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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Volume 7(1); 2009
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Clinical Observation of Paraquat Poisoning
Kyung-Hong Jun, Myung-Soo Kang
J Korean Soc Clin Toxicol. 2009;7(1):1-9.   Published online June 30, 2009
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Purpose: Paraquat, a globally used herbicide, is highly toxic to human beings. Hence, we reviewed some cases of paraquat poisoning in Korea. Methods: We analyzed the clinical and laboratory findings of 50 patients poisoned with paraquat retrospectively. The patients were admitted to the department of internal medicine in the Eumseong KeumWang hospital from January 2008 to December 2008. Results: Among 50 cases of paraquat poisoning, 28 cases were male. Twenty-four cases (48%) were over 60 years old. Fourty-nine patients ingested paraquat on purpose as suicidal attempts, while 1 patient underwent accidental ingestion. Seven patients swallowed less than one mouthful of paraquat, of which 4 patients survived. Eleven patients swallowed two mouthfuls of paraquat, of which 8 patients survived. Thirty-two patients swallowed over three mouthfuls of paraquat and they all died. Thirty-one patients with leukocytosis died. Twenty-one patients with metabolic acidosis died. Increased levels of blood amylase and glucose were related to high mortality, and increased level of blood creatinine was related to severe mortality. Hemoperfusions were accomplished in 27 patients of paraquat poisoning, of which 12 patients survived. Conclusion: Paraquat is a highly toxic herbicide. When patients arrive at the hospital, laboratory findings, urine paraquat concentrations, arrival time, and the amount of paraquat consumed must be considered for treatment plan.
Risk Factors Associated with Complications of Carbon Monoxide Poisoning
Sung-Won Jang, Jae-Cheon Jeon, Woo-Ik Choi
J Korean Soc Clin Toxicol. 2009;7(1):10-18.   Published online June 30, 2009
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Purpose: Carbon Monoxide Poisoning is an important medical emergency in Korea, but the factors leading to its serious manifestation are not well studied. Methods: We conducted a 5-year retrospective study of 98 carbon monoxide poisoned patients who visited the emergency departments of the Medical Center between December 2004 and March 2009. We categorized the patients into those exhibiting only local symptoms (group 1) and those showing systemic symptoms and complications (group 2). We compared the general characteristics as well as the clinical and laboratory findings between both groups. Results: The male to female ratio was 1.18. The most common systemic symptom was a mental change (43.9%), while the most common complication was rhabdomyolysis (31.6%). Poisoned area closed private room in group 2 were 23 (41.8%) cases and burning region in group 2 were 16(29.1%) cases (p=0.956). Individuals who were accidentally poisoned comprised of 43 (78.2%) cases while those that attempted suicidal poisoning comprised 12 (21.8%) cases (p=0.016). The most common symptom at arrival was mental change 33 (60.0%) cases in group 2. The mean time exposed to carbon monoxide was 43$pm$3.97 hours in group 1 and 55$pm$10.11 in group 2 (p=0.012). The patient's age, context of poisoning, symptom at arrival, and time exposed to the poison were found to be significant risk factors for complications by logistic regression analysis. Conclusion: Carbon monoxide poisoning is an emergency medical condition and the risk factors involved in the development of serious complications must be evaluated.
Digitalis-like Toxic Symptoms Occurring after Accidental Nerium indicum Poisoning
Ye-Wan Song, Jung-Hwan Ahn, Chung-Ah Lee, Gi-Woon Kim, Sang-Cheon Choi, Yoon-Seok Jung
J Korean Soc Clin Toxicol. 2009;7(1):19-22.   Published online June 30, 2009
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Although Nerium indicum poisoning is a globally rare occurrence, Nerium oleander poisoning is known to occur frequently in the Mediterranean regions. To our knowledge, this is the first reported case of accidental Nerium indicum poisoning in Korea. Its poisoning symptoms and signs are similar to that of digitalis poisoning, because of the presence of cardiac glycosides in Nerium indicum. A 16-year-old boy was admitted to the emergency department four hours prior to the accidental ingestion of Nerium indicum petals. The patient complained of nausea, vomiting, and dizziness. His initial vital signs were stable; laboratory blood test results were within normal levels, except for the blood digoxin level (1.5 ng/dL). An electrocardiogram (ECG) analysis showed normal sinus rhythm, progressive PR prolongation and second-degree Morbiz type I AV block. Conservative treatments including activated charcoal administration were conducted, because toxic symptoms and signs were not severe. The patient was admitted to the intensive care unit for close observation. His ECG was converted to normal rhythm after 1 day and the toxic symptoms and signs were completely resolved after 4 days.
A Case of Seizure in Diphenhydramine Overdose
Jung-Soo Park, Hoon Kim, Suk-Woo Lee
J Korean Soc Clin Toxicol. 2009;7(1):23-25.   Published online June 30, 2009
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A 21-year-old woman ingested 1,250 mg of diphenhydramine in a single overdose. Diphenhydramine, a rare ingredient in over-the-counter medication, is used to treat insomnia in Korea. Toxicity is usually limited to anticholinergic symptoms. The standard approach to therapy for the treatment of diphenhydramine overdose is supportive care, including physostigmines and sodium bicarbonates. Here, we review the literature and for the first time report a case of acute diphenhydramine overdosage in Korea, complicated with seizures.
Two Cases of Comatose Patients Presenting after Exposure to Hydrogen Sulfide Gas
Hyun-Ho Ryu, Byeong-Guk Lee, Kyung-Woon Jeung, Tag Heo, Yong-Il Min
J Korean Soc Clin Toxicol. 2009;7(1):26-31.   Published online June 30, 2009
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Hydrogen sulfide is a by-product of decayed organic material and is ubiquitously found as an ingredient of manufacturing reagents or as an undesirable by-product of the manufacturing or industrial processing. Hydrogen sulfide is a chemical asphyxiant and interferes with cytochrome oxidase and aerobic metabolism. It has thus been deemed an important cause of work-related sudden death. This gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. Here, we report two cases of comatose patients presenting after accidental exposure to hydrogen sulfide gas.
Esophageal Stricture and Acute Renal Failure after Formic Acid Poisoning: - A Case Report -
Kyung-Il Song
J Korean Soc Clin Toxicol. 2009;7(1):32-37.   Published online June 30, 2009
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Formic acid or formate is a common industrial compound used in the production of ensilage, disinfectants, decalcifying agents and mainly as a precursor in industrial chemical synthesis. It is also a well-known toxic metabolite produced in methanol poisoning. Thus, formate is a potential source of both accidental and deliberate poisoning. Very few reports have been published thus far, on the toxicology of direct formic acid poisoning. Here, we report a case of a 74-year-old man without a history of depression, who ingested about 30 gm of formic acid. The patient presented with profound high anion gap metabolic acidosis, acute renal failure and esophageal stricture. The patient was successfully treated with hemodialysis and supportive measures. But permanent esophageal stricture was complicated by formic acid burns in the gastrointestinal tract. We discuss the pathophysiology and treatment of this case.
A Case of Intoxication of Ingested Formalin
Seon-Hee Baek, Kyung-Hwan Kim, Jun-Seok Park, Dong-Wun Shin, Jun-Young Roh, Kyoung-Mi Lee, Ah-Jin Kim
J Korean Soc Clin Toxicol. 2009;7(1):38-40.   Published online June 30, 2009
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Formalin is a water-soluble, colorless, pungent, irritating and highly reactive gas. A 40% solution of formaldehyde in water, also known as formalin, is used as a disinfectant, antiseptic, deodorant, tissue fixative and embalming fluid. Ingestion can lead to immediate deleterious effects on almost all systems of the body including gastrointestinal tract, central nervous system, cardiovsacular system and hepato-renal system, causing gastrointestinal hemorrhage, cardiovsacular collapse, unconsciousness or convulsions, severe metabolic acidosis and acute respiratory distress syndrome. We treated a 39-year-old woman who ingested 300 ml formalin in a suicidal attempt. Despite hemodialysis, death occurred after 23 h.
A Fatal Case of Methylene Chloride Poisoning
Kyoung Sook Jeong, Hyun-Sul Lim
J Korean Soc Clin Toxicol. 2009;7(1):41-43.   Published online June 30, 2009
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A 52-year-old man was found dead in the driver's seat of his tank lorry. The tank lorry was used to transport industrial wastewater to a disposal plant; the material was transferred into a storage tank with the help of compressed air. The wastewater contained methylene chloride and 2-chloropyridine. No respiratory protective equipment was used while working under these conditions. The autopsy report showed extensive edema and congestion of the brain, lung, and intraperitoneal organs. The concentrations of methylene chloride in lung and brain were reported at 398 and 67 mg/kg, respectively.
Emergency Cesarean Section Rescue of a Fetus from Maternal Severe Drug Intoxication
Jung-Geun Park
J Korean Soc Clin Toxicol. 2009;7(1):44-46.   Published online June 30, 2009
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Herein, we report a case of emergency cesarean section after severe maternal drug intoxication in late pregnancy. At a 38-week-gestation, a 32-year-old woman with a 10-year history of bipolar disorder took olanzapine (200 mg), diazepam (20 mg), and zolpidem (200 mg) as part of a suicidal attempt. Given her unconscious state and the evident concern regarding the toxic effects of the drugs on the fetus, a cesarean section was performed immediately. The patient gave birth to a male baby with Apgar scores of 5 at 1 and 8 at 5 minutes. The baby showed dyspnea and decreased activity directly after birth. After supportive care, the condition of both mother and baby improved and both were discharged.

JKSCT : Journal of The Korean Society of Clinical Toxicology