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JKSCT : Journal of The Korean Society of Clinical Toxicology

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7 "Cardiotoxicity"
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A case of various clinical aspects associated with cardiotoxicity after glufosinate poisoning
Seon Tae Kim
J Korean Soc Clin Toxicol. 2021;19(2):133-138.   Published online December 31, 2021
DOI: https://doi.org/10.22537/jksct.2021.19.2.133
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AbstractAbstract PDF
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.
A Fatal Case of Colchicine Poisoning
Seung Hyun Ko, Gun Woo Lee
J Korean Soc Clin Toxicol. 2017;15(1):51-55.   Published online June 30, 2017
DOI: https://doi.org/10.22537/jksct.2017.15.1.51
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AbstractAbstract PDF
Colchicine is a drug that has long been used to treat a variety of illnesses; however, it reportedly has adverse effects at apparent toxic doses as well as at lower and therapeutically recommended doses. The typical therapeutic dose of colchicine is up to 2.4 mg daily, although it is sometimes as high as 8-10 mg daily. Here, we describe a case in which the patient showed sudden deterioration and died because of unintentional colchicine poisoning with a relatively small dose. When a colchicine poisoned patient visits the hospital, the physician should identify the patient's colchicine poisoning dose and concomitant drugs. Moreover, the patients should be monitored intensively for 24 to 72 hours and managed with various supportive treatment methods early and actively.
A Case of Aconite Poisoning Successfully Recovered after Intravenous Fat Emulsion Therapy
Hee Jun Shin, Hoon Lim
J Korean Soc Clin Toxicol. 2016;14(1):60-65.   Published online June 30, 2016
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AbstractAbstract PDF
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.
Clinical Analysis of Patients with Cardiotoxicity Caused by Himalayan Mad Honey
Sung Ho Kim, Dong Woo Seo, Seung Mok Ryoo, Won Young Kim, Bum Jin Oh, Kyoung Soo Lim, Chang Hwan Sohn
J Korean Soc Clin Toxicol. 2013;11(2):119-126.   Published online December 31, 2013
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AbstractAbstract PDF
Purpose: The aim of this study was to evaluate the clinical characteristics and outcome of patients who presented to the emergency department (ED) with cardiotoxicity caused by ingestion of Himalayan mad honey. Methods: Medical records of 12 patients who presented to the ED from January 1, 2005 to December 31, 2012 with cardiotoxicity caused by ingestion of Himalayan mad honey were retrospectively reviewed. Results: The mean age of patients was 54.5 years and 58.3% were men. The median amount of mad honey ingested was 30.0 cc, and the mean time from ingestion to onset of symptoms was 39.4 minutes. All patients had hypotension and bradycardia upon arrival in the ED. The initial electrocardiogram showed sinus bradycardia in seven patients, junctional bradycardia in four patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eight patients were treated with intravenous normal saline solution and atropine sulfate in a dose ranging from 0.5 to 2.0 mg. Blood pressure and pulse rate returned to normal limits within 24 hours in all patients. Conclusion: Our study showed that all patients with cardiotoxicity caused by ingestion of Himalayan mad honey had severe hypotension, bradycardia, and bradyarrythmias, including sinus bradycardia and junctional bradycardia and all patients responded well to conservative treatment, including intravenous normal saline solution and intravenous atropine sulfate.
Cardiac Toxicities Associated with Herbal Remedies
Woo-Jin Jung, Hyun Kim, Yong-Sung Cha, Oh-Hyun Kim, Kyoung-Chul Cha, Kang-Hyun Lee, Sung-Oh Hwang
J Korean Soc Clin Toxicol. 2012;10(1):1-7.   Published online June 30, 2012
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AbstractAbstract PDF
Purpose: Herbal preparations have long been used for medical purposes by traditional cultures, and their use is increasing in modern societies. However, many herbal agents produce specific cardiovascular toxicities in humans. We performed this study in order to investigate the clinical characteristics of the cardiac toxicities associated with herbal remedies. Methods: We conducted a retrospective study of 45 patients (mean age $57{pm}10$ years) who presented with cardiotoxicity between January 2007 and May 2011 due to ingestion of herbal remedy substances. Patients were identified as suffering cardiotoxicity if they presented with chest pain, EKG abnormality, and elevation of cardiac enzyme. Results: Of the 45 total cases, 17 included hemodynamic instability (37.8%), 7 with increasing cardiac enzyme (15.6%), 2 with cardiac arrest (4.4%) and one case of mortality (2.2%). The cardiotoxic herb group that demonstrated the worst clinical course was Ranunculaceae. Conclusions: In our study results, 57.6% of the herbal intoxication patients demonstrated the effects of cardiotoxicity. Thus, we recommend careful monitoring of herbal intoxication patients.
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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AbstractAbstract 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.
Myopericarditis by an Ingestion of Hydrofluoric acid - A case report
Sun Hyu Kim, Hyun Kim, Ho Jin Ji, Yong Soo Jang, Sung Bum Oh, Kang Hyun Lee, Sung Oh Hwang
J Korean Soc Clin Toxicol. 2004;2(1):63-66.   Published online June 30, 2004
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AbstractAbstract PDF
Hydrofluoric acid (HF), one of the strongest inorganic acids, is used mainly for industrial purpose. Hydrofluoric acid injuries has a potential for both systemic as well as severe local tissue destruction. One of the most serious consequences of severe exposure to HF by any route is marked lowering of serum calcium (hypocalcemia) and other metabolic changes, such as hypomagnesemia and which may result in a fatal outcome if not recognized and treated. promptly cardiotoxicity is not well known except arrhythmias, which are a primary cause of death. We report a case of myopericarditis by ingestion of hydrofluoric acid.

JKSCT : Journal of The Korean Society of Clinical Toxicology