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- A case of various clinical aspects associated with cardiotoxicity after glufosinate poisoning
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Seon Tae Kim
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J Korean Soc Clin Toxicol. 2021;19(2):133-138. Published online December 31, 2021
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DOI: https://doi.org/10.22537/jksct.2021.19.2.133
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Abstract
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- Glufosinate-containing herbicides is a non-selective herbicide commonly used worldwide. As the use of them increased gradually since paraquat was banned in 2012, the number of suicides by their ingestion is also increasing continuously. Complications of glufosinate-containing herbicide poisoning include various central nervous system (CNS) toxicities such as convulsions, loss of consciousness, memory impairment, and respiratory depression, which may be accompanied by hemodynamic changes such as bradycardia and hypotension. However, it is very rare that arrhythmias other than bradycardia occurred and Takotsubo cardiomyopathy was combined due to cardiotoxicity. A 71-year-old female patient was transferred to our hospital after ingesting 500 mL of glufosinate-containing herbicide and receiving 5 L of gastric lavage at a local hospital. A few hours later, she presented stuporous mentality, respiratory depression, and convulsions, and was accompanied by hypotension and bradycardia. On the second day of admission, electrocardiogram (ECG) showed bradycardia and QTc prolongation with hemodynamic Instability. Accordingly, we conducted the early treatment with continuous renal replacement therapy (CRRT) and the application of temporary cardiac pacemaker. An echocardiogram demonstrated decreased ejection fraction (EF) and Takotsubo cardiomyopathy on the third day of admission. Then, she was discharged safely with conservative treatment. At the follow-up after 1 year, Takotsubo cardiomyopathy, EF and QTc prolongation were recovered on echocardiogram and ECG. Because cardiac toxicity after glufosinate-containing herbicide poisoning may cause life-threatening consequences, caution is required while treating the patient. Therefore, if electrocardiogram changes are seen in the elderly with a large amount of glufosinate herbicide ingestion, additional cardiac function test through echocardiography should be concerned, and early treatment through CRRT or artificial cardiac pacing should be considered.
- Severe Case of Hypermagnesemia Caused by Ingesting Magnesium Containing Fertilizer
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Ka-young Lee, Jin-young Yu, Nam-Jun Cho, Samel Park, Eun-young Lee, Hyo-Wook Gil
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J Korean Soc Clin Toxicol. 2020;18(2):141-144. Published online December 31, 2020
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DOI: https://doi.org/10.22537/jksct.2020.18.2.141
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- Hypermagnesemia is a rare condition that is usually iatrogenic in patients with elderly or renal failure. Severe hypermagnesemia is uncommon in patients with a normal renal function. Symptoms due to hypermagnesemia can range from mild symptoms, such as nausea, to severe symptoms, such as cardiac and respiratory arrest. This paper describes a case of a 49-year-old woman who ingested a magnesium-containing fertilizer with normal renal function. Cardiac arrest occurred eight hours after poisoning. Electrocardiography changed from a narrow QRS to a wide QRS and then to a complete atrioventricular block. Her hemodynamic state was unstable. Continuous renal replacement therapy was performed to remove magnesium from the blood, with the subsequent resolution of arrhythmia and hemodynamic stabilization. This paper reviews the pathophysiologic effects of magnesium on the cardiovascular system, clinical manifestation, and treatment of hypermagnesemia.
- Clinical Characteristics of Patients after Aryloxyphenoxy Propionate Herbicide Ingestion
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Junyeong Lim, Jeongmi Moon, Byeongjo Chun
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J Korean Soc Clin Toxicol. 2016;14(2):71-77. Published online December 31, 2016
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DOI: https://doi.org/10.22537/jksct.2016.14.2.71
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- Purpose: No studies have been conducted to investigate the acute toxicity of aryloxyphenoxypropionate herbicides in humans following ingestion. Therefore, this study was conducted to investigate the clinical characteristics of aryloxyphenoxypropionate herbicide poisoning and provide guidance for physicians treating patients who have ingested these types of herbicides. Methods: A retrospective observational case series was conducted using ten patients with history of aryloxyphenoxy propionate herbicide. Data were collected for clinical manifestation, management and final outcome. Results: The most common symptoms were gastrointestinal irritation and an altered mental state (Glasgow Coma Scale<15). An elevated lactate level was a common laboratory abnormality, and prolonged QTc interval was commonly observed. These clinical features normalized within one day of supportive treatment. Conclusion: The acute toxicity of aryloxyphenoxypropionate herbicides in humans is manageable with supportive treatment. However, physicians should take into account depressed consciousness, the possibility of arrhythmia, and an elevated lactate level when planning their treatment strategy.
- A Case of Aconite Poisoning Successfully Recovered after Intravenous Fat Emulsion Therapy
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Hee Jun Shin, Hoon Lim
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J Korean Soc Clin Toxicol. 2016;14(1):60-65. Published online June 30, 2016
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- Aconitum is a genus of various species of flowering plants that belongs to the Family Ranunculaceae. Most Aconitum sp. have extremely toxic alkaloid substances such as aconitine, mesaconitine and hypaconitine. Among these substances, aconitine can cause fatal cardiotoxicity by activating sodium channels followed by calcium channels in myocardial cells. Even though there have been various therapeutic plans suggested comprising antidotes based on diverse case reports and studies, there is no confirmatory treatment protocol for aconite poisoning. Here, we report an aconite poisoning patient who had refractory ventricular tachyarrhythmia that did not respond to intravenous amiodarone therapies even though they were sustained for over 2 hours, but showed successful recovery following intravenous fat emulsions (IFE) therapy.
- A Patient Presenting with Elevations of Cardiac Enzyme Levels after Veratrum Oxysepalum Ingestion
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Ji Young Hwang, Hyun Kim
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J Korean Soc Clin Toxicol. 2015;13(2):111-116. Published online December 31, 2015
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- Veratrum patulum has toxicological relevance because of the potential for misidentification of this plant as mountain garlic. Veratrum patulum has an ester-alkaloid that provokes cardiac arrhythmias by excessive vagal stimulation and depression of the sinoatrial and atrioventricular nodes of the heart and hypotension, cardiomegaly. We report on a retrospective case of successful outcome in patients with veratrum patulum poisoning through active treatment from the early phase after ingestion. We report on a case involving a patient who experienced dizziness, dyspnea, hypotension, and elevation of cardiac enzyme, cardiomegaly. These cases were kept under observation and generally recovered with supportive care. We report on cases of veratrum patulum poisoning with review of literature.
- A Case of Successful Resuscitation of 10,150 J Shocks and Therapeutic Hypothermia on Aconitine-induced Cardiovascular Collapse
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Hyung Jun Moon, Jung Won Lee, Ki Hwan Kim, Dong Kil Jeong, Jong Ho Kim, Young Ki Kim, Hyun Jung Lee
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J Korean Soc Clin Toxicol. 2014;12(2):97-101. Published online December 31, 2014
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- Aconitine, found in the Aconitum species, is highly extremely toxic, and has been known to cause fatal cardiac arrhythmias and cardiovascular collapse. Although several reports have described treatment of aconitine intoxication, management strategy for the patient in a hemodynamically compromised state who experienced cardiopulmonary collapse is unknown. We report here on a case of a successful cardiopulmonary resuscitation and therapeutic hypothermia in an aconitine-induced cardiovascular collapsed patient. A 73-year-old male who presented with nausea, vomiting, chest discomfort, and drowsy mental state after eating an herbal decoction made from aconite roots was admitted to the emergency department. He showed hemodynamic compromise with monomorphic ventricular tachycardia resistant to amiodarone and lidocaine. After 3 minutes on admission, he collapsed, and cardiopulmonary resuscitation was initiated. We treated him with repeated cardioversion/defibrillation of 51 times, 10,150 joules and cardiopulmonary resuscitation of 12 times, 69 minutes for 14 hours and therapeutic hypothermia for 36 hours. He recovered fully in 7 days.
- A Case of Severe Aconitine Intoxication with Ventricular Tachycardia, Successfully Treated by a Combination of Two Anti-arrhythmic Drugs
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Seung-Mok Ryoo, Chang-Hwan Sohn, Bum-Jin Oh, Won Kim, Kyoung-Soo Lim
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J Korean Soc Clin Toxicol. 2011;9(2):105-108. Published online December 31, 2011
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- Aconitine is an anti-inflammatory agent with therapeutic uses in oriental medicine as an analgesic and for treatment of stroke. Because of its sodium channel effect, aconitine can promote undesirable, wide complex tachyarrhythmia. If tachycardia develops during use of aconitine, class Ia and class III anti arrhythmic drugs can be utilized for treatment. However there are no single anti-arrhythmia agents which are uniformly effective. We report a case, characterized by wide complex tachyarrhythmia and severe hypotension, which was successfully treated by simultaneous injections of amiodarone and lidocaine. A 59-year-old woman exhibiting clinical signs of drowsiness as a result of ingesting 6 g of aconitine, was admitted to the emergency department. Initially, wide complex tachyarrhythmia (ventricular tachycardia and pulse rate of 180 beats/min) and severe hypotension (blood pressure of 53/26 mmHg) was observed. After simultaneous injection of amiodarone and lidocaine, the patient's rhythm pattern changed to an accelerated junctional rhythm with ventricular premature complex. Two hours later, the patient's heart pattern became a sinus rhythm. As demonstrated by this case, simultaneous injections of amiodarone and lidocaine can be useful in treating ventricular arrhythmia induced by aconitine.
- Toxicologic Features and Management in Aconitine Intoxication Following Ingestion of Herbal Tablets Containing Aconitum Species
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Wool-Lim Cho, Young-Ho Jin, Tae-Oh Jeong, Jae-Baek Lee, Ji-Hun Kang
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J Korean Soc Clin Toxicol. 2008;6(2):104-109. Published online December 31, 2008
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- Purpose: Unrefined tablets prepared from Aconitum tubers are occasionally used in Korean folk medicine. This study defines the potential sources, clinical toxicology, and treatment of aconitine poisoning. Methods: A retrospective survey was conducted in 63 patients in the ED of a tertiary University Hospital with suspected toxicity from an unrefined tablet prepared from Aconitum tubers from 1999 to 2007. Results: A total of 63 cases enrolled included 26 men and 37 women, aged 30 to 86 years. Forty-eight patients ingested aconitine tablets as digestives, 26 tablets on average. After a latent period of 30 to 450 minutes, patients developed a combination of neurologic (87.3%), gastrointestinal (82.5%), cardiopulmonary (41.3%), and other (28.6%) features typical of aconitine poisoning. Initial ECG abnormalities revealed dysrhythmia (61.9%), conduction disturbance (42.9%), and abnormal waveforms (39.7%), with 28.6% of patients having normal ECGs. All patients received supportive treatment or close observation regardless of ingestion amounts. Patients with hypotension or ventricular arrhythmia were treated with inotropic agents or amiodarone. Conclusion: Toxicologic signs and symptoms can occur after the consumption of aconitine tablets, regardless of ingestion amount. The risk occurs because of inadequately processed aconitine roots. This study will provide important data for public education and distribution regulations for Aconitum sp. in Korea.
- A Case of Fatal Arrhythmia after Propafenone Overdose
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Yeon-Young Kyong, Kyoung-Ho Choi
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J Korean Soc Clin Toxicol. 2008;6(2):123-129. Published online December 31, 2008
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- A 36-year-old female was transferred to our emergency medical center with decreased mental status after a 6.0 g propafenone overdose because of domestic disturbance. She had no previous history of epilepsy, diabetes mellitus, hypertension or psychiatric illness. Before presenting to our center, gastrointestinal decontamination, charcoal administration, and endotracheal intubation due to bradycardia and generalized seizure had been performed. Soon after hospital arrival, at 5 h after ingestion, she collapsed into shock and fatal arrhythmia. We successfully resuscitated the patient with amiodarone, sodium bicarbonate, a large volume of normal saline, calcium, and ventilator care. At 23 h after ingestion, she was fully recovered and had no subjective signs or symptoms. To our knowledge, this is the first case report of intentional propafenone overdose in Korea, which we report with reviews of the previous literature.
- A Case of Acute Poisoning with Dry Ice
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Soon-Young Hwang, Jin-Hee Jung, Eun-Kyung Eo
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J Korean Soc Clin Toxicol. 2007;5(1):43-45. Published online June 30, 2007
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- Carbon dioxide is the fourth most abundant gas in the earth's atmosphere, and it is widely used in the chemical industry. Solid carbon dioxide is commonly known as dry ice. At low concentration, carbon dioxide appears to have little toxicological effect. At higher concentrations, however, it can produce an increased respiratory rate, tachycardia, cardiac arrhythmia, loss of consciousness, convulsion, and even death. Management of carbon dioxide poisoning requires the immediate removal of an individual from the toxic environment and administration of oxygen. It is important to know the concentration of carbon dioxide to which a patient has been exposed. We report a case of acute poisoning from solid carbon dioxide in a patient presenting with drowsiness and diminished mental capacity when she arrived in the emergency department. She recovered completely after administration of oxygen with conservative treatment.
- Prolonged Cardiopulmonary Resuscitation in a Cardiac Arrest Patient with Aconitine Intoxication
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In-Woo Hwang, Tae-O Jeong, Jae-Baek Lee, Youn-Ho Jin
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J Korean Soc Clin Toxicol. 2007;5(1):67-70. Published online June 30, 2007
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- Aconitum is an extremely dangerous plant that contains various toxic diterpenoid alkaloids, primarily concentrated in the roots. We report a case of acute intoxication of a 60-year-old man admitted to our emergency department after ingestion of a large amount of homemade aconitine decoction. At presentation about one hour after intake, the patient was unconscious and electrocardiographic analysis showed a ventricular tachycardia/fibrillation. Several times defibrillation was applied and antiarrhythmic agents were administered, but the patient still exhibited a refractory ventricular fibrillation and failed to return to spontaneous circulation. Sustained cardiopulmonary resuscitation finally produced a pulsatile cardiac rhythm at two hours after intake. The patient was discharged from our hospital on day 8. The authors stress that clinicians must be aware of the possible occurrence of life-threatening ventricular arrhythmia in cases of aconitine intoxication and be prepared to persist with prolonged CPR as necessary.
- Ventricular Arrhythmia Following Aconitine-Ingestion - 2 Case Reports -
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Mi-Ran Kim
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J Korean Soc Clin Toxicol. 2006;4(2):180-186. Published online December 31, 2006
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- The various species of aconitum contain diterpene (C-20) and norditerpene (C-19) forms of the natural alkaloid aconitine that cause neurologic, gastrointestinal, cardiovascular symptoms. In chinese medicine, these plants has been used as drugs to treat pain, dyspepsia, cerebrovascular disease, and so on. Because the therapeutic window is narrow, poisoning may occur from unintentional exposure, with a variety of toxic effects such as arrhythmia, hypotension, paresthesia, paralysis, nausea, vomiting, and abdominal pain. Aconitine-containing folk remedies are widely used in Korea. We encountered two cases of ventricular arrhythmia in patients who ingested tablets, known as 'Wha-Pung-Dan' made with aconitine extracts and were subsequently admitted to the ED. A 42 year-old man who took 35 tablets presented with ventricualr tarchycardia, and 40 year-old woman who took 40 tablets showed premature ventricular contractions. Both patients were discharged normally without any complications after three days.
- Transient Change of Electrocardiogram in Two Young Women With Salicylate Intoxication - Two Cases Report -
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Je-Sung You, Jong-Woo Park, Young-Hwan Choi, Young-Soon Cho, Kwang-Hyun Cho, Jun-Seok Park, Sung-Pil Chung, Hahn-Shick Lee
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J Korean Soc Clin Toxicol. 2006;4(1):44-47. Published online June 30, 2006
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- 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.
- Datura Stramonium Intoxication of Which Resulted in Changing Mentality - A Case Report -
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Je-Sung You, Yeoun-Woo Nam, Jin-Hee Lee, Sung-Pil Chung, Seung-Ho Kim, In-Cheol Park
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J Korean Soc Clin Toxicol. 2006;4(1):52-54. Published online June 30, 2006
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- 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.
- 2 Cases of Toad Venom Intoxication
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Cheong-Hoon Kwon, Woo-Chan Jun, Yoon-Suk Jung, Jung-Hwan Ahn
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J Korean Soc Clin Toxicol. 2006;4(1):58-60. Published online June 30, 2006
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- 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.
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