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JKSCT : Journal of The Korean Society of Clinical Toxicology

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A Case of Mental Change in a Patient Who Received a Zoletil Injection
Yeong Ki Lee, In Gu Kang, Cheol Sang Park, Seok Jin Heo, Youn Seok Chai, Seong Soo Park, Jae Kwang Lee, Hyun Jin Kim, Won Joon Jeong
J Korean Soc Clin Toxicol. 2013;11(1):23-27.   Published online June 30, 2013
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AbstractAbstract PDF
Zoletil is a non-opioid, non-barbiturate animal anesthetic and proprietary combination of two drugs, a dissociative anesthetic drug, tiletamine, with the benzodiazepine anxiolytic drug, zolazepam. Zoletil has greater potency than ketamine. Zoletil is abused for recreational purposes, especially by people with easy access to medicine. However, in Korea, it is available over-the-counter. Here we report on a case of an 83-year-old woman who received injection of seven vials of "Zoletil 50" by her daughter and presented with an altered mental change. Her mental state was stupor and vital sign was hypotension, bradycardia. Her blood tests indicated metabolic and respiratory acidosis and hyperkalemia. She was treated with intravenous naloxone and flumazenil but was not responsive. She was admitted to the ICU and treated with supportive therapy. Her mental state showed transient recovery, however, her clinical manifestation worsened and she expired.
A Case of Delayed Administration of Naloxone for Morphine Intoxicated Patient
Gun-Bea Kim, Won-Nyung Park, Hong-Du Gu
J Korean Soc Clin Toxicol. 2012;10(1):33-36.   Published online June 30, 2012
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AbstractAbstract PDF
Opioids are the one of the most commonly used drugs to control cancer pain all over the world. But, we should not overlook the potential risk of opioid intoxication because they have well-known detrimental side effects. The opioid intoxication can be diagnosed thorough various clinical manifestations. The altered mental status, respiratory depression, and miosis is very representative clinical features although these symptoms don't always appear together. Unfortunately the opioid-toxidrome can be varied. A 42 years old man came to our emergency room after taking about 900 mg morphine sulfate per oral. He was nearly alert and his respiration was normal. Even though his symptoms didn't deteriorated clinically, serial arterial blood gas analysis showed increase in PaCO2. So we decided to use intravenous naloxone. Soon, he was fully awaked and his pupils size was increased. After a continuous infusion of intravenous naloxone for 2 hours, PaCO2 decreased to normal range and his pupil size also returned to normal after 12 hours. Though the levels of serum amylase and lipase increased slightly, his pancreas was normal according to the abdominal computed tomography. He had nausea, vomit, and whole body itching after naloxone continuous infusion, but conservatively treated. We stopped the continuos infusion after 1 day because his laboratory results and physical examinations showed normal. As this case shows, it is very important to prescribe naloxone initially. If you suspect opioid intoxication, we recommend the initial use of naloxone even though a patient has atypical clinical features. In addition, we suggest intranasal administration of naloxone as safe and effective alternative and it's necessary to consider nalmefene that has a longer duration for opioid intoxication.
Survey of the Antidote Stocking in the Emergency Medical Centers in Korea
Je-Sung You, Eui-Chung Kim, Hahn-Shick Lee, Seung-Ho Kim, Sung-Pil Chung
J Korean Soc Clin Toxicol. 2007;5(2):106-111.   Published online December 31, 2007
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AbstractAbstract PDF
Purpose: Inadequate hospital stocking and unavailability of essential antidotes is a worldwide problem. The purpose of this study was to determine the adequacy of antidote stocks in Korean hospitals based on a modified version of US antidote stocking guidelines. Methods: Both written and telephone surveys to collect information on hospital demographics and antidote stocking were given to the emergency departments or hospital pharmacies of 117 hospitals with emergency medical centers. The twenty antidotes included in the survey were taken from year 2000 US antidote stocking guidelines, except for activated charcoal and black widow spider antivenin. Antidote stocks were compared by hospital size, geographic location, and type of emergency medical center. Results: Complete responses were received from all hospitals. A mean of $12.4{pm}2.9$ antidotes were adequately stocked per hospital. All hospitals stocked atropine, $CaCl_2$ naloxone, and sodium bicarbonate. However, digoxin Fab fragment (16%), cyanide kits (15%), EDTA (10%), BAL (9%), and fomepizole (1%) were not uniformly stocked. Large and teaching hospitals were significantly more likely to stock greater numbers of antidotes. Conclusions: Korean hospitals as a group do not have adequate antidote stocks. Korean stocking guidelines and an antidote management system are recommended in order to correct these deficiencies.
Research on Poisoning Data Collection using Toxic Exposure Surveillance System: Retrospective Preliminary Survey
Bum-Jin Oh, Won Kim, Gyu-Chong Cho, Hui-Dong Kang, Yoo-Dong Shon, Jae-Ho Lee, Kyoung-Soo Lim
J Korean Soc Clin Toxicol. 2006;4(1):32-43.   Published online June 30, 2006
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AbstractAbstract PDF
Purpose: Toxic Exposure Surveillance System (TESS) is widely used for poisoning data collection and making a counterplan. But, there were few reports about poisoning data collection using TESS in Korea. The aim was to collect poisoning data using TESS report form and investigate the recognition of emergency physician about the necessity of TESS as preliminary survey. Methods: Retrospectively, we gathered data from hospital records about the patient who admitted hospital emergency room due to poisoning. Date were gathered by paper and/or web client system report form in patients recruited by ICD-10 codes Results: From Jun 2004 to May 2005,3,203 patients were enrolled in 30 hospitals and their mean age was $44.9{pm}20.3years$ old(male: female = 1,565: 1,638). The most frequent site of exposure was their own residence (73.2%, 2,345/3,203) and most of reported patients were older than 20 years(89.7%, 2,871/3,203). Frequent substances involved in poisoning were medication(41.9%) and pesticide(33.3%). Intentional poisoning was 60.7%(1,954). In fatality, overall frequency was 5.1%(162/3,203) and the most frequent route of exposure was ingestion(96.3%, 156/162) and the most frequent substance was pesticide(85.2%, 138/ 162). Antidotes were administered in 202 patients(2-PAM, atropine, antivenin, N-acetylcystein, vitamin K, flumazenil, ethanol, methylene blue, naloxone, calcium compound). 19 of 20 emergency physicians agreed with necessity of TESS. Conclusion: Data collection using TESS report form showed preliminary poisoning events in Korea. Frequent poisoning substance were medication and pesticide. The fatality was mainly related with pesticide ingestion. Many doctors in emergency room recognized the necessity of TESS.
A Case of Hemoperfusion and L-Carnitine Management in Valproic Acid Overdose
Jin Hee Jung, Gi Beom Kim, Ki Ok Ahn, Eun Kyung Eo
J Korean Soc Clin Toxicol. 2005;3(2):126-129.   Published online December 31, 2005
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AbstractAbstract PDF
Valproic acid (VPA) is used in the management of a variety of conditions including simple and complex absence seizure disorder. bipolar disorder, and migraine prophylaxis. Clinical manifestation of VPA overdose vary in severity from mild confusion and lethargy to severe coma and death. The treatment of VPA toxicity is mainly supportive. There is no specific antidote, nor are there specific guidelines for the management of VPA intoxication. Anecdotal reports describe the efficacy of naloxone and L-carnitine, but the data are insufficient to make strong conclusions. Various techniques of extracoporeal therapy for the management of VPA toxicity have been described, but none has prevailed as standard therapy. We report a patient with VPA overdose who was successfully treated with hemoperfusion with activated charcoal and L-carnitine. VPA levels of the patient was more than 1,000 ${mu}g$/ml and was normalized after 3 times hemoperfusion. The patient was injected with L-carnitine by maximum 600 mg/kg/day for 5days without complications.

JKSCT : Journal of The Korean Society of Clinical Toxicology