. Results: The plasma concentrations of only 3 patients was measured. Methidation clearance by hemoperfusion was 82.2%, fenitrothion was 23%, and endosulfan was 0% Conclusion: Measurement of plasma organophosphate concentration is not a practical application. Our results suggest that hemoperfusion is applicable in patients with pesticide intoxication according to clinical status.

The Antioxidant Effect of Vitamin C and Deferoxamine on Paraquat-induced Cytotoxicity in Cultured Lymphocytes: Eun-Kyung Eo, Kyung-Hee Kim; J Korean Soc Clin Toxicol. 2006;4(1):7-16. Published online June 30, 2006

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Abstract PDF: Purpose: As basic information of antioxidant treatments for the patient with paraquat intoxication, in human peripheral lymphocytes, the cytotoxicity of paraquat was measured, and to evaluate the antioxidant effect of vitamin C and deferoxamine against this cytotoxicity, malondialdehyde (MDA), superoxide dismutase (SOD) activity and total antioxidant status (TAS) were measured. Methods: From 10 healthy adults, after obtaining a consent, 20ml peripheral blood was collected. Experimental groups were divided to (1) control group, the group treated with an identical amount of saline, (2) P group: the group treated with paraquat only, (3) PV group: the group treated with paraquat followed by vitamin C 30 minutes later, (4) PD group: the group treated with paraquat followed by deferoxamine 30 minutes later, (5) PVD group: the group treated with paraquat followed by vitamin C 30 minutes later and subsequently deferoxamine one hour later, and (6) PDV group: the group treated with paraquat followed by deferoxamine 30 minutes later and subsequently vitamin C 1 hour later, and thus to total 6 groups. In each group, 10 samples of peripheral blood was assigned and $100{mu}M;paraquat,;100{mu}M$ vitamin C, and $100{mu}M$ deferoxamine were used as reagent. Lymphocytes were isolated, cultured, and cytotoxicity was measured by the Microculture Tetrazolium method (MTT assay), MDA and SOD activity, and TAS concentration were measured. Results: In regard to the cytotoxicity measured in each group, their cytotoxicity was decreased in the group treated with antioxidants, in comparison with the group treated with paraquat only. In the cases that the order of the treatment of these two antioxidants was altered, viability in the PDV group $(1.077{pm}0.121)$ was increased more that the PVD group $(0.888{pm}0.152)$ statistically significantly (p=0.018). Concerning the amount of MDA, in comparison with the P group $(6.78{pm}0.93{mu}mol/L)$, after the treatment of each antioxidant, the concentration of MDA was decreased statistically significantly (p<0.05). In the group treated with two antioxidants together, in comparison with the group treated only with one antioxidant, the amount of MDA was increased statistically significantly $(PV:;3.96{pm}0.98{mu}mol/L,;PD:;4.92{pm}1.50{mu}mol/L,;PVD:;3.22{pm}0.83{mu}mol/L,;and;PDV:;3.42{pm}0.95{mu}mol/L,;p=0.007)$. The concentration of SOD measured in the blood in each group after the administration of paraquat, in comparison with the control group, a pattern of the elevation of SOD activity and subsequent decrease was detected, however, it was not statistically significant. In the comparison of the groups treated with antioxidants, in comparison with the P group $(1419.9{pm}265.9{mu}mol/L)$, SOD activity was decreased statistically significantly in only the PDV group $(1176.4{pm}238.9{mu}mol/L)$ (p=0.017). In regard to TAS measured in each group, in comparison with the P group $(0.87{pm}0.05{mu}mol/L)$, in all groups treated with the antioxidants, the PV group was $1.00{pm}0.03{mu}mol/L$ (p=0.005), the PD group was $9.01{pm}0.24{mu}mol/L$ was $4.64{pm}3.98{mu}mol/L$ (P=0.005), and the PDV group was $9.41{pm}0.27{mu}mol/La$ (p=0.005), and thus total antioxidant activity was increased statistically significantly In a multiple comparison test, the PDV group showed the highest total antioxidant activity (p<0.0001). Conclusion: The result of the assessment of the antioxidant effect of vitamin C and deferoxamine on paraquat-induced cytotoxicity showed that in regard to cytotoxicity, SOD activity and TAS measurement, the best result was observed in the PDV group. Therefore, it was found that vitamin C and deferoxamine were effective antioxidants for the paraquat-induced cytotoxicity, and it suggests that the administration of deferoxamine followed by vitamin C may improve their antioxidant effect more.

The Differences of Clinical Aspects in Children and Adolescents Poisoning: Joo-Hyun Suh, Eun-Kyung Eo; J Korean Soc Clin Toxicol. 2006;4(1):17-24. Published online June 30, 2006

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Abstract PDF: Objectives
To analyze the general characteristics and clinical differences of poisoning in children and adolescents and to take precautions of occasions. Methods: We retrospectively evaluated poisoning children and adolescents (less than 19 years) visiting to the emergency medical center of tertiary hospital in urban area. We collected demographic data, substance exposure data (materials, causes of poisoning and amount), and clinical outcome of poisoning for the past 2 years and 9 months. Results: 189 cases were reported of concerning poisoning in children and adolescents. The age groups were divided into four categories. (1) Infants group:<2 year, (2) Preschool age group: $2{sim}5year$, (3) Children group: $6{sim}12year$ and (4) Adolescents group: $13{sim}18year$. The most vulnerable age group was the infants group. There were two-peaks of age distribution in poisoned patients on the whole. Various types of materials belonged to classes of druqs (56.6%). household products (34.4%) and industrial solvents (9.0%). On adolescents group, the frequency of drug poisoning was significantly high, in comparison with infants, preschool age, and children group (p=0.001). Most of the patient groups had been poisoned accidentally(73.5%), while most cases of adolescents poisoning had been intentional. 63% of the adolescents group had a suicidal purpose. Conclusion: The incidence of poisoning was most highly due to drugs. The cause of poisoning is most commonly accidental. while in adolescent group, intentional poisoning is mostly common. Special cares, like keeping children away from drugs, will be needed to prevent children poisoning, and psychiatric consultation and supportive cares can reduce the adolescents poisoning cases.

The Survey of Intoxication in the Two Hospitals of the City of Goyang: Kyung-Hwan Kim, Jun-Soek Park, Dong-Wun Shin, Jun-Young Rho, Hey-Jin Kim, Hong-Du Gu, Jin-Kyung Cho, Ah-Jin Kim; J Korean Soc Clin Toxicol. 2006;4(1):25-31. Published online June 30, 2006

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Abstract PDF: Purpose: In the year of 2005, it enforced the basic study for establishing program of Poison Control Center by National Institute of Toxicologic Research. The object of our survey is to analyze the characteristics of intoxication from the City of Goyang by same protocol. Methods: We retrospectively reviewed the data of medical records of the intoxication patient in the two hospitals of the Goyang from 2004 June 1st to 2005 May 31th. The investigation protocol applied the TESS report form which was used from the Basic study for establishing program of Poison Control Center. Results: The intoxication patients were total 269 persons, the patients of A hospital were 184 persons, B hospital were 185 persons. The most common intoxication materials were medicines, in afterwords it was an agricultural chemical. The most common place of intoxication was the home. The intentional suicidal attempts in the reason of intoxication were 51.2%. The rate of the patients who discharges from the emergency department was 50.4% and death rate was 4.3%. Conclusion: We concluded that the continuous and systemic report and analysis should be accomplished from the Goyang area.

Research on Poisoning Data Collection using Toxic Exposure Surveillance System: Retrospective Preliminary Survey: Bum-Jin Oh, Won Kim, Gyu-Chong Cho, Hui-Dong Kang, Yoo-Dong Shon, Jae-Ho Lee, Kyoung-Soo Lim; J Korean Soc Clin Toxicol. 2006;4(1):32-43. Published online June 30, 2006

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Abstract PDF: Purpose: Toxic Exposure Surveillance System (TESS) is widely used for poisoning data collection and making a counterplan. But, there were few reports about poisoning data collection using TESS in Korea. The aim was to collect poisoning data using TESS report form and investigate the recognition of emergency physician about the necessity of TESS as preliminary survey. Methods: Retrospectively, we gathered data from hospital records about the patient who admitted hospital emergency room due to poisoning. Date were gathered by paper and/or web client system report form in patients recruited by ICD-10 codes Results: From Jun 2004 to May 2005,3,203 patients were enrolled in 30 hospitals and their mean age was $44.9{pm}20.3years$ old(male: female = 1,565: 1,638). The most frequent site of exposure was their own residence (73.2%, 2,345/3,203) and most of reported patients were older than 20 years(89.7%, 2,871/3,203). Frequent substances involved in poisoning were medication(41.9%) and pesticide(33.3%). Intentional poisoning was 60.7%(1,954). In fatality, overall frequency was 5.1%(162/3,203) and the most frequent route of exposure was ingestion(96.3%, 156/162) and the most frequent substance was pesticide(85.2%, 138/ 162). Antidotes were administered in 202 patients(2-PAM, atropine, antivenin, N-acetylcystein, vitamin K, flumazenil, ethanol, methylene blue, naloxone, calcium compound). 19 of 20 emergency physicians agreed with necessity of TESS. Conclusion: Data collection using TESS report form showed preliminary poisoning events in Korea. Frequent poisoning substance were medication and pesticide. The fatality was mainly related with pesticide ingestion. Many doctors in emergency room recognized the necessity of TESS.

Transient Change of Electrocardiogram in Two Young Women With Salicylate Intoxication - Two Cases Report -: Je-Sung You, Jong-Woo Park, Young-Hwan Choi, Young-Soon Cho, Kwang-Hyun Cho, Jun-Seok Park, Sung-Pil Chung, Hahn-Shick Lee; J Korean Soc Clin Toxicol. 2006;4(1):44-47. Published online June 30, 2006

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Abstract PDF: Symptoms of aspirin overdose may vary from acid-base disturbance, electrolyte abnormality, non-cardiogenic pulmonary edema, chemical hepatitis, seizure to cardiac toxicity. Cardiac adverse effects from aspirin are uncommon but there are reports of arrhythmia, cardiopulmonary arrest, and myocardial infarction. We report 2 cases of young women with aspirin overdose who exhibited ischemic changes on their ECGs a few hours after the ingestion with spontaneous recovery in a few days. First case, a 29 year old woman, presented to the emergency department 6 hours after ingesting 250 tablets of aspirin (325 mg/T). On examination, the temperature was $36.3^{circ}C$: blood pressure, 105/72mmHg; Pulse, 111/min and respiratory rate, 24/min. Second case, a 27 year old woman, an hour after ingesting 60 tablets (325mg/T). On examination, the temperature was $36.0^{circ}C$: blood pressure, 102/72 mmHg; pulse, 89/min and respiratory rate, 25/min. In both cases, ECG after 6 hours of ingestion had sinus tachycardia and developed T wave inversion on the anterior leads in the following ECGs. Their initial serum salicylate levels after 6 hours of ingestion were 71.2 mg/dL and 28.4 mg/dL respectively. These salicylate levels were resolving when these ECGs were observed. The ECG changes resolved in the following days and they were discharged without any further symptoms. Further studies are needed, but for the time being, when dealing with salicylate overdose, transient cardiac depression should be kept in mind to avoid adverse ischemic cardiac events.

A Patient Presenting with Abnormal Behavior after Wild Plant Ingestion: Taek-Geun Ohk, Yoon-Seong Kim, Chan-Woo Park, Joong-Bum Moon, Ki-Hoon Choi, Jeong-Yeul Seo, Hee-Cheol Ahn, Moo-Wob Ahn, Jun-Hwi Cho; J Korean Soc Clin Toxicol. 2006;4(1):48-51. Published online June 30, 2006

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Abstract PDF: With well-being boom recently, the common people, but not experts, are increasingly taking in them directly by picking wild herbs. However, only experts can distinguish between edible vegetables and poisonous herbs from the wild herbs. Especially, it is not even easy for experts to distinguish them only by looking into buds in spring without flowers or fruit. So, sometimes many patients are being carried into the emergency room by the toxic symptom after taking by misunderstanding the poisonous herbs as edible vegetables. For herb intoxication as well as drug intoxication, what kinds of vegetables patients took in, and when and how much they took in them are important information for curing. Of course, in the case of intoxicating in the wild herbs, the patients can have a lot of symptoms and sings-hemodynamic alteration and abnormal neurologic sign as well as gastrointestinal symptoms-according to the kinds of herbs which they took in. Therefore, it is difficult to find the kinds of herbs which they took in through the specific symptoms. Recently we experienced a case with showing typical anticholinergic symptoms after ingestion of Scopolia japonica. As a result, the publicity activities about the wild plants needs because if the person without their previous knowledge take in the poisonous herbs, serious side effects can be produced..

Datura Stramonium Intoxication of Which Resulted in Changing Mentality - A Case Report -: Je-Sung You, Yeoun-Woo Nam, Jin-Hee Lee, Sung-Pil Chung, Seung-Ho Kim, In-Cheol Park; J Korean Soc Clin Toxicol. 2006;4(1):52-54. Published online June 30, 2006

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Abstract PDF: Datura stramonium is a wild growing plant, consumption of which can result in severe toxicity. It contains a variety alkaloids include atropine, hyoscamine, and scopolamine that can all cause anticholonergic poisoning. It has been use of herb medicine in Korea. Side effects from ingesting Datura stramonium include dry mouth, blurred vision, photophobia, and may be followed by hyperthermia, confusion, agitation, hallucination, and aggressive behavior. In severe toxicity, it can cause seizure, coma, life-threatening arrhythmia, and death. We experienced one patient who developed stupor mentality caused by Datura stramonium. Severe presentation, especially mental change of Datura stramonium should draw attention. Poisoning associated with Datura stramonium can be prevented through educational public health program.

A Case of Hydrogen Cyanide Inhalation at Working -A Case Report-: Yang-Weon Kim, Young-Jin Eom; J Korean Soc Clin Toxicol. 2006;4(1):55-57. Published online June 30, 2006

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Abstract PDF: Cyanides and Hydrogen cyanide are used in production of chemicals, electroplating, photographic development, making plastics, fumigating ships, and some mining processes. We experienced of Hydrogen cyanide inhalation injury. A 45-year-old man worked at electroplating. As soon as he mixed sodium cyanide with acid, cyanide produced hydrogen cyanide, occasionally he inhaled Hydrogen cyanide and he lost his consciousness. He was moved to near hospital and took emergency treatment and then was transferred to our hospital. On arrival he had severe dyspnea, metabolic acidosis, and tachycardia. After he was treated with supportive method he recovered his consciousness in 20 hours at emergency room.

2 Cases of Toad Venom Intoxication: Cheong-Hoon Kwon, Woo-Chan Jun, Yoon-Suk Jung, Jung-Hwan Ahn; J Korean Soc Clin Toxicol. 2006;4(1):58-60. Published online June 30, 2006

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Abstract PDF: The venom gland of Toad contains large quantities of cardiac glycosides, and toad venom poisoning is similar to digitalis toxicity and carries a high mortality. Sometimes after ingestion of aphrodisiac pills which contain dried toad, a patient develops gastrointestinal symptoms and bradycardia, psychoneurologic symptoms. We have experienced 2 cases of toad venom intoxication, who ingested asian toads. Patients were presented to our ED with nausea, vomiting, and abdominal pain. The patients were peformed monitoring and conservative treatment and were fully recovered. Toad venom intoxication should be considered in patients with clinical manifestation of gastrointestinal irritation, cardiac arrhythmias, hyperkalemia, and detectable serum digoxin level without current medication of digoxin.

A Case of anterograde amnesia with hippocampal lesions following glufosinate intoxication: Seung-Hwan Seol, Hyeon-Soo Park, Jung-Hwan Ahn, Hee-Young Park, Phil-Hyu Lee, Gi-Woon Kim; J Korean Soc Clin Toxicol. 2006;4(1):61-64. Published online June 30, 2006

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Abstract PDF: Glufosinate ammonium (GLA), a phosphinic acid derivate of glutamate, is a broad-spectrum contact herbicide. It structurally resembles glutamate, a typical excitatory amino acid in the central nervous system. In korea, the ingestion of GLA for suicidal attempt or accidental event has increased. The neurological complication of GLA intoxication are characterized by loss of consciousness, convulsion, or memory impairment. But, the exact mechanism of GLA toxicity is yet unknown. This report is about a patient with GLA intoxication who showed anterograde amnesia with selective bilateral hip-pocampal lesions supported GLA intoxication with literature reviews supported.

Two Cases of Contact Urticaria Syndrome from Cefotiam in Nurses: Pyeong-Moon Jang, Jung-Won Lee, Yong-Seung Kim, Young-Shin Cho, Ki-Won Yu, Hoon Lim, Ho-Jung Kim; J Korean Soc Clin Toxicol. 2006;4(1):65-68. Published online June 30, 2006

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Abstract PDF: Contact urticaria describes a wheal and falre response elicitied within 30-60 minutes after cutaneous exposure to certain agents. Contact urticaria encompasses a number of different clinical manifestations and the symptoms which can vary from the mildest forms of burning, stinging and itching sensation to life-threatening anaphylaxis referred to as contact urticaria syndrome. Cefotiam is one of the most popular second generation cephem antibiotic used in korea. Since 1975, contact urticaria due to cephalosporins has been reported, and also, in japan, this reported from about last 15 years. Recently we experienced three nurses working at the general wards with showing contact urticaria and anaphylaxis after occupational exposure to cefotiam antibiotics.

A Fatal Case of Dicamba Intoxication: Dae-Young Hong, Wook-Hyun Um, Kyoung-Mi Lee, Ji-Hye Kim, Seung-Baik Han, Joo-Hyun Suh, Jun-Sig Kim, Hyung-Keun Roh; J Korean Soc Clin Toxicol. 2006;4(1):69-72. Published online June 30, 2006

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Abstract PDF: Dicamba is a benzoic acid and classified as a chemically related chlorophenoxy herbicide which is widely used for the control of broad-leaved weeds. While the chlorophenoxy herbicide poisoning is known to be uncommon, its ingestion can result in serious or sometimes fatal outcome. A 65-year-old man ingested about 300 ml of dicamba in a suicidal attempt and three hours later he was admitted hospital, complaining abdominal pain, nausea and vomiting. On admission his vital signs were normal and laboratory findings were not remarkable except metabolic acidosis in arterial blood gas analysis. Shortly after the admission endotracheal tube was inserted due to altered mental state and activated charcoal was given after performing gastric lavage. However, his vital signs became unstable 6hrs after the ingestion and mechanical ventilation was started with administration of inotropic agents. In spite of urine alkalization for rapid elimination of the absorbed dicamba, the metabolic acidosis was aggravated with concomitant rhabdomyolysis and acute renal failure, and he died 24 hrs after the ingestion.

Severe Liver Toxicity Caused by Amatoxin (Case Series): Joo-Hyun Suh, Sung-Jin Kim, Young-Kuk Chung, Woong-Gil Choi, Young-Se Kwon, Hyung-Keun Roh; J Korean Soc Clin Toxicol. 2006;4(1):73-77. Published online June 30, 2006

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Abstract PDF: Poisoning with mushroom containing amatoxin may be a real medical emergency and is characterized by long incubation time lag, gastrointestinal symptoms, hepatotoxic phase and sometimes death. We report a family of parents and two children who ingested wild mushroom and recovered from varying degrees of hepatotoxicity. After eating cooked wild mushroom and its soup, they all developed abdominal pain, vomiting and diarrhea 11 hours later, Their liver enzymes reached peak level between 48 and 72 hours after the ingestion. Among the family members, 5-year-old girl showed the most severe hepatic toxicity of AST/ALT 14,099/13,176 IU/L. They were all treated with supportive measures including repeated activated charcoal and penicillin G and recovered from the hepatotoxicity between 7 and 28 days after the ingestion. Being based on the shape and a typical course of the amatoxin poisoning, we presume that this wild mushroom belongs to Amanita virosa.

Two Cases of Mad-Honey Poisoning with Cardiovascular Symptom: Young-Gil Ko, Kyung-Hwan Kim, Ah-Jin Kim, Dong-Wun Shin, Jun-Soek Park, Jun-Young Roh, Ji-Young Ahn; J Korean Soc Clin Toxicol. 2006;4(1):78-81. Published online June 30, 2006

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Abstract PDF: Mad-honey poisoning is mainly brought about by the honey imported from Napal, Turkey, Brazil and other parts of Europe. This mad honey is extracted from Ericaceae plants of Rhododendron species and contains grayanotoxins that causes poisoning. These toxic compounds exert a specific stimulatory action on membrane permeability to Na+ions in various excitable tissues and cause depolarization of cell membranes. The toxic effects of grayanotoxins contained honey are mainly cardiovascular disturbances with bradycardia, cardiac arrhythmia, hypotension. There are Other symptoms like nausea, vomiting, salivation, dizziness, weakness and loss of consciousness. The precise amount for a toxic dose is not known. In general the severity of the honey poisoning depends on the amount ingested. Two cases of mad-honey poisoning are described here. Both patients showed bradycardia and arterial hypotension after ingestion of honey which was brought from Nepal. They were recovered fully within 24 hours after administration of fluids and atropine sulphate.

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