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Most-download articles are from the articles published in 2022 during the last three month.

Original Articles
Enteral nutrition in mechanically ventilated patients after organophosphate poisoning
Sang U Bark, Jeong Mi Moon, Byeng Jo Chun
J Korean Soc Clin Toxicol. 2024;22(1):1-9.   Published online June 28, 2024
DOI: https://doi.org/10.22537/jksct.2024.00001
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  • 85 Download
AbstractAbstract PDF
Purpose: Nutritional therapy is a crucial component of therapy for critically ill patients, but there is a lack of nutritional support guidelines for organophosphate (OP) poisoning, likely due to the gastrointestinal effects of atropine, the main antidote for OP. This study investigated whether enteral nutrition (EN) during atropinization is acceptable for mechanically ventilated patients after OP poisoning.
Methods
This retrospective study classified 82 patients with OP poisoning according to whether they were fed during atropinization while on mechanical ventilation (MV). Data on the baseline characteristics, nutritional support, and clinical outcomes were compared. Univariate and multivariate regression models were constructed to analyze the associations between atropine administration for OP poisoning and feeding intolerance-related EN after adjustment for risk factors.
Results
Eighty-two patients received EN after 72 hours on MV, and 40 of them simultaneously received 2 mg/hr atropine for the first 120 hours after EN initiation. The overall incidence of feeding intolerance was 57.3% during the first 12 days after EN initiation and did not differ according to atropine administration. Appropriate atropinization during EN in regression model 1 and the dosage of atropine administered during EN and the duration of EN during atropinization in model 2 were not associated with feeding intolerance in patients on MV after OP poisoning.
Conclusion
Appropriate atropinization is not associated with feeding intolerance after EN provision in patients on MV after OP poisoning. This study will help establish nutritional guidelines for OP poisoning patients. More research on nutritional support is needed to validate our results.
Patterns of self-harm/suicide attempters who visited emergency department over the past 10 years and changes in poisoning as a major method (2011–2020)
Kyu Hyun Pai, Sung Woo Lee, Su Jin Kim, Kap Su Han, Juhyun Song, Sijin Lee, Ji Hwan Park, Jeijoon Song
J Korean Soc Clin Toxicol. 2023;21(2):69-80.   Published online December 29, 2023
DOI: https://doi.org/10.22537/jksct.2023.00019
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  • 1 Citations
AbstractAbstract PDF
Purpose: Suicide ranks among the top causes of death among youth in South Korea. This study aimed to identify the characteristics of suicidal individuals treated at emergency departments between 2011 and 2020.
Methods
A retrospective analysis was conducted using data from January 2011 to December 2020 in the Injury Surveillance Cohort, a prospective registry. Patients’ sex, age, mortality, methods of self-harm, and previous suicide attempts were analyzed. The methods of self-harm were categorized into falls, asphyxiation, blunt injuries, penetrating injuries, poisoning, and others. Sub-groups with and without poisoning were compared.
Results
The proportion of self-harm/suicide attempts increased from 2.3% (2011) to 5.0% (2020). The mortality rate decreased from 10.8% (2011) to 6.3% (2020). Poisoning was the most common method (61.7%). Mortality rates ranged from 42.0% for asphyxiation to 0.2% for blunt injuries. Individuals in their 20s showed a marked increase in suicide/self-harm attempts, especially in the last three years. A large proportion of decedents in their 70s or older (52.6%) used poisoning as a method of suicide. The percentage of individuals with two or more previous attempts rose from 7.1% (2011) to 19.7% (2020). The death rates by poisoning decreased from 7.7% (2011) to 2.5% (2020).
Conclusion
Our findings underscore the urgent need for targeted interventions and suicide prevention policies. Managing and reducing suicide and self-harm in emergency settings will require a focus on poisoning, the 10–29 age group, and the elderly. This paper will be valuable for future policies aiming to reduce the societal burden of suicide and self-harm.

Citations

Citations to this article as recorded by  
  • Development of a Web Application for Simulating Plasma Drug Concentrations in Patients with Zolpidem Intoxication
    Hwa Jun Cha, Sungpil Han, Kwan Cheol Pak, Hyungsub Kim
    Pharmaceutics.2024; 16(5): 689.     CrossRef
Up-to-date treatment of acetaminophen poisoning
Phil Chung Sung, Moon Jeongmi, Chun Byeongjo
J Korean Soc Clin Toxicol. 2022;20(2):39-44.   Published online December 31, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.2.39
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AbstractAbstract PDF
N-Acetylcysteine (NAC) is the standard antidote treatment for preventing hepatotoxicity caused by acetaminophen (AAP) poisoning. This review summarizes the recent evidence for the treatment of AAP poisoning. Several alternative intravenous regimens of NAC have been suggested to improve patient safety by reducing adverse drug reactions and medication errors. A two-bag NAC infusion regimen (200 mg/kg over 4 h, followed by 100 mg/kg over 16 h) is reported to have similar efficacy with significantly reduced adverse reactions compared to the traditional 3-bag regimen. Massive AAP poisoning due to high concentrations (more than 300-lines in the nomogram) needs to be managed with an increased maintenance dose of NAC. In addition to NAC, the combination therapy of hemodialysis and fomepizole is advocated for severe AAP poisoning cases. In the case of a patient presenting with an altered mental status, metabolic acidosis, elevated lactate, and an AAP concentration greater than 900 mg/L, hemodialysis is recommended even if NAC is used. Fomepizole decreases the generation of toxic metabolites by inhibiting CYP2E1 and may be considered an off-label use by experienced clinicians. Since the nomogram cannot be applied to sustained-release AAP formulations, all potentially toxic sustained-release AAP overdoses should receive a full course of NAC regimen. In case of ingesting less than the toxic dose, the AAP concentration is tested twice at an interval of 4 h or more; NAC should be administered if either value is above the 150-line of the nomogram.
Original Articles
Changes in the characteristics of acute carbon monoxide poisoning patients who visited the emergency department during the COVID-19 pandemic
Jun bo Sim, Tae kyu Ahn, Hyun Kim
J Korean Soc Clin Toxicol. 2023;21(2):108-116.   Published online December 29, 2023
DOI: https://doi.org/10.22537/jksct.2023.00008
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AbstractAbstract PDF
Purpose: This study investigated the differences between patients with acute carbon monoxide (CO) poisoning who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
This was a single-center retrospective observational study. Patients with CO poisoning who visited the ED during the period from February 2020 to January 2023 were classified as the COVID-19 pandemic group, and those from February 2019 to January 2020 were classified as the non-pandemic group. Patients’ medical records were reviewed, their demographic and clinical characteristics were compared, and the length of stay in ED was checked. The time from admission to the ED to the start of hyperbaric oxygenation (HBO) was defined as the door-to-HBO time, and this parameter was compared between both groups.
Results
In total, 672 patients were included in this study. The proportion of intentional poisoning was significantly higher in the COVID-19 pandemic group than in the non-pandemic group (p=0.028). The proportion of intentional poisoning significantly increased in the 20- to 29-year-old age group during the COVID-19 pandemic (p<0.001). In addition, it took longer to initiate HBO in the COVID-19 pandemic group than in the non-pandemic group (p=0.001).
Conclusion
These findings suggest that pandemics of infectious diseases, such as COVID-19, increase the proportion of intentional CO poisoning, and it may take longer to initiate HBO after visiting the ED. Efforts will be needed to decrease intentional CO poisoning and length of stay in ED.
2022 Annual Report of the Seoul Poison Control Center
Yo Han Shin, Sijin Lee, Su Jin Kim, Young Hoon Yoon, Sung Woo Lee
J Korean Soc Clin Toxicol. 2023;21(1):39-55.   Published online June 30, 2023
DOI: https://doi.org/10.22537/jksct.2023.00006
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  • 1 Citations
AbstractAbstract PDFSupplementary Material
Purpose: The Korea University Anam Hospital Seoul Poison Control Center (SeoulPCC) was established in accordance with Seoul Metropolitan Government Ordinance No. 7524 “Seoul Metropolitan Government Ordinance on the Prevention of Toxic Substances Poisoning and Accident Safety.” Herein, the center’s annual performance in terms of project results and consultation information for 2022 are reported.
Methods
SeoulPCC operates a helpline (Help Call, 1855-2221) that the general public can use from 9:00 AM to 5:00 PM on weekdays, as well as chatting and chatbot counseling through KakaoTalk’s “Seoul Poison Control Center,” and one-on-one online counseling through the website. Additionally, it has constructed a system for communicating with the general public through social media. Poisoning disease information collected from SeoulPCC from January to December 2022 was analyzed according to the number of requests, age of exposure, gender, location, and reason. Requests from the general public were summarized, and a brief image presenting information on poisoning disease-related consultations was produced.
Results
SeoulPCC has a database containing information on 188,065 toxic substances collected by public institutions and provides this information to the general public and medical staff through its website. In 2022, consultations were performed through phone calls and SNS (social networking service) for 577 cases of poison information and first aid treatment due to exposure to toxic substances. There were 1,431 instances of providing poison information services. The annual requests included 512 exposure cases and 65 non-exposure cases. Furthermore, 366 cases were in Seoul, 145 cases were outside of Seoul, and 66 had an unknown location. The exposure cases included 161 requests from the general public and 351 requests from medical staff.
Conclusion
This is the first annual report in Korea to analyze the occurrence of poisoning based on consultations. It is of major significance that this report serves as a starting point for identifying and tracking the aspects and characteristics of poisoning cases in the pre-hospital stage. In the future, poisoning-related disease information provided through consultations and at the emergency room should be linked, and through real-time collection and analysis, this information should be used as basic data for poisoning disease management policies.

Citations

Citations to this article as recorded by  
  • Patterns of self-harm/suicide attempters who visited emergency department over the past 10 years and changes in poisoning as a major method (2011–2020)
    Kyu Hyun Pai, Sung Woo Lee, Su Jin Kim, Kap Su Han, Juhyun Song, Sijin Lee, Ji Hwan Park, Jeijoon Song
    Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 69.     CrossRef
Protective effects of mealworm (Tenebrio molitor) extract on N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)–induced cellular toxicity in SH-SY5Y neuroblastoma cells
In Ho Jo, Yoo Ji Kim, Seon Tae Kim
J Korean Soc Clin Toxicol. 2023;21(2):81-91.   Published online December 29, 2023
DOI: https://doi.org/10.22537/jksct.2023.00021
  • 1,265 View
  • 7 Download
AbstractAbstract PDF
Purpose: Edible insect extracts have been used as an alternative source for medicinal supplements due to their significant antioxidative and anti-inflammatory activity. Recent studies have reported that anti-microbial peptides from insects have neuroprotective effects on dopamine toxins. The purpose of this study was to investigate the protective functions of mealworm (Tenebrio molitor) extract (MWE) on N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)–induced cellular toxicity in SH-SY5Y neuroblastoma cells.
Methods
Cellular toxicity induced by the MPTP toxin and the impact of MWE on cell survival were analyzed using MTT assays. DAPI staining was performed to observe apoptotic phenomena caused by MPTP. Changes in caspase-3 activity and protein expression were observed using enzyme activity assays and western blot assays, respectively.
Results
MWE exerted significant antioxidant activity, which was measured by both DPPH and ABTS radical assays, with a dose-dependent relationship. Furthermore, MWE resulted in cellular proliferation in SH-SY5Y cells in a dose-dependent manner. Furthermore, MWE pretreatment significantly inhibited MPTP-induced cytotoxicity, with a dose-dependent relationship. The morphological characteristics of apoptosis and increased reactive oxygen species induced by MPTP were also significantly reduced by MWE pretreatment.
Conclusion
MWE treatment significantly attenuated MPTP-induced changes in the levels of proteins associated with apoptosis, such as caspase-3 and PARP. These findings suggest that MWE exerts neuroprotective effects on human neuroblastoma SH-SY5Y cells subject to MPTP-induced dopaminergic neurodegeneration.
Case Report
Pulmonary thromboembolism following organophosphate intoxication: a case report
Ji Ho Lee
J Korean Soc Clin Toxicol. 2023;21(1):64-67.   Published online June 30, 2023
DOI: https://doi.org/10.22537/jksct.2023.00002
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AbstractAbstract PDF
Various symptoms manifest after organophosphate intoxication due to muscarinic, nicotinic, and central nervous system effects. Complications are common, and morbidity occurs due to respiratory center depression, cardiovascular complications, aspiration pneumonia, general weakness, and neurological symptoms. Some studies have reported a statistically significant association between organophosphate intoxication and deep vein thrombosis. However, cases of pulmonary thromboembolism (PTE) resulting from organophosphate poisoning are very rare. A 45-year-old male patient was transferred to our hospital after ingesting an unknown amount of an insecticide and receiving 6 L of gastric lavage at a local hospital. Other than nausea, no symptoms (e.g., dyspnea) were present, but a hemodynamic test showed an elevated lactic acid level, and metabolic acidosis worsened over time. Accordingly, we conducted initial treatment including continuous renal replacement therapy. After 7 hours, the poisoning analysis result was confirmed, and lambda-cyhalothrin and chlorpyrifos (0.441 µg/mL and 0.401 µg/mL, respectively) were detected. We introduced pralidoxime. Although no increase in pseudocholinesterase was found during hospitalization, continuous renal replacement therapy and pralidoxime were discontinued because the patient did not show symptoms of intermediate syndrome, including dyspnea and altered consciousness. The patient complained of abdominal pain on hospital day 8. Abdominal computed tomography was performed to evaluate the possibility of a corrosive injury to the stomach or esophagus, and we confirmed PTE. The D-dimer level was 1.96 mg/L (normal range, 0–0.55 mg/dL). A radiologic examination showed a PTE in the main pulmonary artery leading to the segmental pulmonary artery. After heparinization, the patient was discharged after being prescribed a vitamin K-independent oral anticoagulant. Through this case, we would like to emphasize the need for a thorough evaluation of clinical symptoms because atypical symptoms can occur after poisoning with organophosphate pesticides.
Original Articles
Predicting serum acetaminophen concentrations in acute poisoning for safe termination of N-acetylcysteine in a resource-limited environment
Dahae Kim, Kyungman Cha, Byung Hak So
J Korean Soc Clin Toxicol. 2023;21(2):128-134.   Published online December 29, 2023
DOI: https://doi.org/10.22537/jksct.2023.00013
  • 1,086 View
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AbstractAbstract PDF
Purpose: The Prescott nomogram has been utilized to forecast hepatotoxicity from acute acetaminophen poisoning. In developing countries, emergency medical centers lack the resources to report acetaminophen concentrations; thus, the commencement and cessation of treatment are based on the reported dose. This study investigated risk factors that can predict acetaminophen detection after 15 hours for safe treatment termination.
Methods
Data were collected from an urban emergency medical center from 2010 to 2020. The study included patients ≥14 years of age with acute acetaminophen poisoning within 15 hours. The correlation between risk factors and detection of acetaminophen 15 hours after ingestion was evaluated using logistic regression, and the area under the curve (AUC) was calculated.
Results
In total, 181 patients were included in the primary analysis; the median dose was 150.9 mg/kg and 35 patients (19.3%) had acetaminophen detected 15 hours after ingestion. The dose per weight and the time to visit were significant predictors for acetaminophen detection after 15 hours (odds ratio, 1.020 and 1.030, respectively). The AUCs were 0.628 for a 135 mg/kg cut-off value and 0.658 for a cut-off 450 minutes, and that of the combined model was 0.714 (sensitivity: 45.7%, specificity: 91.8%).
Conclusion
Where acetaminophen concentrations are not reported during treatment following the UK guidelines, it is safe to start N-acetylcysteine immediately for patients who are ≥14 years old, visit within 15 hours after acute poisoning, and report having ingested ≥135 mg/kg. Additional N-acetylcysteine doses should be considered for patients visiting after 8 hours.
Demographic characteristics of patients admitted to the emergency department for intoxication and a time series analysis during the COVID-19 period
Bongmin Son, Nayoon Kang, Eunah Han, Gina Yu, Junho Cho, Jaiwoog Ko, Taeyoung Kong, Sung Phil Chung, Minhong Choa
J Korean Soc Clin Toxicol. 2023;21(2):92-107.   Published online December 29, 2023
DOI: https://doi.org/10.22537/jksct.2023.00011
  • 1,254 View
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AbstractAbstract PDF
Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits.
Methods
A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department.
Results
The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm.
Conclusion
Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.
The 2022 Annual Report on Toxicology Surveillance and Severe Poisoning Cases at Emergency Departments in Korea
Eun Sun Lee, Su Jin Kim, Gyu Chong Cho, Mi Jin Lee, Byung Hak So, Kyung Su Kim, Juhyun Song, Sung Woo Lee
J Korean Soc Clin Toxicol. 2023;21(1):1-16.   Published online June 30, 2023
DOI: https://doi.org/10.22537/jksct.2023.00007
  • 1,248 View
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  • 1 Citations
AbstractAbstract PDFSupplementary Material
Purpose: This study investigated the actual incidence of acute poisoning in Korea on a nationwide scale, with the aim of laying the groundwork for future initiatives in prevention, strategic antidote distribution, and the development of effective emergency treatment for acute poisoning.
Methods
The study analyzed data from 3,038 patients who presented to emergency departments with poisoning-related conditions from June 1, 2022 to December 31, 2022 at 10 sites in nine cities across the country. We extracted data on general characteristics of the poisoning cases, including demographic characteristics (age and gender), place of exposure, reason for poisoning, route of exposure, and the substance involved in the poisoning incident. Age-related patterns in reasons for poisoning, medical outcomes, frequent and primary poisoning substances, and deaths were also analyzed.
Results
The population analyzed in our study was predominantly female, with women constituting 54.74% of all cases. Among infants and children, non-intentional poisoning due to general accidents was the most common cause, accounting for 71.43% of cases. Conversely, suicidal poisoning was more prevalent among teenagers and adults over 20. Fifty-two patients died during the study period, with males comprising approximately two-thirds (67.31%) of these fatalities. Pesticides were the most common poisoning substance among those who died, accounting for 55.77% of such cases. Notably, a significant majority of the victims were elderly individuals aged 60 and above.
Conclusion
This study holds substantial significance, since it represents the first comprehensive investigation and analysis of the symptoms, treatment, and causes of death due to poisoning in Korea on a national scale. By substantially expanding the range and types of poisonous substances examined, we were able to more precisely identify the characteristics and clinical patterns of poisoning cases nationwide.

Citations

Citations to this article as recorded by  
  • Development of a Web Application for Simulating Plasma Drug Concentrations in Patients with Zolpidem Intoxication
    Hwa Jun Cha, Sungpil Han, Kwan Cheol Pak, Hyungsub Kim
    Pharmaceutics.2024; 16(5): 689.     CrossRef
Cardiac arrest and severe encephalopathy following e-cigarette nicotine intoxication: a case report
Park Jinwon, Yun Sunghyun
J Korean Soc Clin Toxicol. 2022;20(2):82-85.   Published online December 31, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.2.82
  • 253 View
  • 13 Download
  • 1 Citations
AbstractAbstract PDF
Traditionally, most cases of nicotine poisoning have been due to ingestion of nicotine pesticides. However, the increasing use of electronic cigarettes (e-cigarettes) has resulted in both intentional and unintentional exposure to concentrated liquid nicotine or “eliquid” leading to an increase in nicotine poisoning cases. However, fatalities following the ingestion of the e-liquid are extremely rare. We report a rare case of cardiac arrest and severe encephalopathy following the intentional ingestion of e-liquid. We present the case of a 20-year-old woman who intentionally ingested liquid nicotine intended for e-cigarette use. She was found in asystole and experienced a return of spontaneous circulation (ROSC) after undergoing approximately 46 mins of cardiopulmonary resuscitation. Her plasma nicotine levels were >500 ng/ml. Despite aggressive supportive care, she was found to have encephalopathy consistent with severe anoxic brain injury on magnetic resonance imaging. In recent times, there have been some reports of deaths following liquid nicotine ingestion. Our case illustrates the potential for fatal nicotine toxicity from ingestion of e-cigarettes.

Citations

Citations to this article as recorded by  
  • A Systematic Review on Health Impact of Electronic Cigarettes in South Korea
    Eunsil Cheon, Hana Kim, Naeun Kang, Susan Park, Sung-il Cho, Jieun Hwang
    Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(2): 29.     CrossRef
Characteristics of poisoning patients visiting emergency departments before and after the COVID-19 pandemic
Jae Kee Seung, Cho Yongil, Kang Hyunggoo, Ho Lim Tae, Oh Jaehoon, Sung Ko Byuk, Lee Juncheol
J Korean Soc Clin Toxicol. 2022;20(2):66-74.   Published online December 31, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.2.66
  • 1,459 View
  • 19 Download
  • 2 Citations
AbstractAbstract PDF
Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion: The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.

Citations

Citations to this article as recorded by  
  • Demographic characteristics of patients admitted to the emergency department for intoxication and a time series analysis during the COVID-19 period
    Bongmin Son, Nayoon Kang, Eunah Han, Gina Yu, Junho Cho, Jaiwoog Ko, Taeyoung Kong, Sung Phil Chung, Minhong Choa
    Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 92.     CrossRef
  • Changes in the characteristics of acute carbon monoxide poisoning patients who visited the emergency department during the COVID-19 pandemic
    Jun bo Sim, Tae kyu Ahn, Hyun Kim
    Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 108.     CrossRef
Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) syndrome due to antidepressant
Sangun Nah, Han Bit Kim, Sangsoo Han, Sungwoo Choi, Hoon Lim
J Korean Soc Clin Toxicol. 2022;20(1):31-34.   Published online June 30, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.1.31
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AbstractAbstract PDF
Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) syndrome is characterized by an altered mental status. The acute MRI lesions show abnormal restricted diffusion imaging bilaterally and symmetrically in the cerebellum, hippocampus, and basal nuclei. This syndrome is an unknown syndrome and is presumed to be mainly an opioidinduced toxidrome. Here, we present a case study wherein we show that it can also be caused by an antidepressant overdose.
Original Articles
Utility of the APACHE II score as a neurological prognostic factor for glufosinate-intoxicated patients with alert mental status
Rok Lee, Tae Yong Shin, Hyung Jun Moon, Hyun Jung Lee, Dongkil Jeong, Dongwook Lee, Sun In Hong, Hyun Joon Kim
J Korean Soc Clin Toxicol. 2023;21(2):135-142.   Published online December 29, 2023
DOI: https://doi.org/10.22537/jksct.2023.00018
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AbstractAbstract PDF
Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status.
Methods
This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups.
Results
There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027–1.844), 1.017 (95% CI, 1.002–1.032), and 0.196 (95% CI, 0.040–0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746–0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652–0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527–0.722).
Conclusion
The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.
Status and trends of medical expenditures for poisoning patients
Eung Nam Kim, Soyoung Jeon, Hye Sun Lee, Sung Phil Chung
J Korean Soc Clin Toxicol. 2023;21(1):24-31.   Published online June 30, 2023
DOI: https://doi.org/10.22537/jksct.2022.00017
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AbstractAbstract PDF
Purpose: The purpose of this study was to estimate the medical expenditures for poisoning patients in Korea using data from National Health Insurance and the Korea Health Panel Survey.
Methods
The operational definition of poisoning was the presence of Korean Standard Classification of Diseases codes from T36 to T65. The number of poisoning patients, the amount of legal copayments, and benefit and non-benefit costs were extracted from both databases. The frequency of emergency, inpatient, and outpatient treatment utilization by poisoning patients was determined, and medical expenses were calculated. Linear regression analyses were performed to investigate factors affecting the medical expenses of poisoning patients.
Results
The number of poisoning patients increased from 97,965 in 2011 to 147,984 persons in 2020. Medical expenses also increased by 74% from Korean won (KRW) 30.1 billion to KRW 52.3 billion, and benefit costs also increased by 79%. The average outpatient cost per person was KRW 67,660, and the inpatient cost was KRW 1,485,103. The average non-benefit medical expenses were KRW 80,298, accounting for about 16.2% of the total expenses. Multivariable analysis showed that the total expenditure was associated with economic status and disabilities.
Conclusion
The average medical expenditure per poisoning patient was KRW 534,302 in 2020, and poisoning-related costs gradually increased during the study period. Further research on the economic burden of poisoning should include indirect costs and reflect disease-adjusted life years.

JKSCT : Journal of The Korean Society of Clinical Toxicology