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- A Case of Green Tobacco Sickness (GTS) in Elderly Patient
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Dong Kil Jeong, Doh-Eui Kim
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J Korean Soc Clin Toxicol. 2019;17(2):132-134. Published online December 31, 2019
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DOI: https://doi.org/10.22537/jksct.2019.17.2.132
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Abstract
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- Green tobacco sickness is an illness caused by dermal exposure to nicotine. The common symptoms of the disease include dizziness, headache, nausea, vomiting, severe general weakness, fluctuations of blood pressure or heartbeat, abdominal cramping, chills, increased sweating, salivation, and difficulty breathing. A 79-year-old female arrived at the emergency room for an evaluation of sudden onset dizziness. Magnetic resonance imaging and angiography of the brain did not show any relevant abnormal findings. Four days later, with supportive care, she said that she had harvested green tobacco for six hours on the day of admission and the tobacco harvest was the first time in her life. She sweated excessively during the hot and humid weather and the tobacco leaves were wet from rain the night before. The serum cotinine tested at five days of admission was 16ng/ml. She was diagnosed with acute nicotine poisoning by her clinical symptoms and the half-life of cotinine in the blood.
- Two Cases of Tetramine Intoxication from Neptunea contricta
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Seong You Lee, Jang Young Lee, Won Suk Lee, Won Young Sung, Sang Won Seo
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J Korean Soc Clin Toxicol. 2017;15(1):65-67. Published online June 30, 2017
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DOI: https://doi.org/10.22537/jksct.2017.15.1.65
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- Even though Neptunea contricta appears similar to Batilus cornutus and Rapana venosa, they are different in tetramine content which inhibits the neuronal calcium channel. Therefore, mistaking Neptunea contricta for Batilus cornutus or Rapana venosa, can result in the occurrence of toxic symptoms. Three patients developed nausea, epigastric pain, chest pain, dizziness, blurred vision, dyspnea, hypertension and tachycardia after eating Neptunea contricta. Moreover, consumption of one only piece was sufficient to cause symptoms because each Neptunea contricta has 17.3 mg of tetramine. Accordingly, care should be taken when patients are consuming more than 5 pieces because toxic symptoms such as dyspnea can occur. Moreover, correct species identification is important because the quantity of tetramine varies among sea snail species. Finally, it is important to educate people to remove the salivary glands completely before consuming Neptunea contricta.
- Two Cases of Neurotoxin Tetramine Poisoning Following Ingestion of Buccinum Striatissinum
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So Eun Kim, Jae Baek Lee, Young Ho Jin, Jae Chol Yoon, Si On Jo, Jeong Moon Lee, Tae Oh Jeong
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J Korean Soc Clin Toxicol. 2016;14(1):66-69. Published online June 30, 2016
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- Some carnivorous gastropods have heat stable tetramine toxins in their salivary glands. This toxin is an autonomic ganglionic blocking agent that enables them to catch the prey easily by paralyzing their targets. Acute tetramine toxin poisoning in humans from eating whelks has been well described based on numerous cases, but is rare in Korea. Symptoms of tetramine poisoning include eyeball pain, blurred vision, headache, dizziness, muscular twitching, tingling of hands and feet, weakness, paralysis and sometimes collapse. Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting can also occur. However, intoxication is self-limiting and patients will usually recover in about 24 hours. Herein, we report 2 cases of tetramine poisoning after ingestion of Buccinum striatissinum as meat and soup.
- Two Cases of Phytolacca Americana Intoxication with Confusion and Abdominal Cramping
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Yang-Weon Kim, Yoo-Sang Yoon, Mi-Ran Kim, Sang-Hoon Park, Jun-Cheol Choi
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J Korean Soc Clin Toxicol. 2008;6(2):146-148. Published online December 31, 2008
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- Phytolacca americana poisoning is a benign plant intoxication that causes gastrointestinal symptoms, including abdominal cramps, vomiting, diarrhea, and gastrointestinal bleeding. Other signs and symptoms include diaphoresis, salivation, visual disturbance, and seizures or mental changes. We report two cases of patients who experienced confusion and abdominal pain, vomiting, and hematemesis after oral ingestion of pokeweed. A 60-year-old female with confusion and a 67-year-old female with abdominal pain, vomiting, and diarrhea were admitted to the emergency department after pokeweed poisoning. After supportive treatment of hydration and gastrointestinal medication, the two patients showed full recovery within 24 h and were discharged from the hospital.
- Clinical Implication of Acetylcholinesterase in Acute Organophosphate Poisoning
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Hoon Kim, Seung-Baik Han, Jun-Sig Kim, Mi-Jin Lee, Joon-Seok Park, Woon-Yong Kwon, Eun-Kyung Eo, Bum-Jin Oh, Sung-Woo Lee, Joo-Hyun Suh, Hyung-Keun Roh
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J Korean Soc Clin Toxicol. 2008;6(1):25-31. Published online June 30, 2008
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- Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.
- A Familial Case of Tetramine Intoxication from Neptunea
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Chang-Won Lee, Jung-Keun Kwak, Kyung-Choon Park, Ji-Yeong Ryu, Ji-Young You, Gyu-Chong Cho
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J Korean Soc Clin Toxicol. 2007;5(1):50-52. Published online June 30, 2007
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- Certain parts of shellfish contain poisonous substances and cause intoxication. Tetramine toxin is found in the salivary gland of Neptunea. Three family members were admitted to the hospital with chief complaints of dizziness and blurred vision, gait disturbance, and spasms of the lower extremities after ingesting Neptunea. Physical examination revealed sluggish pupil light reflexes, but laboratory studies were normal. Symptoms were completely resolved within 24 hours after injection of atropine. We report a case of three patients with dizziness and blurred vision, gait disturbance, and spasms of the lower extremities due to Neptunea tetramine toxin.
- A Case Report of Saliva-type Hyperamylasemia in Mad Honey Poisoning
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Kun-Woo Lee, Kyu-Nam Park, Mi-Jin Lee
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J Korean Soc Clin Toxicol. 2006;4(2):166-169. Published online December 31, 2006
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- Poisonings caused by 'mad honey' are known to occur in response to grayanotoxins, which bind to sodium channels in the cell membrane, increasing membrane sodium permeability and preventing inactivation. Mild symptoms of mad honey intoxication are dizziness, weakness, hypersalivation, nausea, vomiting, and paresthesia. Severe intoxication, however, leads to serious cardiac manifestations such as atrioventricular block, dose-dependent hypotension, bradycardia, and respiratory depression. Atropine and vasoactive drugs improve symptoms of both bradycardia and respiratory rate depression. We report an unusual case of saliva-type hyperamylasemia in a mad honey poisoning patient who developed clinically significant bradycardia. She recovered fully within 3 days following atropine administration and medical treatment.
- Two Cases of Mad-Honey Poisoning with Cardiovascular Symptom
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Young-Gil Ko, Kyung-Hwan Kim, Ah-Jin Kim, Dong-Wun Shin, Jun-Soek Park, Jun-Young Roh, Ji-Young Ahn
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J Korean Soc Clin Toxicol. 2006;4(1):78-81. Published online June 30, 2006
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- Mad-honey poisoning is mainly brought about by the honey imported from Napal, Turkey, Brazil and other parts of Europe. This mad honey is extracted from Ericaceae plants of Rhododendron species and contains grayanotoxins that causes poisoning. These toxic compounds exert a specific stimulatory action on membrane permeability to Na+ions in various excitable tissues and cause depolarization of cell membranes. The toxic effects of grayanotoxins contained honey are mainly cardiovascular disturbances with bradycardia, cardiac arrhythmia, hypotension. There are Other symptoms like nausea, vomiting, salivation, dizziness, weakness and loss of consciousness. The precise amount for a toxic dose is not known. In general the severity of the honey poisoning depends on the amount ingested. Two cases of mad-honey poisoning are described here. Both patients showed bradycardia and arterial hypotension after ingestion of honey which was brought from Nepal. They were recovered fully within 24 hours after administration of fluids and atropine sulphate.
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