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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Volume 1(1); 2003
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Gut Decontamination in the Treatment of Ingested Poisons
Byoung-Geun Han, Seung-Ok Choi
J Korean Soc Clin Toxicol. 2003;1(1):1-5.   Published online June 30, 2003
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Dialysis Related Treatment to Increase Elimination of Toxic Agent
Heung-Soo Kim, Gyu-Tae Shin
J Korean Soc Clin Toxicol. 2003;1(1):6-11.   Published online June 30, 2003
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Various forms of dialytic techniques are available for detoxification. Hemodialysis, hemoperfusion and hemofiltration (hemodialfiltration) are the main treatment modalities. Because these modalities are rather invasive and expensive, it must be decided in balance of the risk and benefit to the patient. The prime consideration in the decision is based on the clinical features of poisoning; hemodialysis or hemoperfusion should be considered in general if the patient's condition progressively deteriorates despite intensive supportive therapy. The hemodialysis technique relies on passage of the toxic agent through a semipermeable membrane so that it can equilibrate with the dialysate and subsequently removed. It needs a blood pump to pass blood next to a dialysis membrane, which allows agents permeable to the membrane to pass through and reach equilibrium. Solute (or drug) removal by dialysis has numerous determinants such as solute size, its lipid solubility, the degree to which it is protein bound, its volume of distribution etc. The technique of hemoperfusion is similar to hemodialysis except there is no dialysis membrane or dialysate involved in the procedure. The patient's blood is pumped through a perfusion cartridge, where it is in direct contact with adsorptive material (usually activated charcoal) that has a coating material such as cellulose. This method can be used successfully with lipid-soluble compounds and with higher-molecular-weight compounds than for hemodialysis. Protein binding does not significantly interfere with removal by hemoperfusion. In conclusion, hemodialysis, hemoperfusion and hemofiltration can be used effectively as adjuncts to the management of severely intoxicated patients.
Chemical Asphyxiants - Cyanides and Hydrogen Sulfides
Yang Ho Kim, Young Hee Choi, Choong Ryeol Lee, Ji Ho Lee, Cheolln Yoo, Hun Lee
J Korean Soc Clin Toxicol. 2003;1(1):12-20.   Published online June 30, 2003
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Cyanides and hydrogen sulfide ($H_2S$) are major chemical asphyxiants. They have common mechanism of action which inhibit cellular respiration and induce histotoxic hypoxia. They do not generate ATP, and all processes dependent on ATP are stopped. No extraction of $O_2$ from blood decreases AV $O_2$ differences, and the shift to anaerobic glycolysis brings about lactic acidosis with high anion gap. The mainstay of the treatment is rapid treatment with appropriate use of antidotes. However, there are several differences between cyanides and $H_2S$. First, $H_2S$ is not metabolized by enzymes such as thiosulfate. Thus thiosulfate does not play any role in treatment of $H_2S$. Second, $H_2S$ is a more potent inhibitor of cytochrome aa3 than cyanide. Third, $H_2S$ induces more divergent neurologic sequele than cyanide. Finally, $H_2S$ is not absorbed via skin.
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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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.
Clinical Analysis of Rhabdomyolysis Complicated with Drug Intoxications
Mi Jin Lee, Hyung Min Kim, Young Min Kim, Won Jae Lee, Byung Hak So, Se Kyung Kim
J Korean Soc Clin Toxicol. 2003;1(1):27-33.   Published online June 30, 2003
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Purpose: According as the accessibility about drugs becomes various, the occurrence of drug intoxication is increasing. Since report that doxylamine causes rhabdomyolysis often, drug-induced rhabdomyolysis is one of the most important complications in patients with drug intoxication. Acute renal failure (ARF)'s availability is important to the management in rhabdomyolysis, but report about rhabdomyolysis or ARF occurrence for whole intoxicated drugs is lacking up to now. Methods: This research did to 61 patient who had rhabdomyolysis of drug intoxication. First, object patients were divided into two gruops: doxylamine-ingested (Group I) vs non-doxylamine ingested (Group II). And then we analyzed on the early patient's clinical events and laboratory data. We used ROC curve to recognize'the early clinical factors that could forecast ARF appearance among these patients in addition. Results: Almost rhabdomyolysis was happened by doxylamine in drug intoxication ($55.7\%$). However, as compared to group II, group I showed better clinical course, lesser ARF occurrence and hemodialysis requirement. In group II, time was longer in hospital reaching from intoxication, the ARF occurrence rate was higher ($52.6\%$). Analyzing the ROC curve to useful initial factors, they were creatinine, uric acid and interval time from ingestion to hospital. These cut-off values were 1.44 mg/dL, 6.8 mg/dL and 5 hrs. Sensitivity for ARF estimate was $100\%$, specificity $69-98\%$. Conclusion: Compared to group II, Doxylamine-ingested group showed good clinical course. Creatinine, uric acid, interval time from ingestion to hospital aided in ARF estimate in drug-induced rhabdomyolysis.
Postmortem Blood and Tissue Concentration of Carisoprodol and Meprobamate
Hye Young Choi, Hwa Kyung Choi, Ju Seon Lee, Sang Hee Woo, Han Sun Lee, Yoo Sin Park, Hee Sun Chung
J Korean Soc Clin Toxicol. 2003;1(1):34-39.   Published online June 30, 2003
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Carisoprodol (CSP) is commonly prescribed as a skeletal muscle relaxant. Recently, we encountered 7 suicidal cases in which carisoprodol was detected. We developed a rugged, sensitive, and specific method for the determination of CSP and meprobamate (MPB) by GC and GC/MS. Postmortem blood concentrations of CSP and MPB ranged 22.9-124.4 ,$mu$g/ml and its metabolite, 26.8-144.5 ,$mu$g/ml respectively. Among 7 cases studied, Only CSP was ingested in 4 cases and combination of CSP and dextromethorphan was ingested in 2 cases according to the case history and one case was with ethanol. The order of the tissue concentration of CSP and MPB was liver> kidney > brain, and the concentration of MPB was higher than that of CSP in all tissues. The MPB /CSP concentration ratios of urine, bile juice, liver, kidney, brain and blood were 15.7, 4.0, 1.2, 1.4, 1.4 and 1.0 respectively. There was a big difference in concentration of CSP and MPB in 7 cases due to differences in the amount of dose administered and time to death after dosing.
A Case Of Toxicity Caused By Arisaematis Rhizoma Ingestion
Min-Ki Hong, Ju-Ok Park, Soon-Joo Wang
J Korean Soc Clin Toxicol. 2003;1(1):40-42.   Published online June 30, 2003
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Korean people use a lot of herbal agents for medical purposes, such as curing diseases, improving health state, but some of the herbal agents have toxic side effects. In terms of toxicology, herbal agents classified into 3 categories generally nontoxic, potentially toxic and toxic. But, there are few studies about the mechanisms and clinical features of intoxication of herbal agents. So detoxification or initial treatment of these agents is very difficult to clinicians in hospital. Authors experienced an uncommon case of intoxication after Arisaematis Rhizoma Ingestion. We report this case with review of Arisaematis Rhizoma.
A Case of Phenypropanolamine Induced Myocardial Injury
Jong Woo Park, Min Hong Choa, Joon Seok Park, Kwang Hyun Cho
J Korean Soc Clin Toxicol. 2003;1(1):43-46.   Published online June 30, 2003
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Phenypropanolamine (PPA) is a sympathetic amine used in over-the-counter cold remedies and weight-control preparations. The side effects are hypertension, dysrhythmias, stroke, etc. The Food and Drug Administration (FDA) is taking steps to remove PPA from all drug products and has requested that all drug companies discontinue marketing products containg PPA due to high risk of hemorrhage stroke. But, in Korea now, patinets take products containg PPA with over the counter. We report here the case of PPA induced myocardial injury in a young woman who takes overdose for suicide.
Two Cases of Acute Intoxication of Endosulfan
Sang Jin Lee, Hye Young Jang, Eun Kyung Eo, Koo Young Jung
J Korean Soc Clin Toxicol. 2003;1(1):47-50.   Published online June 30, 2003
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Endosulfan, one of organochlorine insecticides, is $gamma$-aminobutyric acid (GABA) antagonist. In sufficient dose, this pesticide lower the seizure threshold and produce CNS stimulation, with resultant seizures, respiratory failure, and death. In patients with endosulfan intoxication, the first manifestation of toxicity is largely a generalized seizure without prodromal signs or symptoms. So the management of airway and seizure control are essential for survival and prognosis of intoxicated patients. We report two cases of acute endosulfan poisoning who manifest 'status epilepticus' similarly, but have different prognosis.
A Case of Pyloric Obstruction Developed after Upper GI Barium Study in Patients with Caustic Injury on Gastrointestinal Tract
Jeong-Goo Kim, Hye-Jin Cho, Seung-Hee Lee, Pum-Soo Kim, Hyung-Keun Roh
J Korean Soc Clin Toxicol. 2003;1(1):51-55.   Published online June 30, 2003
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Caustic ingestion can produce a progressive and devastating injury to the esophagus and stomach, In the acute stage, perforation and necrosis may occur. Long-term complications include esophageal stricture, antral stenosis and the development of esophageal cancer. Endoscopy should be performed as soon as possible in all cases to evaluate the extent and severity of damage, unless there is evidence of perforation. Endoscopy is the diagnostic procedure of choice. However, when the endoscopy cannot be passed through due to esophageal stricture, upper GI barium studies may be useful as a follow-up measure and in the evaluation of complications. A 44-year-old man visited our hospital complaining frequent vomiting 1 hour after ingestion of unknown amount of hydrochloric acid. At the time of arrival, the patient's oral cavity was slightly swollen and erythematous. On the endoscopic examination fourteen hour after the caustic ingestion, marked swelling of the arytenoids and circumferential ulceration with brown and black pigmentation at the upper esophagus were observed. Four weeks after the caustic injury, upper esophageal narrowing was observed and then the scope could not be advanced to the stomach. Upper GI barium study performed at that time revealed diffuse luminal narrowing of the esophagus and concentric luminal narrowing from prepyloric antrum to pylorus with disturbance of barium passage. At a week after the Upper GI study, through endoscopic examination after bougie dilatation of the esophagus, barium impaction in the stomach and the pylorus was noticed.
증독관리체계
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J Korean Soc Clin Toxicol. 2003;1(1):56-58.   Published online June 30, 2003
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Statistics of Poison Exposure in Korea
Jung-Yun Hwang, Jae-Ook Ko
J Korean Soc Clin Toxicol. 2003;1(1):59-64.   Published online June 30, 2003
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Objective: This study was conducted for the nationwide statistical survey of poison exposure to provide the rationale for establishing and developing the poison control center (PCC) in Korea. Design: Study group for Korea PCC in National Medical Center reviewed the medical literature on poison exposure of Korea from death reports of National Statistical Office (NSO), the toxic exposure statistics from the report of National Health Insurance Corporation (NHIC), and poison related data from 119 ambulance services (FD) for the purpose of obtaining the poison and its related data. We also conducted questionnaire from the expert who work in emergency medicine department at the designated 320 emergency medical centers in Korea for the preparedness and acknowledgement about necessity of PCC and their need for that. Results: We reviewed the reliable data from the death report of NSO, poison exposure data from NHIC, and running report from FD. Poisoning death occured at home ($36.7\%$) and hospital ($46.3\%$). Poisoning are more common in rural area than the city area. Patients were seen more frequently in the local clinics than in any hospital. The drugs ($45.7\%$) and pesticide ($18.1\%$) are common poison. Common place to poison exposure were residential area ($39.9\%$), industry ($9\%$). mass residential area ($7\%$). and farm ($6\%$). The education level were primary school ($33.2\%$), high school ($23.7\%$), and middle schol ($21.3\%$) in order. We have to provide the poison guideline for lay public to understand easily, and for medical experts. The medical facilities need to be invested and have more interest for toxicology. All medical staff who work in the designated emergency medical center want PCC to establish. They want to have poison information from hospital ($91.3\%$), regional poison information center ($45.0\%$), regional poison control center ($52.5\%$), nationwide poison information center ($48.8\%$), nationwide poison control center ($46.25\%$), as a role of poison control center. They also want that pcc have poison epidemiologic study and statstics, training program for the experts, registration of rare case of posion on website, reflection of policies to activities for antidote production etc., speedy consultation system for poison analysis, public education, establishment of both regional and national pee, etc. Conclusion: Poison center must be established to provide poison information for all the public and medical experitise, focusing rural area and private clinic, to detoxify, to reduce the cost, time, morbity, and mortality through the whole country.
WHO Guidelines for Poison Control
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J Korean Soc Clin Toxicol. 2003;1(1):65-72.   Published online June 30, 2003
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JKSCT : Journal of The Korean Society of Clinical Toxicology