Journal of The Korean Society of Clinical Toxicology

Review Article

Diagnosis and treatment of serotonin syndrome: Je Sung You, Sung Phil Chung; J Korean Soc Clin Toxicol. 2024;22(2):11-17. Published online December 31, 2024; DOI: https://doi.org/10.22537/jksct.2024.00008

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Abstract PDF: Serotonin syndrome is a drug-induced clinical syndrome caused by increased serotonin activity in the central nervous system. It occurs when starting a serotonergic drug, increasing its dose (including overdoses) or using a serotonergic drug in combination with other drugs. It manifests along a broad spectrum, ranging from mild side effects to life-threatening conditions. This condition should be suspected if patients have altered mental states, autonomic dysfunction, or neuromuscular symptoms such as clonus and tremor after using serotonergic drugs. Although the Hunter criteria have been widely used, new diagnostic criteria have recently been proposed to screen severe serotonin toxicity. It is necessary to differentiate it from neuroleptic malignant syndrome, which is associated with taking antipsychotic drugs that exert dopamine-antagonistic effects. If serotonin syndrome is suspected, the relevant drug should be stopped, and the patient should be treated with benzodiazepines. Severely ill patients with hyperthermia or neuromuscular symptoms require aggressive treatment. Serotonin receptor antagonists such as cyproheptadine or chlorpromazine have been tried as antidotes, but the level of evidence for their therapeutic effectiveness is very low.

Original Article

A retrospective analysis of toxic alcohol poisoning: Jin Kim, Yu Jin Lee, Tae Kyu Ahn, Soo Kang; J Korean Soc Clin Toxicol. 2023;21(2):143-150. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00014

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Abstract PDF Supplementary Material: Purpose: This study aimed to compare the clinical features of methanol and ethylene glycol poisoning.
Methods
This single-center retrospective observational study included patients with toxic alcohol poisoning who visited a regional emergency medical center. Patients with methanol and ethylene glycol poisoning from January 2004 to June 2023 were selected for the study using diagnostic codes.
Results
Twenty-two patients with toxic alcohol poisoning visited during the study period, with 11 patients for each category. Compared to methanol poisoning, ethylene glycol poisoning patients were more likely to have consumed alcohol for suicidal purposes (n=4 [36.36%] vs. n=8 [72.73%]) and were more likely to be drowsy (n=0 vs. n=6 [54.55%], p=0.016). The anion gap (25.43±8.35 mmol/L vs. 13.22±6.23 mmol/L, p=0.001) and lactic acid levels (1.785 [1.3–2.785] mmol/L vs. 9.90 [4.20–11.81] mmol/L, p=0.007) were higher in ethylene glycol poisoning patients than in methanol poisoning patients. Among alcohol dehydrogenase blockers, oral ethanol was administered to 10 patients (45.45%) (n=4 [36.36%] vs. n=6 [54.55%]), and intravenous ethanol was administered to six patients (n=4 [36.36%] vs. n=2 [18.18%]). Fomepizole was administered to two patients (9.09%) each, and renal replacement therapy was non-significantly more common in patients with ethylene glycol poisoning (n=8 [72.73%] vs. n=3 [27.27%], p=0.128). Three patients had delays in diagnosis and treatment, and while there were no fatalities, one patient was left with permanent vision damage.
Conclusion
Because these are uncommon types of poisoning and the clinical presentation is difficult to recognize early, healthcare providers should be familiar with toxic alcohol types and screen for them to ensure proper diagnosis and treatment.

Comparative Analysis of decreased Mental state Patients after Overdose with Sedative-hypnotics: Seung Jae Oh, Soo Hyung Cho, So Yeon Ryu; J Korean Soc Clin Toxicol. 2022;20(1):8-14. Published online June 30, 2022; DOI: https://doi.org/10.22537/jksct.2022.20.1.8

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Abstract PDF: Purpose: This study was undertaken to investigate how sedative-hypnotics affect the occurrence and severity of the patient's symptoms. In addition, we conducted a study to determine the type of patients who reacted severely and required hospitalization; patients were accordingly classified as hospitalized patients and patients discharged from the emergency room. Methods: From January 2017 to December 2019, we investigated the demographics, drug information, history, laboratory tests, and severity of patients who visited our emergency department and were diagnosed with benzodiazepine, zolpidem, and doxylamine succinate overdose. We further compared details of hospitalized patients and discharged patients. Results: Subjects who had overdosed and visited the ED included 120 for benzodiazepine, 147 for zolpidem, and 27 for doxylamine succinate. Comparisons between the three groups revealed differences in their early diagnosis, psychiatric history, and sleep disturbance. Differences between groups were also determined for mental state, poisoning history, treatment received in the intensive care unit, and intubation and ventilator support. In cases of benzodiazepine overdose, we obtained a high hospitalization rate (40.0%), admission to the intensive care unit (24.2%), and intubation rate (18.3%). Comparisons between hospitalized patients and discharged groups showed differences in transferred patients, early diagnosis, and mental state. Conclusion: Patients poisoned by sedative-hypnotics are increasing every year. In cases of benzodiazepine and zolpidem, the hospitalization rates were high, and benzodiazepine overdose resulted in hospitalization, intensive care unit admission, and pneumonia in a majority of cases. Therefore, active treatment and quick decisions in the emergency room are greatly required.

Inflammatory cytokines in patients with pesticide poisoning: a pilot study: Hyun Joon Kim, Wook-Joon Kim, Dong Wook Lee, Seung-Hyun Jung, Nam-Jun Cho, Samel Park, Eun Young Lee, Hyo-Wook Gil; J Korean Soc Clin Toxicol. 2022;20(1):15-21. Published online June 30, 2022; DOI: https://doi.org/10.22537/jksct.2022.20.1.15

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Abstract PDF

Purpose: Acute pesticide poisoning is lethal and can lead to death. A few studies about the effects of acute pesticide poisoning have focused on the immune system. In the current study, we preliminarily investigated the changes in blood inflammatory cytokine levels in acute pesticide poisoning patients. Methods: In this study, we prospectively investigated the inflammatory cytokines in patients with acute pesticide poisoning. This study included patients admitted from February 2021 to November 2021 with a diagnosis of intentional poisoning by pesticide ingestion. The inflammatory cytokines measured were IFN-γ, IL-1β, IL-6, and TNF-α. Results: Totally, 27 patients were enrolled in this study. The types of pesticide ingested were glufosinate (n=6), glyphosate (n=8), organophosphate (n=4), pyrethroid (n=2), and others (n=7). The levels of inflammatory cytokines obtained were as follows: IFN-γ 2.78±8.03 pg/ml, IL-1β 2.62±2.03 pg/ml, IL-6 44.58±80.16 pg/ml, and TNF-α 11.80±15.60 pg/ml. The overall mortality rate was 11.1% (3/27), and levels of IL-1β and TNF-α were significantly higher in the death group compared to the survival group. Conclusion: Increased levels of IL-6 and TNF-α were observed in patients with acute pesticide poisoning. IL-1β and TNF-α were significantly higher in the death group as compared to the survival group. Our results indicate the occurrence of an inflammatory response due to the activation of immune cells by pesticide poisoning. Future large-scale studies need to be conducted to investigate the application of inflammatory cytokines as predictors and therapeutic targets.

Citations

Citations to this article as recorded by

Insecticides and testicular health: mechanisms of injury and protective natural products
Samar F. Darwish, Yasser M. Moustafa, Sherif S. Abdel Mageed, Ghaneya S. Hassan, Safwat Abdelhady Mangoura, Shaza H. Aly, Mai A. Mansour, Ahmed Amr Raouf, Al-Aliaa M. Sallam, Sylvia F. Fawzi, Asmaa M. Atta, Ola Elazazy, Walaa A. El-Dakroury, Aya A. El-Dem
Naunyn-Schmiedeberg's Archives of Pharmacology.2025;[Epub] CrossRef

Comparison of medical history based diagnosis and urine test using ultra-performance liquid chromatography-tandem mass spectrometry in drug overdose: Ja-Young Lee, Kyungman Cha, Won Jung Jeong, Hyung Min Kim, Byung Hak So; J Korean Soc Clin Toxicol. 2022;20(1):1-7. Published online June 30, 2022; DOI: https://doi.org/10.22537/jksct.2022.20.1.1

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Abstract PDF: Purpose: In patients with acute drug overdose, identification of drugs ingested is crucial to make a precise diagnosis. In most cases, the diagnoses are made on the medical history and physical examination findings. This study was undertaken to determine the concordance of diagnosis made on the basis of patient history by comparing it with urine toxicology analysis. Methods: This was a retrospective study of drug intoxicated patients over 18 years old who presented to the emergency center from 2017 to 2019. Specimens from urine were tested using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-TMS). The test results were compared with information obtained from patients. Diagnostic concordances for drug detection in intoxicated patients were calculated. Logistic regression analysis was used to examine the association between clinical characteristics and diagnostic discrepancy. Results: Totally, 370 patients were included in the analysis. Overall, 66 types of drugs were detected by UPLC-TMS. The drugs detected most frequently were zolpidem (104, 27.8%), citalopram (70, 18.7%), and paracetamol (66, 17.6%). The mean diagnostic concordance of patients was 52.7%. There were statistically significant diagnostic discrepancies in patients with underlying depression and patients intoxicated with multiple types of drugs. Conclusion: In ED patients with acute drug overdose, the diagnoses made on history alone were often inaccurate. It is essential to perform urine toxicology tests such as UPLC-TMS as a confirmatory instrument to improve accuracy in evaluating patients with drug intoxication.

Causative Substance and Time of Mortality Presented to Emergency Department Following Acute Poisoning: 2014-2018 National Emergency Department Information System (NEDIS): Hyeonjae Lee, Minhong Choa, Eunah Han, Dong Ryul Ko, Jaiwoog Ko, Taeyoung Kong, Junho Cho, Sung Phil Chung; J Korean Soc Clin Toxicol. 2021;19(2):65-71. Published online December 31, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.2.65

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Abstract PDF

Purpose: The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea. Methods: The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified. Results: There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (<6 h) 27.9%, acute (6-24 h) 32.6%, subacute (1-7 d) 29.7%, and delayed period (>7 d) were 9.8%. Conclusion: This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.

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A Novel Method for Medical Predictive Models in Small Data Using Out-of-Distribution Data and Transfer Learning
Inyong Jeong, Yeongmin Kim, Nam-Jun Cho, Hyo-Wook Gil, Hwamin Lee
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Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts
Kyung-Eun Kim, Sun-Hee Moon, Chieun Song, Minjeong An
Journal of Korean Critical Care Nursing.2024; 17(2): 1. CrossRef
Implementation of Regenerative Thermal Oxidation Device Based on High-Heating Device for Low-Emission Combustion
Hoon-Min Park, Dal-Hwan Yoon, Joon-Seong Lee, Hyun-Min Jung, Dae-Hee Lee, Dong-Hwan Jeon, Tae-Yeung Lim
Energies.2024; 17(20): 5182. CrossRef
Implementation of an Improved 100 CMM Regenerative Thermal Oxidizer to Reduce VOCs Gas
Hoon-Min Park, Hyun-Min Jung, Dae-Hee Lee, Hei-Na Park, Tae-Young Lim, Jong-Hwa Yoon, Dal-Hwan Yoon
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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
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 1. CrossRef
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
Machine Learning-Based Prediction Models of Acute Respiratory Failure in Patients with Acute Pesticide Poisoning
Yeongmin Kim, Minsu Chae, Namjun Cho, Hyowook Gil, Hwamin Lee
Mathematics.2022; 10(24): 4633. CrossRef

Characteristics of Korean Poisoning Patients: Retrospective Analysis by National Emergency Department Information System: Woongki Kim, Kyung Hwan Kim, Dong Wun Shin, Junseok Park, Hoon Kim, Woochan Jeon, Joon Min Park, Jung Eon Kim, Hyunjong Kim; J Korean Soc Clin Toxicol. 2019;17(2):108-117. Published online December 31, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.2.108

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Purpose: The study examined the poisoned patients' characteristics nationwide in Korea by using data from the National Emergency Department Information System (NEDIS). Methods: Among the patients' information sent to NEDIS from January 1, 2013 to December 31, 2015, the included subjects' main diagnosis in ED showed poisoning according to the 7th edition of the Korean Standard Disease Classification (KCD-7). We analyzed the patients' gender, age, initial vital signs, visit time, stay time of staying in ED, results of ED care, main diagnosis in ED, length of hospitalization, and results of hospitalization. Results: A total of 106,779 ED visits were included in the analysis. There were 55,878 males (52.3%), which was more than the number of females. The number of intentional poisoning was 49,805 (59.6%). 75,499 cases (70.8%) were discharged, and 25,858 cases (24.2%) were hospitalized. The numbers of poisoning patients per 1,000 ED visits were 14 in Chungnam and 11.9 in Jeonbuk. The most common cause of poisoning, according to the main diagnosis, was venomous animals. It was the same for hospitalized patients, and pesticide was next. Pesticide was the most common cause of mortality in ED (228 cases, 46.1%) and after hospitalization (584 cases, 54.9%). The incidence of poisoning by age group was frequent for patients in their 30s to 50s, and mortality in ED and post-hospitalization were frequent for patients in their 60s to 80s. Conclusion: This study investigated the characteristics of poisoning patients reported in the past 3 years. Pesticide poisoning had a high mortality rate for patients in ED and in-hospital. For mortality, there was a high proportion of elderly people over 60. Thus, policy and medical measures are needed to reduce this problem. Since it is difficult to identify the poison substance in detail due to nature of this study, it is necessary to build a database and monitoring system for monitoring the causative substance and enacting countermeasures.

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응급실 기반 중독 심층 실태조사 1차년도 결과 보고
성우 이, 수진 김, 규종 조, 미진 이, 병학 소, 경수 김, 주현 송
Public Health Weekly Report.2024; 17(14): 535. CrossRef
Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts
Kyung-Eun Kim, Sun-Hee Moon, Chieun Song, Minjeong An
Journal of Korean Critical Care Nursing.2024; 17(2): 1. CrossRef
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
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 1. CrossRef
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
Prioritising Risk Factors for Prescription Drug Overdose among Older Adults in South Korea: A Multi-Method Study
Eun-Hae Lee, Ju-Ok Park, Joon-Pil Cho, Choung-Ah Lee
International Journal of Environmental Research and Public Health.2021; 18(11): 5948. CrossRef
Changes in Diagnosis of Poisoning in Patients in the Emergency Room Using Systematic Toxicological Analysis with the National Forensic Service
Je Seop Lee, Yong Sung Cha, Seonghoon Yeon, Tae Youn Kim, Yoonsuk Lee, Jin-Geul Choi, Kyoung-Chul Cha, Kang Hyun Lee, Hyun Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef

A Case of Zaltoprofen Induced Kounis Syndrome: Seong You Lee, Won Young Sung, Jang Young Lee, Sang Won Seo, Won Suk Lee; J Korean Soc Clin Toxicol. 2019;17(1):32-37. Published online June 30, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.1.32

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Abstract PDF: Kounis syndrome is defined as the occurrence of acute coronary syndrome associated with vasoactive mediators, such as histamines in the setting of hypersensitivity and allergic reactions or anaphylactic insults. The condition can be caused by various drugs, foods, or environmental factors that cause allergic reactions. A 35-year-old male visited the emergency room with anaphylaxis accompanied by chest pain approximately 20 minutes after taking zaltoprofen, a nonsteroidal anti-inflammatory drug. After acute treatment for the anaphylaxis, the patient was stabilized and all symptoms disappeared, but the ischemic changes in the electrocardiogram and elevation of the cardiac enzymes were observed. The emergency cardiac angiography and echocardiography were all normal. The allergic reaction of this patient to zaltoprofen was believed to cause a temporary coronary arterial vasospasm, inducing Type 1 Kounis syndrome. Thus far, there have been case reports of Kounis syndrome caused by a range of nonsteroidal anti-inflammatory drugs, but there are no reports of the condition being caused by zaltoprofen. According to the pathophysiology, both cardiac and allergic symptoms must be solved simultaneously, so rapid treatment and diagnosis are needed. Doctors treating acute allergic reactions and anaphylaxis patients must check the cardiovascular symptoms thoroughly and consider the possibility of Kounis syndrome.

Comparison of Mortality Rate according to Hospital Level among Patients with Poisoning Based on Korean Health Insurance and Assessment Service: Soyoung Kim, Sangchun Choi, Hyuk-Hoon Kim, Hee Won Yang, Sangkyu Yoon; J Korean Soc Clin Toxicol. 2019;17(1):21-27. Published online June 30, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.1.21

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Abstract PDF: Purpose: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. Methods: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. Results: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=-6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=-4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). Conclusion: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

Scombroid Fish Poisoning and Histamine Food Poisoning: Sung Phil Chung; J Korean Soc Clin Toxicol. 2019;17(1):1-6. Published online June 30, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.1.1

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Abstract PDF: Scombroid fish poisoning (SFP) is a form of histamine food poisoning caused by the ingestion of improperly stored fish. The term "scombroid" derives from the family name of the fish family first implicated, such as tuna and mackerel. On the other hand, non-scombroid fish species, such as sardine and herring, can also cause histamine poisoning. The histamine is converted from histidine by a bacterial enzyme in the causative fish. Because the symptoms of SFP can easily be confused with food allergies, it is believed to have been significantly under-reported. In 2016, an outbreak of SFP occurred among primary school students who had eaten yellowtail steak in Korea. The most common findings consisted of a rapid onset of flushing of the face and trunk, erythematous and urticarial rash, diarrhea, and headache occurring soon after consuming the spoiled fish. Usually, the course is self-limiting and antihistamines can be used successfully to relieve symptoms, but several life-threatening SFP cases have been reported. Clinical toxicologists should be familiar with SFP and have competency to make a differential diagnosis between fish allergy and histamine poisoning. SFP is a histamine-induced reaction caused by the ingestion of histamine-contaminated fish, whereas a fish allergy is an IgE-mediated reaction. This review discusses the epidemiology, pathophysiology, diagnosis, treatment, and preventive measures of SFP.

Self-poisoning as a Target Group for Prevention of Suicide: Moon Hwan Kwak, Hyun Young Kang, Si Jin Lee, Kap Su Han, Su Jin Kim, Eu Jung Lee, Sung Woo Lee; J Korean Soc Clin Toxicol. 2018;16(2):93-101. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.93

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Abstract PDF: Purpose: The Korean government has tried to decrease the suicide death rate over the last decade. Suicide attempts, particularly non-fatal attempts, are the most powerful known risk factor for a completed suicide. An analysis of suicide attempt methods will help establish the effective preventive action of suicide. Fit prevention according to the method of suicide attempt may decrease the incidence of suicide death. Self-poisoning is suggested as a major method of both suicide attempts and suicide death. The aim of this study was to determine if a self-poisoning patient is a suitable target for the prevention of the suicide. Methods: This was retrospective analysis of a prospective cohort, which included patients who presented to the emergency department (ED) after a self-harm or suicide attempt from Jan 2013 to Dec 2017. The proportion of methods in suicide attempts, psychological consultation, and fatality according to the suicide attempt method were analyzed. The types of poison were also analyzed. Results: Poisoning was the most common method of suicide attempts (52.1%). The rate of psychological consultations were 18.8% for all patients and 29.1% for poison patients (p<0.001). The rate of mortality in poisoning was 0.6%. Psychological consultation was performed more frequently in admission cases than discharged cases. The most common materials of poisons was psychological medicines and sedatives that had been prescribed at clinics or hospital. Conclusion: Self-poisoning is a major method of suicide attempt with a high rate of psychiatric consultation, low mortality rate, versus others methods. The prevention of suicide death for suicide attempts may focus on self-poisoning, which is the major method of suicide attempts. A suitable aftercare program for self-poisoning may be an effective method for preventing suicide if an early diagnosis and management of psychiatric disorders through psychiatric consultation can be made, and early connection to social prevention program for non-fatal patients are possible.

Is it Adequate to Determine Acetaminophen Toxicity Solely on Patients' History? An Analysis on Clinical Manifestation of Intoxication Patients with Positive Serum Acetaminophen Concentrations: Jee Hyun Kim, Won-joon Jeong, Seung Ryu, Yong Chul Cho, Jang Hyuck Moon, Hyun Soo Choi, Song Hee Yang, Hee Sun Chung; J Korean Soc Clin Toxicol. 2017;15(2):94-100. Published online December 31, 2017; DOI: https://doi.org/10.22537/jksct.2017.15.2.94

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Abstract PDF: Purpose: Acute acetaminophen intoxication is a common occurrence that can cause lethal complications. In most domestic emergency departments, clinicians tend to treat acetaminophen intoxication based on patients' history alone, simply due to the lack of a rapid acetaminophen laboratory test. We performed a 20-month study of intoxication patients to determine the correlation between the history of patients and serum laboratory tests for acetaminophen. Methods: We took blood samples from 280 intoxication patients to evaluate whether laboratory findings detected traces of acetaminophen in the sample. Patients were then treated according to their history. Laboratory results came out after patients' discharge. Agreement between patients' history and laboratory results were analyzed. Results: Among the 280 intoxicated patients enrolled, 38 patients had positive serum acetaminophen concentrations; 18 out of 38 patients did not represent a history suggesting acetaminophen intoxication. One patient without the history showed toxic serum acetaminophen concentration. Among the patients with the history, two patients with toxic serum acetaminophen concentration did not receive N-acetylcysteine (NAC) treatment due to their low reported doses, while other 2 patients without significant serum acetaminophen concentration did receive NAC treatment due to their high reported doses. Conclusion: This study showed a good overall agreement between history and laboratory test results. However, some cases showed inconsistencies between their history and laboratory test results. Therefore, in treating intoxication patients, a laboratory test of acetaminophen with rapid results should be available in most domestic emergency departments.

Analysis of Characteristics in Children and Adolescents with Poisoning at Emergency Department: Do Young Kim, Ji Hye Kim, Jin Hui Paik, Seung Baek Han, Hyun Min Jung; J Korean Soc Clin Toxicol. 2017;15(2):140-147. Published online December 31, 2017; DOI: https://doi.org/10.22537/jksct.2017.15.2.140

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Abstract PDF: Purpose: This study was conducted to analyze the features of poisoning in individuals aged 0-18 years to understand the characteristics of potential victims and eventually prevent poisoning. Methods: We retrospectively analyzed poisoned children and adolescents (0-18 years) who visited the emergency department of one tertiary hospital from January 2003 through December 2013. We collected data including their age, sex, reason for poisoning, components and dose of poison, results of treatment, and psychiatric diagnosis. Results: During the study period, there were 436 cases of poisoning (male 47.2% (n=206); female 52.8% (n=230)). Subjects were classified into four groups (0-1 years, 2-5 years, 6-12 years, 13-18 years). The most common cause of poisoning in all age groups was accidental poisoning (72.9%), but intentional poisoning increased as age increased (p<0.001). Moreover, females were more often subject to intentional poisoning than males (p<0.001). The most common poisoning material was drugs (41.7%). Among intentional poisoning patients, 62.7% patients had consulted a psychiatrist, and their most common diagnosis was adjustment disorder (44.6%). Conclusion: The most common cause of poisoning in individuals aged 0-18 years was accidental poisoning, while intentional poisoning was most common among adolescents. Guardians should take care to prevent accidental poisoning, while psychiatric consultation and national moderation will be needed to prevent intentional poisoning.

Pneumatosis Cystoides Intestinales and Portomesenteric Venous Gas following Anticholinesterase Pesticide Poisoning: Suk Hee Lee, Kyung-Woo Lee, Jin Hee Jung; J Korean Soc Clin Toxicol. 2017;15(1):56-59. Published online June 30, 2017; DOI: https://doi.org/10.22537/jksct.2017.15.1.56

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Abstract PDF: Pneumatosis cystoides intestinalis and portomesenteric venous gas are uncommon radiological findings, but are found commonly in cases of bowel ischemia, or as a result of various non-ischemic conditions. A 72-year-old man visited an emergency center with altered mental status 2 hours after ingestion of an unknown pesticide. On physical examination, he showed the characteristic hydrocarbon or garlic-like odor, miotic pupils with no response to light, rhinorrhea, shallow respiration, bronchorrhea, and sweating over his face, chest and abdomen. Laboratory results revealed decreased serum cholinesterase, as well as elevated amylase and lipase level. We made the clinical diagnosis of organophosphate poisoning in this patient based on the clinical features, duration of symptoms and signs, and level of serum cholinesterase. Activated charcoal, fluid, and antidotes were administered after gastric lavage. A computerized tomography scan of the abdomen with intravenous contrast showed acute pancreatitis, poor enhancement of the small bowel, pneumatosis cystoides intestinalis, portomesenteric venous gas and ascites. Emergent laparotomy could not be performed because of his poor physical condition and refusal of treatment by his family. The possible mechanisms were believed to be direct intestinal mucosal damage by pancreatic enzymes and secondary mucosal disruption due to bowel ischemia caused by shock and the use of inotropics. Physicians should be warned about the possibility of pneumatosis cystoides intestinalis and portomesenteric venous gas as a complication of pancreatitis following anticholinesterase poisoning.

General Characteristics for Poisoning-Induced Transient or Sustained Hyperammonemia: Soo Hyung Lee, Hong In Park, Michael Sung Choe, Dong Wook Je, Woo Young Nho, Seong Hun Kim, Mi Jin Lee, Jae Yun Ahn, Sung Bae Moon, Dong Eun Lee, Jung Bae Park; J Korean Soc Clin Toxicol. 2016;14(2):136-143. Published online December 31, 2016; DOI: https://doi.org/10.22537/jksct.2016.14.2.136

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Abstract PDF: Purpose: In patients with altered mentality caused by drugs or unknown causes, ammonia is checked to facilitate differential diagnosis or diagnose hepatic coma. This helps early prevention and treatment of brain damage due to hyperammonemia. This study was conducted to evaluate clinical characteristics of intoxicated adult patients with hyperammonemia. Methods: We evaluated 95 patients with hyperammonemia among intoxicated patients above the age of 15 who visited our ED from January 2013 to December 2015. We analyzed the demographic characteristics and type of poisoning substance, reason for ingestion, toxicological characteristics such as elapsed time from ingestion to hospital visit, lab, clinical progression and complications. Data were evaluated using the student's t test or Mann-Whitney U test for continuous variables, and Chi-square test and Fisher's exact test for frequency analysis of categorical variables. Results: When compared to healthy individuals, patients with hyperammonemia showed statistical significance on their SOFA score (p=0.016) and poison severity score (p<0.001). Additionally, patients with hyperammonemia showed significantly different initial serum AST level (p=0.012) and maximum serum AST level during the hospital stay (p=0.026) when compared to healthy individuals. Moreover, individuals with sustained hyperammonemia compared to transient hyperammonemia showed clinically significant SOFA scores (p<0.001), poison severity scores (p=0.007), mortality rates in the ICU (p=0.021), as well as different duration of hospital stay (p=0.037), serum creatinine level (p=0.002), erythrocyte sedimentation rate (p=0.025), and serum myoglobin (p=0.015). Conclusion: Most poisoning-induced hyperammonemia cases were transient and recovered without special treatment. Therefore, hyperammonemia is almost non-specific among poisoning patients.

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