In this study, we report the case of a 59-year-old male patient with organophosphate pesticide poisoning. He visited the local emergency medical center after ingesting 250 ml of organophosphate pesticide. The patient's symptoms improved after the initial intravenous infusion of pralidoxime 5 g and atropine 0.5 mg. However, 18 hours after admission, there was a worsening of the symptoms. A high dose of atropine was administered to improve muscarinic symptoms. A total dose of 5091.4 mg of atropine was used for 30 days, and fever and paralytic ileus appeared as side effects of atropine. Anticholinergic symptoms disappeared only after reducing the atropine dose, and the patient was discharged on the 35th day without any neurologic complications.
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The effects of case management program completion on suicide risk among suicide attempters: A 5-year observational study Hyun Jo Shin, Gwan Jin Park, Yong Nam In, Sang Chul Kim, Hoon Kim, Suk Woo Lee The American Journal of Emergency Medicine.2019; 37(10): 1811. CrossRef
Chlorfenapyr is a widely used insecticide, that is very lethal if ingested. It exhibits delayed toxicity in which there are few symptoms at first which suddenly worsen after a few days. A 66-year-old female patient ingested about 90 mL of chlorfenapyr liquid hydrating agent (Chlofenapyr 10%) and showed stable vital signs with no specific symptoms and findings other than a mild fever, vomiting, and nausea. From the 3rd day of ingestion, creatine kinase was high, and rhabdomyolysis was suspected. From the 4th day of ingestion, pancreatic enzymes began to gradually increase. A diffusion-weighted image showed a multifocal high signal intensity in the white matter and corpus callosum area. On the 8th day after ingestion, she suffered a high fever and a heart attack and died. Thus, if a patient is suspected of taking chlorfenapyr, he/she needs active treatment and monitoring even if he/she does not exhibit any symptoms.
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A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels Ming-Jin Chung, Yan-Chiao Mao, Chia-Tien Hsu, Mu-Chi Chung, Tsai-Jung Wang, Tung-Min Yu, Po-Yu Liu, Pin-Kuei Fu, Chia-Ming Hsieh Medicina.2022; 58(11): 1630. CrossRef
Purpose: This study examined the clinical and epidemiological characteristics of intensive care unit (ICU) patients admitted or died in the emergency medical center with acute-poisoning to investigate the variables related to the prognosis. Methods: The data were collected from poisoning patients admitted or died in the emergency medical center of a general hospital located in Seoul, from January 2014 to February 2020. The subjects of this study were 190 patients. The medical records were screened retrospectively, and the clinical and epidemiological characteristics of the patients in the emergency room (ER) and ICU were examined to investigate the contributing factors that influence the poor prognosis. Results: The study analyzed 182 patients who survived after being admitted to the intensive care unit (ICU). The results are as follows. The mental change (87.4%) was the most common symptom. Sedative poisoning (49.5%) was the commonest cause. For most patients, pneumonia (26.9%) was the most common complication. Hypotension (23.7%), tachycardia (42.1%), fever (15.8%), seizures (10.5%), dyspnea (2.6%), high poisoning severity score (PSS), type of toxic material, mechanical ventilator application (39.5%), inotropes application (39.5%), and pneumonia (55.3%) were correlated the LOS over 5 days in the ICU. 8 patients died. In the case of death pesticides and carbon monoxide were the main toxic materials; tachycardia, bradycardia, and hypotension were the main symptoms, and a mechanical ventilator and inotropes were applied. Conclusion: Patients with unstable vital signs, high PSS, and non-pharmaceutical poisoning had a prolonged LOS in the ICU and a poor prognosis.
A 47-year-old woman ingested about 12 mg of colchicine with suicidal intent. Colchicine, a highly poisonous alkaloid, is a commonly used treatment for gout, Bechet's disease, and familial Mediterranean fever. Despite the knowledge of its side effects, the risk of a significant overdose is under-appreciated. She suffered from acute multisystem toxicity, including gastrointestinal disorders, bone marrow suppression, alopecia, and probable pancreatitis, but she ultimately recovered with supportive therapy. We report a case of acute colchicine toxicity from a single overdose with a review of the literature.
BASTA is an herbicide which contains glufosinate ammonium as a main component with an anionic surfactant, polyoxyethylene alkylether sulfate, and nonselectively inhibits glutamine synthetase. It became a wildly used herbicide in Korea and its intoxication is now increasing. A 42-year old woman ingested about 300ml of BASTA in a suicide attempt. She showed unconsciousness and respiratory distress in the beginning, and later developed multiple generalized convulsions, low blood pressure, fever and diabetes insipidus. Although she became alert 12 days after the ingestion, she showed retrograde amnesia for a period of about recent 10 years. A neuropsychological test on day 22 revealed frontal lobe dysfunction, visual memory disturbance and slight decrease in visuospatial function. All these neurological abnormalities that might occur due to glufosinate ammonium were almost improved in the follow-up test performed a month later.
Lithium is mainly prescribed for manic and depressive disorder, also frequently prescribed for the other diseases such as migraine, cluster headache, alcoholism, and obsessive-compulsive disorder. An acute lithium intoxication occurs in cases of patients ingesting large amount lithium at a time, a chronic lithium intoxication occurs in patients on chronic lithium therapy. Acute or chronic lithium poisoning occurs frequently in case of patients on chronic lithium therapy ingesting larger dose than prescribed. Manifestations of lithium poisoning are various. It is possible nervous, cardiovascular, renal, gastrointestinal and endocrine systems to be involved. Due to intracellular high concentration, mortality rate is high in acute lithium intoxication patients on chronic lithium therapy. We report a case of acutely intoxicated 40-year-old male on chronic lithium therapy. His chief complaints were deterioration and high fever. On his arrival to an emergency department, he was in cardiac arrest. He restored return of spontaneous circultion (ROSC) 5 minutes later after cardiopulmonary cerebral resuscitation (CPCR) and referred to department of internal medicine for hemodialysis. Vigorous treatment was given to the patient, but he was expired at 4th hospital day.