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JKSCT : Journal of The Korean Society of Clinical Toxicology

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4 "Hypothermia"
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A Case of Successful Resuscitation of 10,150 J Shocks and Therapeutic Hypothermia on Aconitine-induced Cardiovascular Collapse
Hyung Jun Moon, Jung Won Lee, Ki Hwan Kim, Dong Kil Jeong, Jong Ho Kim, Young Ki Kim, Hyun Jung Lee
J Korean Soc Clin Toxicol. 2014;12(2):97-101.   Published online December 31, 2014
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AbstractAbstract PDF
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 Amitraz Insecticide Intoxication after Ingestion of Large Amount
Joo-Hyun Suh, Hyung-Keun Roh
J Korean Soc Clin Toxicol. 2008;6(1):52-56.   Published online June 30, 2008
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AbstractAbstract PDF
Amitraz is used as farm-animal insecticide. Its side effects in humans are related to its pharmacological activity on alpha 2-adrenergic receptors. The case describes a previously healthy 46-year-old woman who intentionally ingested approximately 250mL of liquid amitraz. She presented with vomiting, altered mental status, miosis, dry mouth, hypopnea, metabolic and respiratory acidosis, hypotension, hypothermia, polyuria, metabolic acidosis, elevated serum aminotransferase and abdominal distension. Supportive treatments including mechanical ventilation, hydration, dopamine infusion, bicarbonate infusion and gastric decompression resulted in improvement. By hospital day 3, she recovered with resolution of abdominal distension. It is paramount to recognize amitraz poisoning when a pesticide-intoxicated patient presets with signs and symptoms consistent with organophosphate intoxicated patients but with greater alpha 2-adrenergic related symptoms such as decreased bowel motility and xerostomia.
Dimethoate Intoxication with Refractory Shock and Hyperglycemia
Jae-Eun Kim, Jin-Hee Jung, Hyun-A Bae, Eun-Kyung Eo
J Korean Soc Clin Toxicol. 2007;5(1):46-49.   Published online June 30, 2007
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AbstractAbstract PDF
Organophosphorus insecticides induce different clinical manifestations varying according to the different side groups attached to the phosphate, their rates of degradation, and their fat solubilities. In consequence of this variation, specific treatments are required for particular organophosphorus insecticides. We report a unusual case of intoxication with dimethyl organophosphorus insecticide in a 26-year-old woman. She manifested atypical and ultimately fatal symptoms including profound shock, refractory hyperglycemia, and hypothermia.
A case of Hypothermia Resulting from Disulfiram-Ethanol Reaction
Hyun-A Bae, Eun-Kyung Eo
J Korean Soc Clin Toxicol. 2004;2(1):54-57.   Published online June 30, 2004
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AbstractAbstract PDF
Disulfiram (tetraethylthiuram disulphid) is used in the treatment of chronic alcoholism since it causes an unpleasant aversive reaction to alcohol. It works by inactivating hepatic aldehyde dehydrogenase, leading to pronounced rise in the acetaldehyde concentration when ethanol is metabolized. Acetaldehyde causes alcohol sensitivity, which involve vasodilation associated with feeling of hotness and facial flushing, increased heart rate and respiration rates, lowered blood pressure, nausea, headache. One of its metabolites, diethyldithiocarbamate (DDC) can inhibit the enzyme dopamine $eta$-hydroxylase (DBH), this may account for the profound refractory hypotension and hypothermia seen with the disulfiram-ethanol reaction (DER), resulting from norepinephrine depletion. This report is presents the case of a patient we met, who presented with hypothermia caused by the disulfiram-ethanol reaction, and along with a brief review of the subject.

JKSCT : Journal of The Korean Society of Clinical Toxicology