Journal of The Korean Society of Clinical Toxicology

Hoon Kim

8 Articles

A Preliminary Study for Effect of High Flow Oxygen through Nasal Cannula Therapy in Carbon Monoxide Poisoning: Young-Min Kim, Sang-Chul Kim, Kwan-Jin Park, Seok-Woo Lee, Ji-Han Lee, Hoon Kim; J Korean Soc Clin Toxicol. 2019;17(2):102-107. Published online December 31, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.2.102

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Abstract PDF: Purpose: Acute carbon monoxide (CO) poisoning is one of the most common types of poisoning and a major health problem worldwide. Treatment options are limited to normobaric oxygen therapy, administered using a non-rebreather face mask or hyperbaric oxygen. Compared to conventional oxygen therapy, high-flow nasal cannula oxygen (HFNC) creates a positive pressure effect through high-flow rates. The purpose of this human pilot study is to determine the effects of HFNC on the rate of CO clearance from the blood, in patients with mild to moderate CO poisoning. Methods: CO-poisoned patients were administered 100% oxygen from HFNC (flow of 60 L/min). The fraction of COHb (fCOHb) was measured at 30-min intervals until it decreased to under 10%, and the half-life time of fCOHb (fCOHb t1/2) was subsequently determined. Results: At the time of ED arrival, a total of 10 patients had fCOHb levels ≥10%, with 4 patients ranging between 10% and 50%. The mean rate of fCOHb elimination patterns exhibits logarithmic growth curves that initially increase quickly with time (HFNC equation, Y=0.3388*X+11.67). The mean fCOHbt1/2 in the HFNC group was determined to be 48.5±12.4 minutes. Conclusion: In patients with mild to moderate CO poisoning, oxygen delivered via high flow nasal cannula is a safe and comfortable method to treat acute CO toxicity, and is effective in reducing the COHb half-life. Our results indicate HFNC to be a promising alternative method of delivering oxygen for CO toxicity. Validating the effectiveness of this method will require larger studies with clinical outcomes.

Characteristics of Korean Poisoning Patients: Retrospective Analysis by National Emergency Department Information System: Woongki Kim, Kyung Hwan Kim, Dong Wun Shin, Junseok Park, Hoon Kim, Woochan Jeon, Joon Min Park, Jung Eon Kim, Hyunjong Kim; J Korean Soc Clin Toxicol. 2019;17(2):108-117. Published online December 31, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.2.108

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Purpose: The study examined the poisoned patients' characteristics nationwide in Korea by using data from the National Emergency Department Information System (NEDIS). Methods: Among the patients' information sent to NEDIS from January 1, 2013 to December 31, 2015, the included subjects' main diagnosis in ED showed poisoning according to the 7th edition of the Korean Standard Disease Classification (KCD-7). We analyzed the patients' gender, age, initial vital signs, visit time, stay time of staying in ED, results of ED care, main diagnosis in ED, length of hospitalization, and results of hospitalization. Results: A total of 106,779 ED visits were included in the analysis. There were 55,878 males (52.3%), which was more than the number of females. The number of intentional poisoning was 49,805 (59.6%). 75,499 cases (70.8%) were discharged, and 25,858 cases (24.2%) were hospitalized. The numbers of poisoning patients per 1,000 ED visits were 14 in Chungnam and 11.9 in Jeonbuk. The most common cause of poisoning, according to the main diagnosis, was venomous animals. It was the same for hospitalized patients, and pesticide was next. Pesticide was the most common cause of mortality in ED (228 cases, 46.1%) and after hospitalization (584 cases, 54.9%). The incidence of poisoning by age group was frequent for patients in their 30s to 50s, and mortality in ED and post-hospitalization were frequent for patients in their 60s to 80s. Conclusion: This study investigated the characteristics of poisoning patients reported in the past 3 years. Pesticide poisoning had a high mortality rate for patients in ED and in-hospital. For mortality, there was a high proportion of elderly people over 60. Thus, policy and medical measures are needed to reduce this problem. Since it is difficult to identify the poison substance in detail due to nature of this study, it is necessary to build a database and monitoring system for monitoring the causative substance and enacting countermeasures.

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응급실 기반 중독 심층 실태조사 1차년도 결과 보고
성우 이, 수진 김, 규종 조, 미진 이, 병학 소, 경수 김, 주현 송
Public Health Weekly Report.2024; 17(14): 535. CrossRef
Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts
Kyung-Eun Kim, Sun-Hee Moon, Chieun Song, Minjeong An
Journal of Korean Critical Care Nursing.2024; 17(2): 1. CrossRef
The 2022 Annual Report on Toxicology Surveillance and Severe Poisoning Cases at Emergency Departments in Korea
Eun Sun Lee, Su Jin Kim, Gyu Chong Cho, Mi Jin Lee, Byung Hak So, Kyung Su Kim, Juhyun Song, Sung Woo Lee
Journal of The Korean Society of Clinical Toxicology.2023; 21(1): 1. CrossRef
Demographic characteristics of patients admitted to the emergency department for intoxication and a time series analysis during the COVID-19 period
Bongmin Son, Nayoon Kang, Eunah Han, Gina Yu, Junho Cho, Jaiwoog Ko, Taeyoung Kong, Sung Phil Chung, Minhong Choa
Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 92. CrossRef
Prioritising Risk Factors for Prescription Drug Overdose among Older Adults in South Korea: A Multi-Method Study
Eun-Hae Lee, Ju-Ok Park, Joon-Pil Cho, Choung-Ah Lee
International Journal of Environmental Research and Public Health.2021; 18(11): 5948. CrossRef
Changes in Diagnosis of Poisoning in Patients in the Emergency Room Using Systematic Toxicological Analysis with the National Forensic Service
Je Seop Lee, Yong Sung Cha, Seonghoon Yeon, Tae Youn Kim, Yoonsuk Lee, Jin-Geul Choi, Kyoung-Chul Cha, Kang Hyun Lee, Hyun Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef

Pharmaceutical Drug Poisoning after Deregulation of Over the Counter Drug Sales: Emergency Department Based In-depth Injury Surveillance: Sung Ho Kim, Hyunjong Kim, Ji Sook Lee, Junseok Park, Kyung Hwan Kim, Dong Wun Shin, Hoon Kim, Joon Min Park, Woochan Jeon; J Korean Soc Clin Toxicol. 2018;16(2):141-148. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.141

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Abstract PDF: Purpose: The Korean government approved selected nonprescription drugs (Over-The-Counter drug; OTC drug) to be distributed in convenience stores from 15. Nov. 2012. This study examined the changes in the incidence and the clinical outcome of acute pharmaceutical drug poisoning after the deregulation of OTC drug sales. Methods: This study analyzed the data of Emergency Department based Injury In-depth Injury Surveillance (EDIIS), Korea Centers for Disease Control and Prevention, from 2011 to 2014. The following items were examined: age, gender, intention, alcohol association, pharmaceutical drugs resulting acute poisoning, the clinical outcomes in emergency department, and the admission rate of intensive care unit (ICU). This is a retrospective cross section observational study. Results: A total of 10,162 patients were subject to pharmaceutical drug poisoning. Acute poisoning by acetaminophen and other drugs were 1,015 (10.0%) and 9,147 (90.0%) patients, respectively. After the deregulation of OTC drug sales, acute poisoning by other drugs increased from 4,385 to 4,762 patients but acute poisoning by acetaminophen decreased from 538 to 477 patients (p<0.05). The rate of admission of acetaminophen poisoning increased from 36.1% (194/538) to 46.8% (223/477). The admission rate to the ICU by acetaminophen poisoning increased from 4.6% (25/538) to 11.3% (54/477) after the deregulation of OTC drug sales (p<0.05). Conclusion: Since the deregulation of OTC drugs sales, pharmaceutical drug poisoning has increased but acetaminophen poisoning has decreased. The rate of hospitalization and ICU admission by pharmaceutical drug poisoning with or without acetaminophen has also increased.

Trends in Korean Pediatric Poisoning Patients: Retrospective Analysis of National Emergency Department Information System: Kyeongjae Lee, Kyung Hwan Kim, Dong Wun Shin, Junseok Park, Hoon Kim, Woochan Jeon, Joon Min Park, Hyunjong Kim; J Korean Soc Clin Toxicol. 2017;15(2):69-78. Published online December 31, 2017; DOI: https://doi.org/10.22537/jksct.2017.15.2.69

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Abstract PDF: Purpose: This study reports the clinical features of infant, child, school aged and adolescent patients treated for acute poisoning in nationwide emergency departments (EDs). Methods: We retrospectively analyzed clinical data pertaining to patients under 19 years of age who were treated for acute poisoning in nationwide EDs from 2013 to 2015. The data were collected by the National Emergency Department Information System (NEDIS). All patients were divided into three groups: 'Infant and child group' (0 to 5 years), 'school age group' (6 to 12 years) and 'adolescent group' (13 to 18 years). General characteristics, Korea Standard Classification of Disease $7^{th}$ (KCD-7) codes and results of care were collected. Results: There were 14,500 pediatric poisoning cases during the study period. The distribution of patient age was bimodal with two peaks among infant, child and adolescent group. The proportion of alert mentality at the ED visit of the infant and child group was 99.3%, while that of the adolescent group was 86.4%. The proportion of intentional intoxication was higher in the adolescent group (40.7%) than other age groups. Among children less than 13 years of age, various poisonous substances and therapeutic drugs were common. Conclusion: There were some clinical differences in acute poisoning patients between age groups. It is necessary to establish a preventive plan considering characteristics by age. Since the KCD-7 code has limitations in analyzing the characteristics of poisoning patients, it is necessary to consider the registration system of poisoning patients.

Epidemiologic Characteristics of Carbon Monoxide Poisoning: Emergency Department Based Injury In-depth Surveillance of Twenty Hospitals: Sohyun Bae, Jisook Lee, Kyunghwan Kim, Junseok Park, Dongwun Shin, Hyunjong Kim, Joonmin Park, Hoon Kim, Woochan Jeon; J Korean Soc Clin Toxicol. 2016;14(2):122-128. Published online December 31, 2016; DOI: https://doi.org/10.22537/jksct.2016.14.2.122

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Purpose: This study was conducted to describe the characteristics of patients with carbon monoxide (CO) poisoning. Methods: We retrospectively surveyed data from the Emergency Department based Injury In-depth Surveillance of 20 hospitals (2011-2014). We included patients whose mechanism of injury was acute CO poisoning caused by inhalation of gases from charcoal or briquettes. We surveyed the annual frequency, gender, age, result of emergency treatment, rate of intensive care unit (ICU) admission, result of admission, association with alcohol, and place of accident. We also surveyed the cause and experience of past suicide attempts by intentional poisoning. Results: A total of 3,405 patients were included (2,015 (59.2%) and 1,390 (40.8%) males and females, respectively) with a mean age of $39.83{pm}18.51$ year old. The results revealed that the annual frequency of CO poisoning had increased and the frequency of unintentional CO poisoning was higher than that of intentional CO poisoning in January, February and December. The mean age of intentional CO poisoning was younger than that of unintentional CO poisoning ($38.41{pm}13.03$ vs $40.95{pm}21.83$) (p<0.001). The rates of discharge against medical advice (DAMA), ICU care and alcohol association for intentional CO poisoning were higher than for unintentional CO poisoning (36.4% vs 14.0%, 17.8% vs 4.7%, 45.2% vs 5.6%) (p<0.001). The most common place of CO poisoning was in one's residence. Conclusion: The annual frequency of total CO poisoning has increased, and unintentional CO poisoning showed seasonal variation. DAMA, ICU care, and alcohol association of intentional CO poisoning were higher than those of unintentional CO poisoning.

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Prevalence of Carbon Monoxide Poisoning and Hyperbaric Oxygen Therapy in Korea: Analysis of National Claims Data in 2010–2019
Eunah Han, Gina Yu, Hye Sun Lee, Goeun Park, Sung Phil Chung
Journal of Korean Medical Science.2023;[Epub] CrossRef

A Case of Chemical Burn Caused by Trifluoroacetic Anhydride that Mimicked a Hydrofluoric Acid Burn: Jung-Soo Park, Hoon Kim, Suk-Woo Lee; J Korean Soc Clin Toxicol. 2010;8(1):43-45. Published online June 30, 2010

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Abstract PDF: A 22-year-old woman was referred to our emergency department for the treatment of a chemical injury on her arm. She had accidentally spilled 99% trifluoroacetic anhydride (TFAA) over her left forearm during an organic chemistry experiment. She visited a primary care unit, and then she was referred to our hospital for inactivation of the released fluoride ions. Her skin lesions were different from those caused by hydrofluoric acid (HF) injury. The injured area showed painful whitish maculae and patchy areas with accentuated rim. No vesiculation and bulla formation was detected. We intradermally injected a 5% solution of calcium through a 24-gauge needle into the burned skin. After the injection, she complained of more severe pain. Although TFAA contains fluorine, it does not release free fluoride ions on contact with the skin, unlike HF. In fact, application of calcium gluconate for TFAA burns is not recommended. Rather, it should be avoided since it increases pain and local abscess formation.

A Case of Seizure in Diphenhydramine Overdose: Jung-Soo Park, Hoon Kim, Suk-Woo Lee; J Korean Soc Clin Toxicol. 2009;7(1):23-25. Published online June 30, 2009

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Abstract PDF: A 21-year-old woman ingested 1,250 mg of diphenhydramine in a single overdose. Diphenhydramine, a rare ingredient in over-the-counter medication, is used to treat insomnia in Korea. Toxicity is usually limited to anticholinergic symptoms. The standard approach to therapy for the treatment of diphenhydramine overdose is supportive care, including physostigmines and sodium bicarbonates. Here, we review the literature and for the first time report a case of acute diphenhydramine overdosage in Korea, complicated with seizures.

Clinical Implication of Acetylcholinesterase in Acute Organophosphate Poisoning: 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; J Korean Soc Clin Toxicol. 2008;6(1):25-31. Published online June 30, 2008

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Abstract PDF: 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.

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