Journal of The Korean Society of Clinical Toxicology

Volume 5(2); 2007

The Study of Pyrethroid Intoxication: The basis of Agrichemical Intoxication Survey in 2005: Ah-Jin Kim, Kyung-Hwan Kim, Joon-Seok Park, Eun-Kyung Eo, Bum-Jin Oh, Mi-Jin Lee, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh; J Korean Soc Clin Toxicol. 2007;5(2):99-105. Published online December 31, 2007

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Abstract PDF: Purpose: Pyrethroid is an insecticide that produces moderate intoxication in mammals, with neither exposure to skin nor inhalation resulting in severe systemic manifestations. In 2005 we made a nationwide survey of agrichemical human intoxication. The object of this study is to analyze pyrethroid intoxications based on the 2005 survey. Methods: We prospectively collected data from 1 August 2005 to 31 July 2006 by a standard investigation protocol. We analyzed demographic data, exposure data (cause, amount, ingredients), clinical features, and courses. Results: A total of 125 cases of pyrethroid intoxication were surveyed. The mean patient age was $56.78{pm}16.158$ years old, and the mean amount ingested was $121.85{pm}110.732ml$. Patients were classified into four severity groups according to symptoms and mental status: the asymptomatic group (27 patients, 21.6%), the mild symptom group (48, 38.4%), the moderate symptom group (21, 16.8%), and the severe symptom group (7, 5.6%). There were statistically significant differences in mental status, severity, and mean ICU days between two groups. Admission days by severity grade for the asymptomatic, mild, moderate, and severe symptom groups were $5.49{pm}16.051,;3.65{pm}4.143,;4.59{pm}3.335,;and;8.14{pm}7.199days$, respectively (p=0.047). Conclusion: Nationwide surveillance was extremely telling in uncovering a high frequency of agrichemical intoxication in Korea. In pyrethroid intoxication, severity grading can be a useful prognostic tool.

Survey of the Antidote Stocking in the Emergency Medical Centers in Korea: Je-Sung You, Eui-Chung Kim, Hahn-Shick Lee, Seung-Ho Kim, Sung-Pil Chung; J Korean Soc Clin Toxicol. 2007;5(2):106-111. Published online December 31, 2007

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Abstract PDF: Purpose: Inadequate hospital stocking and unavailability of essential antidotes is a worldwide problem. The purpose of this study was to determine the adequacy of antidote stocks in Korean hospitals based on a modified version of US antidote stocking guidelines. Methods: Both written and telephone surveys to collect information on hospital demographics and antidote stocking were given to the emergency departments or hospital pharmacies of 117 hospitals with emergency medical centers. The twenty antidotes included in the survey were taken from year 2000 US antidote stocking guidelines, except for activated charcoal and black widow spider antivenin. Antidote stocks were compared by hospital size, geographic location, and type of emergency medical center. Results: Complete responses were received from all hospitals. A mean of $12.4{pm}2.9$ antidotes were adequately stocked per hospital. All hospitals stocked atropine, $CaCl_2$ naloxone, and sodium bicarbonate. However, digoxin Fab fragment (16%), cyanide kits (15%), EDTA (10%), BAL (9%), and fomepizole (1%) were not uniformly stocked. Large and teaching hospitals were significantly more likely to stock greater numbers of antidotes. Conclusions: Korean hospitals as a group do not have adequate antidote stocks. Korean stocking guidelines and an antidote management system are recommended in order to correct these deficiencies.

Clinical Aspects of the Chlorophenoxy Herbicide Intoxicated Patients: Young-Soon Cho, Ho-Jung Kim, Bum-Jin Oh, Joo-Hyun Suh, Woon-Yong Kwon, Joon-Seok Park, Eun-Kyung Eo, Mi-Jin Lee, Sung-Woo Lee, Hyung-Keun Roh, Hoon Lim; J Korean Soc Clin Toxicol. 2007;5(2):112-118. Published online December 31, 2007

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Abstract PDF: Purpose: There have been relatively few reports of chlorophenoxy herbicide poisoning. The purpose of this study is to analyze the general characteristics and clinical aspects of the chlorophenoxy herbicide intoxicated patients in Korea. Methods: We prospectively evaluated the chlorophenoxy herbicide intoxicated patients visiting to the 38 emergency medical centers in Korea from the 1 August 2005 to the 31 July 2006. Results: 24 patients were enrolled during the study periods. Their mean age was 55.7 years old. The median amount of the chlorophenoxy herbicide intoxicated is 150 mL. The most frequent location where the patients obtained and took the chlorophenoxy herbicide was their home. Frequent compounds involving chlorophenoxy herbicide poisoning were dicamba(66.7%), MCPP(16.7%), and 2,4-D(12.5%). The most common symptom of the patients was confusion and vomiting. 16 patients(66.7%) intended to suicide. 3 patients out of 24 patients(13.0%) were died. Conclusion: There were 24 patients intoxicated by the chlorophenoxy herbicide during the study periods. The mortality rate was 13.0%. The suicidal attempts and the numbers of death involving chlorophenoxy herbicide were high in Korea.

Two Cases of Fatal Paraquat Intoxication by Parenteral Injection: Dong-Hoon Kim, Kyung-Woo Lee; J Korean Soc Clin Toxicol. 2007;5(2):119-122. Published online December 31, 2007

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Abstract PDF: Paraquat poisoning is a fatal type of herbicide intoxication. It is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure. Intravenous and intramuscular injection of paraquat is rarely described. However, We encountered two fatal cases of acute poisoning caused by paraquat injection. Two patients were admitted to our emergency unit after intravenous and intramuscular injection of 23.8% paraquat (about 476 mg of paraquat). A 37-year-old man diluted 2 ml of 23.8% paraquat solution with 1 ml of normal saline and injected it both intravenously into his left antecubital fossa and intramuscularly into his abdomen in a suicide attempt. He died 5 days later from respiratory failure and acute renal failure. A 92-year-old man was injected intravenously into his right antecubital fossa by his grandson with 2 ml of 23.8% paraquat solution diluted with 1 ml of normal saline. He died 2 days later from early circulatory collapse and multi-organ failure (metabolic acidosis, acute renal failure, coagulopathy). Intravenous and intramuscular injection with a small quantity of paraquat resulted in fatal toxicity in our patients.

A Case of a Patient with Stuporous Mentality and Hypotension after Amitraz Ingestion: Si-Young Jung, Jin-Hee Jung, Eun-Kyung Eo; J Korean Soc Clin Toxicol. 2007;5(2):123-125. Published online December 31, 2007

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Abstract PDF: Amitraz is a formamidine-derived insecticide and acaricide which is commonly used throughout the world. Amitraz intoxication is mediated through ${alpha}_2$ adrenergic receptor agonist effects, similar to those of the ${alpha}_2$ agonist clonidine. We report a case of a patient who experienced coma and hypotension after amitraz ingestion. A 37-year-old woman visited the ER with symptoms of vomiting and altered mental state. She had ingested a mouthful of liquid amitraz concentrate (12.5%), which rapidly led to vomiting, hypotension, bradycardia, hyperglycemia, and mental stupor. Supportive treatment, including mechanical ventilation and administration of inotropics, resulted in full recovery within four days.

A Case of Lactic Acidosis after Metformin overdose: Jung-Suk Park, Sung-Pil Chung, Han-Shick Lee, Eui-Chung Kim; J Korean Soc Clin Toxicol. 2007;5(2):126-130. Published online December 31, 2007

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Abstract PDF: Metformin is antihyperglycemic, not hypoglycemic. It causes neither insulin release from the pancreas nor hypo glycemia, even when taken in large doses. But, there are several reports of metformin-associated lactic acidosis (MALT). We present a case report of severe lactic acidosis most probably resulting from high doses of metformin in a patient with no known contraindications for metformin. A 43-year-old female was admitted to the emergency department due to a metformin overdose. She had diabetes for 6 years, well-controlled with metformin and novolet. One hour before admission, she impulsively took 50g metformin (100 mg or 100 tablets). Physical examination for symptoms revealed only irritability, and laboratory evaluation revealed only mild leukocytosis. After one hour the patient was drowsy, and arterial blood gas analysis showed severe lactic acidemia Seven hours after ED arrival, she commenced hemofiltration treatment and was admitted to the intensive care unit. Continuous venovenous hemodiafiltration was initiated. Forty-eight hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the third day. A progressive recovery was observed and she was discharged from the general word on the thirteenth day.

A Case of ${eta}-fluoroethyl$ Acetate Poisoning: Dong-Wun Shin, Jun-Seok Park, Ah-Jin Kim, Jun-Young Roh, Kyung-Hwan Kim; J Korean Soc Clin Toxicol. 2007;5(2):131-134. Published online December 31, 2007

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Abstract PDF: The emergence of anticoagulant rodenticides in the 1950's resulted in an epochal reduction in the use of all other agents. It is estimated that anticoagulant rodenticides constitute 95 percent of all rodenticides now in use. However, the advent of rodent resistance to these agents has led to a return to use of some other non-anticoagulant types of rodenticides. Older non-anticoagulant rodenticides have been stored in basements, garages, and barns and are still in use in some regions of the United States and in other countries. We report a case of non-anticoagulant rodenticide (beta-fluoroethyl acetate) poisoning.

Ingestion of Hydrofluoric acid: A rapid and fetal poisoning: Jae-Hee Lee, Jin-Hee Jung, Eun-Kyung Eo; J Korean Soc Clin Toxicol. 2007;5(2):135-137. Published online December 31, 2007

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Abstract PDF: Hydrofluoric acid is a weak inorganic acid used for etching and as rust removals. Systemic toxicity after oral ingestion induces rapid development of hypocalcemia and hyperkalemia, leading to ventricular fibrillation and finally asystole. We report a case of intentional ingestion of hydrofluoric acid producing an altered mental state at the time of the patient's arrival in the emergency department. The patient died approximately 80 minutes after the exposure with asystol.

Salicylate Poisoning After Accidental Ingestion of Chinese Medicated Oil: Soo-Youl Lee, Ji-Yeong Ryu, Gyu-Chong Cho, Ji-Young You; J Korean Soc Clin Toxicol. 2007;5(2):138-141. Published online December 31, 2007

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Abstract PDF: Because of the ready availability of aspirin, salicylate poisoning remains a common problem in many countries. Another potential source of salicylate poisoning is medicated oil containing methyl salicylate (oil of wintergreen). Methyl salicylate poses a much greater safety threat than aspirin tablets because of its liquid, concentrated form and high lipid solubility. Because of this danger, the toxic potential of medicated oil containing methyl salicylate should be fully appreciated both by physicians and by the general public. We encountered two cases of salicylate poisoning resulting from accidental ingestion of Chinese medicated oil. We report these cases along with a review of the literature.

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