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JKSCT : Journal of The Korean Society of Clinical Toxicology

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6 "Neurotoxicity"
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Rhabdomyolysis induced by venomous snake bite
Lee Jungho, Moon Jeongmi, Chun Byeongjo
J Korean Soc Clin Toxicol. 2022;20(2):51-57.   Published online December 31, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.2.51
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AbstractAbstract PDF
Purpose: Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. Methods: This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. Results: The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. Conclusion: RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.
A Case of Cobra Antivenom Therapy in a Patient Bitten by Elapid Snake in South Korea
Ji Eun Kim, In Ho Kwon
J Korean Soc Clin Toxicol. 2022;20(1):22-24.   Published online June 30, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.1.22
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AbstractAbstract PDF
Elapid snakes have neurotoxic venom which causes diverse neuroparalytic manifestations, including fatal respiratory failure. In South Korea, since elapid snakebites are very rare, the cobra antivenom, which is effective against neurotoxicity, was only introduced recently. Most physicians in South Korea have little experience in the treatment of patients who have been bitten by elapid snakes. A 19-year-old man was brought to the emergency department with sudden diplopia, 1 hour after a snakebite on the left 2nd finger. The patient presented with drowsiness and complained of mild dizziness and binocular diplopia. After 1 hour, he had sudden onset of dyspnea and dysphagia and appeared to be agitated. He was immediately intubated and received mechanical ventilation as he was unable to breathe on his own. A total of 2.5 mg of neostigmine diluted with normal saline was slowly infused, and 1 vial of cobra antivenom was infused for an hour, 5 times every 2 hours, for a total of 5 vials. He slowly recovered self-breathing; on the 3rd day of hospitalization, he showed tolerable breathing and was extubated. He was discharged without any neurological deficits or other complications.
Two Cases of Comatose Patients Presenting after Exposure to Hydrogen Sulfide Gas
Hyun-Ho Ryu, Byeong-Guk Lee, Kyung-Woon Jeung, Tag Heo, Yong-Il Min
J Korean Soc Clin Toxicol. 2009;7(1):26-31.   Published online June 30, 2009
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AbstractAbstract PDF
Hydrogen sulfide is a by-product of decayed organic material and is ubiquitously found as an ingredient of manufacturing reagents or as an undesirable by-product of the manufacturing or industrial processing. Hydrogen sulfide is a chemical asphyxiant and interferes with cytochrome oxidase and aerobic metabolism. It has thus been deemed an important cause of work-related sudden death. This gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. Here, we report two cases of comatose patients presenting after accidental exposure to hydrogen sulfide gas.
A Case of Acute Glufosinate Ammonium ($BASTA^{(R)}$) Intoxication Associated with Various Neurological Abnormalities
Jin Hui Paik, Jun Sig Kim, Hyeon Gyu Yi, Hyun Joo Park, Choong-Kun Ha, Hyung-Keun Roh
J Korean Soc Clin Toxicol. 2005;3(2):103-106.   Published online December 31, 2005
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AbstractAbstract PDF
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.
A Case of Hair Neutralizer Induced Non-oliguric Acute Renal Failure
Ah Jin Kim, Kyung Hwan Kim, Jun Seok Park, Dong Wun Shin
J Korean Soc Clin Toxicol. 2005;3(2):119-121.   Published online December 31, 2005
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AbstractAbstract PDF
Sodium bromate or potassium bromate has been used as hair cold neutralizer. Sodium bromate intoxications occurred in children incidentally early days of marketing, but recently in adult suicidally. This chemical intoxication result in renal failure, ototoxicity, neurotoxicity, hemolytic anemia and so on. We experienced a 39-year-old woman of hairdresser with non-oliguric acute renal failure after ingestion hair neutralizer 500 ml. She received hemodialysis 3 times and discharged without complication on 8th admission days.
Neurobiological Effects of Methamphetamine Abuse on Neurotransmitters: A Review
Tae Kyung Lee, E. Grant Jon, Suck Won Kim, Dong Yul Oh
J Korean Soc Clin Toxicol. 2003;1(1):21-26.   Published online June 30, 2003
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AbstractAbstract PDF
Methamphetamine (MA) is a major drug of abuse in Korea. Currently preliminary evidence suggests that MA dependence may cause long-term neural damage in human. Repeated exposure to psychostimulants such as methamphetamine results in behavioral sensitization, a paradigm thought to be relevant to drug craving and addiction in human. Sensitization alters neural circuitry involved in normal processes of incentrive, motivation, and reward. However the precise mechanism of this behavioral sensitization has not yet been fully elucidated. Repeated use of high dose MA causes neurotoxicity which is characterized by a long-lasting depletion of striatal dopamine (DA) and tyrosin hydroxylase activity of DA, DA-transporter binding sites in the striatum. The loss of DA transporters correlates with memory problems and lack of motor coordination. DA fuels motivation and pleasure, but it' s also crucial for learning and movement. This selective review provides a summary of studies that assess the neurobiological mechanisms of MA.

JKSCT : Journal of The Korean Society of Clinical Toxicology