Journal of The Korean Society of Clinical Toxicology

Comparison of Poisoning Severity Score (PSS) according to alcohol co-ingestion in intentional poisoning patients: Min jae Jun, Tae kyu Ahn, Soo Kang; J Korean Soc Clin Toxicol. 2021;19(1):17-23. Published online June 30, 2021; DOI: https://doi.org/10.22537/jksct.2021.19.1.17

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Abstract PDF: Purpose: Alcohol ingestion enhances impulsivity and aggression, and has been proven to have a close relationship with suicide. This study investigates whether alcohol co-ingestion affects the Poisoning Severity Score (PSS) grade in patients with intentional poisoning. Methods: We conducted a retrospective analysis of intentional poisoning patients who visited the emergency department (ED) from January 1 to December 31, 2020. Patients were divided into non-drunken and drunken groups. We collected the data based on the medical records of the patients and serum ethanol level results recorded during initial blood tests at the ED. To grade the PSS, the highest score was assessed through clinical signs and test results during the hospital stay. A comparative analysis was conducted between the two groups. Results: A total of 277 patients were included in the study. 163 (58.8%) were in the non-drunken group, and 114 (41.2%) were in the drunken group. The PSS grade showed a significant difference between the two groups (p=0.002). While grade 1 (mild) was observed more in the non-drunken group, grade 2 (moderate) and grade 3 (severe) were seen more in the drunken group. In an ordinal logistic regression analysis, alcohol co-ingestion (adjusted odds ratio [aOR] 2.557, 95% confidence interval [CI] 1.554-4.208, p<0.001) was considered to be a risk factor for a higher PSS grade. There was no significant correlation between the serum ethanol level and the PSS grade. (p=0.568) Conclusion: Intentional poisoning patients with alcohol co-ingestion had a higher PSS. Hence close observation and aggressive treatment in the ED is warranted in such cases.

Clinical and Epidemiological Characteristics of Severe Poisoning Patients and Analysis of Prognostic Factors: Young Yun Jung, Chul Min Ha, Sung Tae Jung, Hyoung Ju Lee; J Korean Soc Clin Toxicol. 2020;18(2):94-101. Published online December 31, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.2.94

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Abstract PDF: 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.

Clinical Characteristics and Risk Factors of Acute Kidney Injury in Patients with Glyphosate Poisoning: Hyung Hun Park, Kyu Ill Choi, Je Won Lee, Jung Min Park, Jinwook Park, Sang Moon Noh, Jaekyung Cho, Daero Lee, Jae Chul Cho, Dong Chan Park, Yang Hun Kim, Joo Hwan Lee; J Korean Soc Clin Toxicol. 2020;18(2):110-115. Published online December 31, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.2.110

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Abstract PDF: Purpose: Acute kidney injury (AKI) in patients with glyphosate poisoning has a poor prognosis. This study aimed to predict the risk factors for AKI in patients with glyphosate poisoning at the emergency department (ED). Methods: Clinical data on glyphosate poisoning patients at ED who were older than 18 years were collected retrospectively between January 2013 and December 2019. The clinical characteristics and clinical outcomes of the AKI group in patients with glyphosate poisoning were compared with the non-AKI (NAKI) group. Results: Of 63 glyphosate poisoning patients, AKI was observed in 15 (23.8%). The AKI patients group showed the following: old age (p=0.038), low systolic blood pressure (p=0.021), large amount of ingestion (p=0.026), delayed hospital visits (p=0.009), high white blood cells (WBC) (p<0.001), high neutrophil counts (p<0.001), high neutrophil-lymphocyte (LN) ratios (p<0.001), high serum potassium (p=0.005), low arterial blood pH (p=0.015), and low pO2 (p=0.021), low bicarbonate (p=0.009), and high Poisoning Severity Score (PSS) (p<0.001). AKI patients required hemodialysis, ventilator care (p<0.001, p=0.002), and inotropics (p<0.001). They also showed more intensive care unit admission (p<0.001), longer hospitalization (p<0.001), and high mortality (p<0.001). Logistic multivariate regression analysis showed that high WBCs (OR, 1.223) and increased LN ratios (OR, 1.414) were independently associated with the occurrence of AKI. Conclusion: In patients with glyphosate poisoning at ED, high WBCs and increased LN ratios can help predict the occurrence of AKI.

Classify the Acute Drug Intoxication Patients with Poisoning Severity Score(PSS) and Calculate the Optimal Cutoff Value of PSS, PSSsum to Predict Poor Prognosis: Hyun Woo Park, Ha Young Park, Han Byeol Kim, Keon Woo Park, Sang Hun Lee, Hyun Wook Lee, Je Won Lee, Tae Sik Hwang; J Korean Soc Clin Toxicol. 2018;16(2):75-85. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.75

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Abstract PDF: Purpose: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). Methods: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. Results: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was $4.4{pm}6.7;hours$. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. Conclusion: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS>2 and PSSsum>5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.

Clinical Features of Acute Acetanilide Herbicide Poisoning: Cheol-Sang Park, Mi-Jin Lee, Seong-Soo Park, Won-Joon Jeong, Hyun-Jin Kim; J Korean Soc Clin Toxicol. 2011;9(2):49-55. Published online December 31, 2011

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Abstract PDF: Purpose: Acetanilide has been in widespread use as an amide herbicide compound. However, available data regarding acute human poisoning is scarce. The aim of this study was to analyze the clinical characteristics of acetanilide poisoning in order to identify the risk factors associated with severity. Methods: We conducted a retrospective observational study encompassing the period January 2005 to December 2010, including adult ED patients suffering from acetanilide intoxication. Toxicological history, symptoms observed, clinical signs of toxicity, and laboratory test results were collected for each patient. The patients were classified into two groups for analysis, according their poisoning severity score (PSS). Resulting clinical data and prognostic variables were compared between mild-to-moderate poisoning (PSS 1/2 grades), and severe poisonings and fatalities (PSS 3/4 grades). Results: There were a total of 37 patients, including 26 alachlor, 6 s-metolachlor, 4 mefenacet, and 1 butachlor cases. The majority of patients (81.1%) were assigned PSS 1/2 grades. Changes in mental status and observation of adverse neurologic symptoms were more common in the PSS 3/4 group. The median ingested volume of amide herbicide compound was 250 ml (IQR 200-300 ml) in the PSS 3/4 group, and 80 ml (IQR 50-138 ml) in the PSS 1/2 group. Also, the median GCS observed in the PSS 3/4 group was 13 (IQR 10-14), which was markedly low as compared to a median GCS of 15 in the PSS 1/2 group. Overall mortality rate was 5.4%, and profound cardiogenic shock was observed prior to death in all fatalities. Conclusion: When compared to previous reports, acute acetanilide poisoning resulted in relatively moderate severity. The presence of neurologic manifestations, hypotension, lower GCS score, and larger ingested volumes was associated with more serious effects and mortalities.

Clinical Characteristics of Patients with Neonicotinoid Insecticide Poisoning: Jin-Chul Kim, Byung-Hak So, Han-Joon Kim, Hyung-Min Kim, Jung-Ho Park, Se-Min Choi, Kyu-Nam Park, Kyoung-Ho Choi; J Korean Soc Clin Toxicol. 2010;8(1):24-29. Published online June 30, 2010

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Abstract PDF: Purpose: Neonicotinoid insecticides are widely used as they have been proven by experimental studies to have low toxicity to mammals, including humans. As the use of neonicotioids increases, the number of patients with neonicotinoid poisoning has also increased. We conducted a study to investigate the clinical manifestations of neonicotinid poisoning. Methods: We retrospectively analyzed the patients who ingested neonicotinids and who visited the emergency department located in Korea from March 2002 to February 2010. We reviewed the patients' age, gender, the amount of exposure, the elapsed time to presentation, the treatment and the outcome. According to the poisoning severity score, we divided the patients with a Poisoning severity score (PSS) of 0 or 1 into the mild/moderate toxicity group and the patients with a PSS of 2 or 3 into the severe/fatal toxicity group. Results: A total of 24 patients were analyzed. The most common clinical manifestations of neonicotinoid insecticide toxicity were gastrointestinal symptoms (66.7%) such as nausea, vomiting and abdominal pain and the others are respiratory symptoms (16.7%), cardiovascular symptoms (12.5%), metabolic imbalance (12.5%), renal dysfunction (8.3%), CNS symptoms (8.3%), and asymptomatic (29.2%). Twenty patients (83.3%) showed mild/moderate toxicity and 4 patients (16.7%) showed fatal conditions such as shock and mutiorgan failure. The mortality rate was 4.2%. In these fatal cases, the patients developed respiratory failure, hypotension, altered mentality and renal failure at the acute stage and they deteriorated to a more serious condition. This severe toxicity was caused by decreased renal excretion of neonicotinid metabolite, and this was improved after hemodialysis. Conclusion: Most patients with neonicotinoid poisoning and who showed mild toxicity usually improved after symptomatic treatment. However, some patients showed significant toxicity with respiratory failure and renal function deterioration, and intensive care needed, including mechanical ventilation and hemodialysis.

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