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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Clinical features related to alcohol co-ingestion of deliberate self-poisoning patients visiting the emergency department
Won Kim Gyu, Jeong Lee Woon, Kim Daehee, Young Lee June, Yun Kim Sang, Jeong Sikyoung, Hong Sungyoup, Hee Woo Seon
J Korean Soc Clin Toxicol. 2022;20(2):58-65.   Published online December 31, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.2.58
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Purpose: Alcohol is one of the most commonly co-ingested agents in deliberate self-poisoning (DSP) cases presenting at the emergency department (ED). The increased impulsivity, aggressiveness, and disinhibition caused by alcohol ingestion may have different clinical features and outcomes in cases of DSP. This study investigates whether alcohol co-ingestion affects the clinical features and outcomes of DSP patients in the ED. Methods: This was a single-center retrospective study. We investigated DSP cases who visited our ED from January 2010 to December 2016. Patients were classified into two groups: with (ALC+) or without (ALC–) alcohol co-ingestion. The clinical features of DSP were compared by considering the co-ingestion of alcohol, and the factors related to discharge against medical advice (AMA) of DSP were analyzed. Results: A total of 689 patients were included in the study, with 272 (39.5%) in the ALC+ group. Majority of the ALC+ group patients were middle-aged males (45-54 years old) and arrived at the ED at night. The rate of discharge AMA from ED was significantly higher in the ALC+ group (130; 47.8%) compared to the ALC– group (p=0.001). No significant differences were obtained in the poisoning severity scores between the two groups (p=0.223). Multivariate analysis revealed that alcohol co-ingestion (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.01-1.98), alert mental status (OR=1.65; 95% CI, 1.17-2.32), past psychiatric history (OR=0.04; 95% CI, 0.01-0.28), age >65 years (OR=0.42; 95% CI, 0.23-0.78), and time from event to ED arrival >6 hrs (OR=0.57; 95% CI, 0.37-0.88) were independent predictive factors of discharge AMA (p=0.043, p=0.004, p=0.001, p=0.006, and p=0.010, respectively). Conclusion: Our results determined a high association between alcohol co-ingestion and the outcome of discharge AMA in DSP patients. Emergency physicians should, therefore, be aware that DSP patients who have co-ingested alcohol may be uncooperative and at high risk of discharge AMA.
Predicting Factors Associated with Large Amounts of Glyphosate Intoxication in the Early-Stage Emergency Department: QTc Interval Prolongation
Dong-Soo Kyung, Jae-Cheon Jeon, Woo Ik Choi, Sang-Hun Lee
J Korean Soc Clin Toxicol. 2020;18(2):130-135.   Published online December 31, 2020
DOI: https://doi.org/10.22537/jksct.2020.18.2.130
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Purpose: Taking large amounts of glyphosate is life-threatening, but the amounts of glyphosate taken by patients for suicide are not known precisely. The purpose of this study was to find the predictors of large amounts of glyphosate ingestion. Methods: This retrospective study analyzed patients presenting to an emergency department with glyphosate intoxication between 2010 and 2019, in a single tertiary hospital. The variables associated with the intake amounts were investigated. The parameters were analyzed by multivariate variate logistic regression analyses and the receiver operating characteristic (ROC) curve. Results: Of the 28 patients with glyphosate intoxication, 15 (53.6%) were in the large amounts group. Univariate analysis showed that metabolic acidosis, lactic acid, and corrected QT (QTc) interval were significant factors. In contrast, multivariate analysis presented the QTc interval as the only independent factor with intoxication from large amounts of glyphosate. (odds ratio, 95% confidence interval: 1.073, 1.011-1.139; p=0.020) The area under the ROC curve of the QTc interval was 0.838. Conclusion: The QTc interval is associated significantly with patients who visit the emergency department after being intoxicated by large amounts of glyphosate. These conclusions will help in the initial triage of patients with glyphosate intoxication.
The Experiences of the Emergency Antidote Stock and Delivery Service by the Korean Poison Information Center
So Young Park, Bum Jin Oh, Chang Hwan Sohn, Ru Bi Jeong, Kyoung Soo Lim, Won Kim, Seung Mok Ryoo
J Korean Soc Clin Toxicol. 2013;11(1):9-18.   Published online June 30, 2013
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Purpose: Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide stocking and delivery system for emergency antidotes in Korea. We report on a two-year experience of a nationwide stocking and delivery trial for emergency antidotes at emergency departments in Korea. Methods: An expert panel of clinical toxicologists reviewed and made a list of 15 stocked antidote. These antidotes were purchased or imported from other countries and delivered from 14 antidote stocking hospitals nationwide 24 hours per day, seven days per week. Results: From August 1, 2011 to April 30, 2013, 177 patients with acute poisoning, with a median age of 48.5 years, were administered emergency antidotes. The causes of poisoning were intentional in 52.0% and 88.0% were intentional as a suicide attempt. Regarding clinical severity, using the poisoning severity score, 40.7% of patients had severe to fatal poisoning and 39.0% had moderate poisoning according to clinical severity. The most frequent presenting symptom was neurologic deficit, such as altered mentality (62.7%). alerted mentality (62.7%). Emergency antidotes were administered as follows: methylene blue (49 cases), flumazenil (31), N-acetylcysteine (25), glucagon (17), 100% ethanol (15), cyanide antidote kit (12), anti-venin immunoglobulin (5), pyridoxine (4), hydroxocobalamine (2), and deferoxamine (1). The median time interval from antidote request to delivery at the patient's bedside was 95 minutes (interquartile range 58.8-125.8). Conclusion: Findings of this study demonstrated the possibility of successful operation of the nationwide system of emergency antidotes stocking and delivery in Korea.
Drug-Induced Anaphylactic Shock at the Emergency Department
Sang-Guen Han, Ryeok Ahn, Sun-Hyu Kim, Seung-Won Choe, Seung-Won Hong
J Korean Soc Clin Toxicol. 2009;7(2):137-142.   Published online December 31, 2009
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Purpose: This study was conducted to investigate the characteristics of drug induced anaphylactis and anaphylactic shock in patients who were admitted to the emergency department Methods: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. Results: The mean age of the study subjects was $47.9P{pm}14.2$ years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group ($51.5{pm}15.1$ vs $42.5{pm}10.6$, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. Conclusion: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.
Diagnostic Radioopacity in Chloroform Ingestion -A Case Report-
Sung Woo Lee, Sung Hyuk Choi, Yun Sik Hong, Su Jin Kim, Sung Woo Moon, Jun Dong Moon, Sang Hyun Jung, Jong Su Park
J Korean Soc Clin Toxicol. 2005;3(1):48-51.   Published online June 30, 2005
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Diagostic imaging can help in management of toxicologic emergencies. We report a patient who presented to the emergency department with coma and suppressed respiration after ingestion of unknown substance. We documented chloroform with radiopaque material in bowel on abdominal radiograph. We used activated charcoal and laxative to decontaminate bowel. Hepatotoxicity occurred on 3rd admission day and elevation of liver enzyme reached peak level on 5th admission day. The patient received hemoperfusion, N-acetylsystein and supportive cares. The patient was improved from hepatic dysfunction and discharged without complication on 11th admission day. Radiograph in toxicology may confirm a diagnosis and assist in therapeutic intervention.

JKSCT : Journal of The Korean Society of Clinical Toxicology