Journal of The Korean Society of Clinical Toxicology

Original Articles

Prediction of Hematotoxicity in Patients with Acute Valproic Acid Intoxication: Jiwon Lee, Kyungman Cha, Won Jung Jeong, Hwan Song, Byung Hak So; J Korean Soc Clin Toxicol. 2025;23(2):29-37. Published online December 31, 2025; DOI: https://doi.org/10.22537/jksct.2025.00002

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Abstract PDF: Purpose: Valproic acid is a drug used for the treatment of convulsive disorders and for mood stabilization. Acute intoxication can result in gastrointestinal disturbances, neurologic symptoms, and hematologic toxicity. This study aims to identify factors that may predict patient prognosis.
Methods
In this single-center retrospective observational study, medical records from January 1, 2013, to December 31, 2022, were reviewed. The initial clinical features, laboratory results, and serum valproic acid levels of patients with acute valproic acid intoxication who presented to the emergency department were analyzed. Patients were divided into two groups: those who developed hematologic toxicity (hematotoxicity group) and those who did not (non-hematotoxicity group).
Results
A total of 115 patients were included in the analysis, of whom 23 (20%) developed hematotoxicity. The median age of patients with hematotoxicity was 39 years (interquartile range [IQR], 32.0–50.5), which was significantly higher than in the non-hematotoxicity group (p=0.001). The Glasgow Coma Scale score was lower in the hematotoxicity group, with a median of 12 points (IQR, 9.0–14.5) (p=0.013). Intensive care unit admission was more frequent in the hematotoxicity group (p=0.003). Compared with the non-hematotoxicity group, patients with hematotoxicity had a higher incidence of pneumonia, acute kidney injury, rhabdomyolysis, metabolic acidosis, and hyperlactatemia (all p<0.001, except p=0.009 for hyperlactatemia). The initial serum valproic acid concentration was also higher in the hematotoxicity group, with a median of 121.6 μg/mL (IQR, 59.8–154.3) (p<0.001). Multivariate analysis showed that the odds ratio for hematotoxicity was 6.20 (p=0.018) in the presence of metabolic acidosis and 8.32 (p<0.001) when the initial valproic acid concentration exceeded 115.0 μg/mL.
Conclusion
In patients with suspected acute valproic acid poisoning, early evaluation of arterial pH and serum valproic acid concentration is essential for predicting the prognosis.

Narcotics and Psychostimulants in Acute Overdose-Suspected Patients in Emergency Departments in Korea: Analysis of Toxicological Laboratory Data: Yoonsoo Kim, Jiwon Lee, Suncheun Kim, Arum Lee, Misuk Kim, Yun Hee Kim, Jung-In Ko, Bum-Jin Oh; J Korean Soc Clin Toxicol. 2025;23(1):1-9. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00007

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Abstract PDF: Purpose: Narcotic use and associated overdose deaths pose a serious public health threat worldwide. The use of psychostimulants, amphetamines and their derivatives, methamphetamine, ecstasy, or 3,4-methylenedioxy-methamphetamine (MDMA) is a significant challenge to the emergency department (ED). Although cases of illicit psychostimulant use have been reported in Korea, no reports with confirmative laboratory analyses have been reported. The objective of this study was to present data on ED patients who have used psychostimulants.
Methods
We used the 2019–2022 toxicological laboratory database of the National Medical Center, which includes data from six nationwide toxicological laboratories that support suspected acute poisoning patients in the ED. We analyzed demographics (age and sex), presenting mental status, and ethanol co-ingestion. The psychostimulant group was compared with the narcotic group, which contained patients who consumed narcotic drugs but not psychostimulants.
Results
Among 4,366 patients, narcotic drugs were detected in 2,239 patients (51.3%): 2,176 in the narcotic group, one who used cannabis, and 60 in the psychostimulant group. Psychostimulant cases were reported from 2019 to 2022 (13, 11, 25, and 11 each year). The psychostimulant group was younger (39.3±14.3 vs. 55.3±21.5 years), contained more female patients (45.0% vs. 21.1%), and had poorer mental status than the narcotic group (p<0.01). The cases of psychostimulant use were treated in 26 hospitals throughout Korea.
Conclusion
This is the first study reporting results from confirmative analyses of narcotic drug use in ED patients. Psychostimulant-related ED visits were observed throughout Korea.

Characteristics of Acute Toxic Alcohol Poisoning Patients in the Emergency Department: A Toxicological Laboratory Analysis of Ethylene Glycol and Methanol: Min Kyung Park, Emergency Vulnerable Area Regional Cooperation Team, Arum Lee, Misuk Kim, Yun Hee Kim, Jung-in Ko, Bum Jin Oh; J Korean Soc Clin Toxicol. 2025;23(1):19-27. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00006

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Abstract PDF: Purpose: Toxic alcohol exposures are rare yet remain an ongoing and potentially lethal poisoning problem in Korea. Few studies have characterized the epidemiological features and blood substance levels in acutely intoxicated patients presenting to emergency departments (EDs). The objective of this study was to describe the characteristics of intoxicated patients for whom toxicological analyses were requested.
Methods
We reviewed demographic and analytical data from a toxicological laboratory operated by the National Medical Center between 2018 and 2022. In total, 1,244 cases from 35 EDs were analyzed.
Results
Of the analyzed cases, 108 cases (63 patients) tested positive for toxic alcohols, including methanol (MeOH), ethylene glycol (EG), and isopropyl alcohol. Sixty patients had a single toxic alcohol detected: 17 with MeOH and 43 with EG. Clinical features included a median age of 42 years, 63.3% male, 100% acute exposure events, 66.7% suicide attempts, and 50.0% ethanol co-ingestion. Median ingestion amounts were 255 mL (MeOH) and 365 mL (EG). Significant differences between MeOH and EG groups included ingestion of an unknown substance (41.2% vs. 69.8%, p=0.04), initial blood pH (7.33 vs. 7.20, p<0.01), and multiple substance ingestion (52.9% vs. 81.4%, p=0.03). Median blood concentrations were 255 mg/dL (MeOH) and 12 mg/dL (EG). Follow-up analyses occurred in 9 MeOH patients (52.9%, 15 tests) and 15 EG patients (34.9%, 30 tests).
Conclusion
This study presents the first confirmatory analytical data on toxic alcohol poisoning among ED patients in Korea, emphasizing ongoing cases around Seoul.

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.

The Prognosis of Glyphosate herbicide intoxicated patients according to their salt types: Min Gyu Jeong, Kyoung Tak Keum, Seongjun Ahn, Yong Hwan Kim, Jun Ho Lee, Kwang Won Cho, Seong Youn Hwang, Dong Woo Lee; J Korean Soc Clin Toxicol. 2021;19(2):83-92. Published online December 31, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.2.83

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Purpose: Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH. Methods: This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality. Results: Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group. As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis. Conclusion: There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.

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Association between continuous renal replacement therapy and mortality after acute herbicide (glyphosate and/or glufosinate) intoxication: propensity score matching approach
Seung Woo Lee, Won-joon Jeong, Seung Ryu, Yongchul Cho, Yeonho You, Jung Soo Park, Changshin Kang, Hong Joon Ahn, So Young Jeon, Jinwoong Lee
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 17. CrossRef

The Significance of the Strong Ion Gap in Predicting Acute Kidney Injury and In-hospital Mortality in Critically Ill Patients with Acute Poisoning: Tae Jin Sim, Jae Wan Cho, Mi Jin Lee, Haewon Jung, Jungbae Park, Kang Suk Seo; J Korean Soc Clin Toxicol. 2021;19(2):72-82. Published online December 31, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.2.72

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Abstract PDF: Purpose: A high anion gap (AG) is known to be a significant risk factor for serious acid-base imbalances and death in acute poisoning cases. The strong ion difference (SID), or strong ion gap (SIG), has recently been used to predict in-hospital mortality or acute kidney injury (AKI) in patients with systemic inflammatory response syndrome. This study presents a comprehensive acid-base analysis in order to identify the predictive value of the SIG for disease severity in severe poisoning. Methods: A cross-sectional observational study was conducted on acute poisoning patients treated in the emergency intensive care unit (ICU) between December 2015 and November 2020. Initial serum electrolytes, base deficit (BD), AG, SIG, and laboratory parameters were concurrently measured upon hospital arrival and were subsequently used along with Stewart's approach to acid-base analysis to predict AKI development and in-hospital death. The area under the receiver operating characteristic curve (AUC) and logistic regression analysis were used as statistical tests. Results: Overall, 343 patients who were treated in the intensive care unit were enrolled. The initial levels of lactate, AG, and BD were significantly higher in the AKI group (n=62). Both effective SID [SIDe] (20.3 vs. 26.4 mEq/L, p<0.001) and SIG (20.2 vs. 16.5 mEq/L, p<0.001) were significantly higher in the AKI group; however, the AUC of serum SIDe was 0.842 (95% confidence interval [CI]=0.799-0.879). Serum SIDe had a higher predictive capacity for AKI than initial creatinine (AUC=0.796, 95% CI=0.749-0.837), BD (AUC=0.761, 95% CI=0.712-0.805), and AG (AUC=0.660, 95% CI=0.607-0.711). Multivariate logistic regression analyses revealed that diabetes, lactic acidosis, high SIG, and low SIDe were significant risk factors for in-hospital mortality. Conclusion: Initial SIDe and SIG were identified as useful predictors of AKI and in-hospital mortality in intoxicated patients who were critically ill. Further research is necessary to evaluate the physiological nature of the toxicant or unmeasured anions in such patients.

A satisfaction survey of toxicological laboratory: Survey of regional and local emergency medical centers: Dong Woo Son, Ji Hun Kang, Yang Weon Kim, Chul Ho Park, Yoo Sang Yoon, Jae Gu Ji; J Korean Soc Clin Toxicol. 2021;19(2):110-126. Published online December 31, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.2.110

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Purpose: The purpose of this study is to find out the current status of toxicology laboratory operated by six locations nationwide and to investigate the satisfaction of emergency medical professionals who working at local and regional emergency medical centers. Methods: This survey was conducted prospective. It was conducted on 665 emergency medical professionals working at regional and regional emergency medical centers across the South Korea. Among them, the analysis was conducted with data that 510 emergency medical professionals who respond to this survey. The questionnaire was conducted on an online basis for a month. To ensure statistical significance, consider a dropout rate of 10% based on a minimum response recovery rate of 70%. 506 people were selected for the survey. Results: According to a survey on the status of addiction analysis room usage, the average monthly usage of addiction test rooms among respondents were 406 cases.71.0 cases (17.4%) of toxicology laboratory in Seoul and 71 cases (17.4%) in Gwangju. 32 cases (7.8%), 118 cases (29.0%) requested by toxicology laboratory in Busan, and the toxicology laboratory in Daegu. Eighty two cases (20.1%), Daejeon area 25 cases (6.1%), Wonju area toxicology laboratory was 78 (19.6%). According to a survey on the satisfaction of the addiction analysis room,Seoul (4.9±2.71) and Gwangju (4.8±2.52) showed high satisfaction. Conclusion: Due to the limited operation time of the four addiction analysis rooms currently in operation, the satisfaction level of addiction analysis by emergency medical professionals in the area is low due to the delay until the result is notified.

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Changes in deoxyhemoglobin and admission duration in carbon monoxide poisoning patients: a retrospective study
Jae Gu Ji, Yang Weon Kim, Chul Ho Park, Yoo Sang Yoon, Yundeok Jang, JI-Hun Kang, Chang Min Park, Sang Hyeon Park
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 32. CrossRef

Use of succimer as an alternative antidote in copper sulfate poisoning: A case report: Sang Kyoon Han, Sung Wook Park, Young Mo Cho, Il Jae Wang, Byung Kwan Bae, Seok Ran Yeom, Soon Chang Park; J Korean Soc Clin Toxicol. 2021;19(1):59-63. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.59

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Copper sulfate is widely used as a fungicide and pesticide. Acute copper sulfate poisoning is rare but potentially lethal in severe cases. Copper sulfate can lead to cellular damage of red blood cells, hepatocytes, and myocytes. Toxic effects include intravascular hemolysis, acute tubular necrosis and, rhabdomyolysis. A 76-year-old man presented with vomiting and epigastric pain. He had ingested a copper-containing fungicide (about 13.5 g of copper sulfate) while attempting suicide 2 hours prior to presentation. From day 3 at the hospital, laboratory findings suggesting intravascular hemolysis were noted with increased serum creatinine level. He was treated with a chelating agent, dimercaptosuccinic acid (succimer). His anemia and acute kidney injury gradually resolved with a 19-day regimen of succimer. Our case suggests that succimer can be used for copper sulfate poisoning when other chelating agents are not available.

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Acute poisoning of copper sulfate: a case report and review literature
Samaneh Hajimohammadi, Somayeh Gharibi, Vahid Pourbarkhordar, Seyed Reza Mousavi, Hanieh Salmani Izadi
The Egyptian Journal of Internal Medicine.2022;[Epub] CrossRef

Laboratory analysis of acute acetaminophen overdose patients in Emergency Medical Centers: including analysis of one toxicological laboratory data: In Chan Kim, Sinae Won, Arum Lee, Haeun Jung, Jeongsun Lee, Bum Jin Oh; J Korean Soc Clin Toxicol. 2021;19(1):31-37. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.31

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Abstract PDF: Purpose: Acetaminophen (APAP) is a widely available drug responsible for a large part of drug-induced hepatotoxicity in developed countries. Although acetaminophen overdose cases in Korea are being continuously reported, there are no reports related to the level of this drug in the patient's blood or of laboratory analysis at emergency departments (ED). This study sought to analyze the acetaminophen overdose cases at a toxicological laboratory and to survey APAP analysis services offered at select EDs. Methods: We analyzed the demographic and analytic data at a toxicological laboratory run by the National Emergency Medical Center (NMC) in 2019-2020. We surveyed the APAP laboratory service in the 38 regional emergency medical centers (EMCs) and 68 local EMCs near the toxicological laboratory. Results: We studied 175 acute poisoning cases (112 women) with positive blood APAP results (mean age 47.0±24.1 years). Suicide attempts comprised 40.0% of the cases and 30.3% APAP overdose events. In the univariate analysis, we observed that patients were significantly younger, with fewer underlying medical diseases. There were a higher number of APAP overdose events, more favorable initial mental status, more toxic quantity intake in the above treatment line group (p<0.05), In multivariate analysis, the toxic amount intake was significantly more frequent in the above treatment line group (p<0.01). Hospital APAP analysis services were available in six EMCs (3/38 regional and 3/68 local). The hospital blood APAP level reporting intervals were shorter than outside-hospital laboratory services (p<0.01, regional 7.0±3.0 vs. 40.6±27.5, local 5.3±3.1 vs. 57.9±45.1 hours). The NMC toxicological laboratory reporting interval was shorter than the other outside-hospital laboratories (p<0.01, regional 5.7±0.6 vs. 50.2±22.7 local 7.5±3.0 vs. 70.5±41.5 hours). Conclusion: Over the treatment line group, toxic amount intake was significantly more frequent. Only six of 106 EMCs have their own APAP analysis service in their hospitals.

Factors of Determining N-acetylcysteine Administration in Patients with Acute Acetaminophen Poisoning: Jeong Hwa Lee, Sangchun Choi, Sang Kyu Yoon, Kyu Cheol Shin; J Korean Soc Clin Toxicol. 2020;18(2):78-84. Published online December 31, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.2.78

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Abstract PDF: Purpose: In acute acetaminophen poisoning, the administration of N-acetylcysteine (NAC) can effectively treat the main complications, such as kidney injury and liver failure. In the current situation, measurements of the acetaminophen concentration are not checked in the usual medical facilities. Therefore, this study examined the factors of determining the administration of NAC in addition to the stated amount of intake. Methods: The medical records of patients who visited Ajou University Hospital emergency center with acetaminophen poisoning from January 2015 to December 2019 were reviewed retrospectively. One hundred and seventy-nine patients were initially included. Among these patients, 82 patients were finally selected according to the inclusion criteria in the study. The inclusion criteria were as follows: patients who were 15 years of age or older; those whose ingested dose, ingested time, and body weight were clearly identified; and patients whose acetaminophen sampling time was within 24 hours. Patients were divided into two groups: NAC administered vs. non-NAC administered. The following variables were compared in these two groups: ingested dose, ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, psychiatric disease history, classification of toxic/non-toxic groups, duration of hospitalization, and laboratory results. Results: Univariate analysis revealed the ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, and psychiatric disease history to be the determining factors in administering NAC. Logistic regression analysis confirmed that the ingested dose per body weight was the only significant factor leading to an NAC treatment decision. (Odds ratio=1.039, 95% Confidential interval=1.009-1.070, p=0.009) Conclusion: The ingested dose per body weight was the only determining factor for administering NAC in patients with acute acetaminophen poisoning. On the other hand, additional criteria or indicators for the NAC administration decision will be necessary considering the inaccuracy of the ingested dose per body weight and the efficiency of NAC administration.

Associations between Early Hyperoxia and Long Term Neurologic Outcome in Acute Carbon Monoxide Poisoning: Ju Chan Kim, Byeong Jo Chun, Jeong Mi Moon, Young Soo Cho; J Korean Soc Clin Toxicol. 2020;18(1):18-25. Published online June 30, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.1.18

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Abstract PDF: Purpose: We studied the impact of arterial oxygen tension (PaO2) on the long term neurologic outcome in patients with acute carbon monoxide poisoning. Methods: The study population included 311 patients who presented to emergency department with acute CO poisoning from January 2015 to January 2018. These patients underwent arterial blood gas testing at the time of presentation. The baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was the long term neurologic status. Results: The normoxia group was significantly older and it had a higher incidence of diffusion weighted MRI abnormality, and this group needed multiple HBO sessions compared to the group with moderate or severe hyperoxia. Also, the incidence of altered mentality at discharge was higher in the normoxia group than that of the moderate hyperoxia group. The incidence of a poor long term neurologic outcome was 11.3%. The incidence of a poor long term neurologic outcome decreased as the PaO2 increased. The PaO2 was significantly lower in patients with a poor long term neurologic outcome than that of the patients with a good outcome 198 (165.2 to 231.1) mmHg in the good outcome group vs. 154 (119-162) mmHg in poor outcome, p<0.001). In multivariate logistic regression analysis, PaO2 was selected as an independent factor of the poor long-term neurologic outcome (OR 0.981 (95% CI: 0.968 to 0.995)) Conclusion: Higher PaO2 was independently associated with a lower incidence of a poor long-term neurologic outcome.

Zolpidem Detection and Blood Level in Acute Poisoning-suspected Patients in Emergency Departments: Review of 229 Cases: Jaehyung Yu, Hanseok Chang, Sinae Won, Jeonghun Yeom, Arum Lee, Na-Youn Park, Bum Jin Oh; J Korean Soc Clin Toxicol. 2019;17(2):118-125. Published online December 31, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.2.118

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Abstract PDF: Purpose: Non-benzodiazepine hypnotic drugs (including zolpidem) are associated with an increased risk of suicide and suicidal ideation. Considering the wide usage of zolpidem, this drug should be considered a possible etiology for stupor or coma in any patient exposed to this drug. However, there are no reports on zolpidem blood levels in emergency department patients in Korea. We therefore reviewed the analyzed data of a toxicology laboratory at one university affiliated hospital. Methods: The sex, age, chief symptoms, suspiciousness of poisoning, and presumption of poison were analyzed from January 2018 to June 2019. The detection frequency and level of zolpidem in the patient blood were compared to the mental changes presented, which is the main consequence of zolpidem. Results: A total of 229 toxicological analyses, requested to a toxicological laboratory at one university affiliated hospital, were reviewed. Among 229 patients, the mean age was 54.3±20.7 years old with 113 women and 116 men. 8.7% of patients have psychiatric illness and 39.7% were poisoned intentionally. The chief symptoms detected were: mental change 55.0%, gastrointestinal 14.4%, cardiovascular 10.5%, focal neurological 7.4%, respiratory 3.5%, none 8.7%, and unknown 0.4%. A request for detailed reports revealed that causative poisons were specified only in 20.1% cases. Zolpidem was detected in 22.3% cases (51/229), with median blood level 1.26 mg/L (interquartile 0.1, 5.06 mg/L) and urine 0.90 mg/L (interquartile 0.11, 5.6 mg/L). Furthermore, zolpidem was more frequently detected in toxicology analysis of patients where mental change was the primary symptom, as compared to other symptoms (32.5% vs. 9.7%, p<0.01). Conclusion: This study reported the blood level of zolpidem in suspected poisoning patients admitted to the emergency department.

Symptomatic Hypocalcemia Associated with Dioscorea tokoro Toxicity: Jae Chol Yoon, Jae Baek Lee, Tae Oh Jeong, Si On Jo, Young Ho Jin; J Korean Soc Clin Toxicol. 2019;17(1):42-45. Published online June 30, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.1.42

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Abstract PDF: Dioscorea tokoro has long been used in Korean traditional medicine as a pain killer and anti-inflammatory agent. A 53-year-old male who consumed water that had been boiled with raw tubers of D. tokoro as tea presented with numbness and spasm of both hands and feet. Laboratory results showed hypocalcemia, hypoparathyroidism, and vitamin D insufficiency. During his hospital stay, colitis, acute kidney injury, and toxic encephalopathy developed. The patient received calcium gluconate intravenous infusion and oral calcium carbonate with alfacalcidol. His symptoms improved gradually, but hypocalcemia persisted despite the calcium supplementation. We suggest that ingestion of inappropriately prepared D. tokoro can cause symptomatic hypocalcemia in patients with unbalanced calcium homeostasis.

Evaluation of Cut-off Values in Acute Acetaminophen Intoxication Following the Revised Guideline of the United Kingdom: Sung Jin Park, Kyungman Cha, Byung Hak So, Hyung Min Kim, Won Jung Jeoung; J Korean Soc Clin Toxicol. 2018;16(2):68-74. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.68

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Abstract PDF: Purpose: In 2012, a revised guideline for acute acetaminophen overdose was proposed in the UK, recommending that the treatment threshold should be lowered to 100 mcg/ml at 4 hours after ingestion without risk stratification of hepatotoxicity. However, the poison centers in some developing countries do not have laboratory resources to provide serum drug levels in time. The primary aim of the study is to evaluate the cut-off value of reported dose per kilogram to determine when N-acetylcysteine treatment is warranted under the revised guideline. Methods: Data were collected retrospectively from the toxicology registry of an urban emergency medical center between 1st January 2010 and 30th June 2017. Inclusion criteria were single acute overdose of more than 75 mg/kg in 15 hours from ingestion and over 14 years of age. Subgroups were created by 25 mg/kg increments of reported dose, then sensitivity, specificity, positive predictive value and negative predictive value were calculated for the cut-off values of 100 mg/kg, 125 mg/kg, 150 mg/kg and 175 mg/kg for toxic serum level over '100-treatment line'. Results: A total of 99 patients were enrolled in the study; 24 patients showed toxic serum levels (24.2%). Zero of 17 patients with an ingestion dose under 100 mg/kg showed toxic level (0%), and 0 of 15 under 125 mg/kg (0%), 2 of 14 under 150 mg/kg (14.3%), and 4 of 12 under 175 mg/kg (33.3%) had toxic levels. The higher the ingested dose per kilogram of weight, the higher the frequency of the toxic serum concentration on the first test (${chi}^2$ test for trend, ${chi}^2=22.66$, p-value<0.001) and the sensitivity of each value was 100%, 100%, 92% and 76%. Conclusion: In acute single acetaminophen intoxication, the ingestion dose of 100 mg/kg of weight will be useful in determining the need for the N-acetylcysteine antidote in the indigent laboratory environment.

Neutrophil-to-lymphocyte Ratio as A Predictor of Aspiration Pneumonia in Drug Intoxication Patients: Jeong Beom Lee, Sun Hwa Lee, Seong Jong Yun, Seokyong Ryu, Seung Woon Choi, Hye Jin Kim, Tae Kyung Kang, Sung Chan Oh, Suk Jin Cho, Beom Sok Seo; J Korean Soc Clin Toxicol. 2018;16(2):61-67. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.61

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Abstract PDF: Purpose: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission Methods: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (${ ho}$) were performed. Results: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p<0.001) with a sensitivity of 86.0% and a specificity of 72.6%. No correlations between NLR and length of hospital admission (${ ho}=0.195$) and between NLR and length of ICU admission (${ ho}=0.092$) were observed. Conclusion: The NLR is a simple and effective marker for predicting the occurrence of aspiration pneumonia in DI patients. Emergency physicians should be alert for aspiration pneumonia in DI patients with high NLR value (>3.47).

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