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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Volume 3(1); 2005
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Medico-legal Consideration of Gastric Lavage in Acute Intoxicated Patients -In the Supreme Court 2005.1.28, 2003da14119
Hyun-A Bae
J Korean Soc Clin Toxicol. 2005;3(1):1-10.   Published online June 30, 2005
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Gastric lavage is now known to be ineffective, unnecessary or hazardous in some circumstances where it used to be performed as a routine. This article concerns the medico-legal aspect of forced gastric lavage. The Supreme Court 2005.1.28, 2003da14119 is the case where a patient, who ingested the organophosphate insecticide to attempt suicide and refused lavage. At first we discuss the effectiveness or hazards of lavage because a very high degree of proof -of negligence, not error of clinical judgment - would be required. Lavage, with or without the informed consent, performed negligently which result in harm could, of course, give rise to a claim in negligence. A doctor might also be held negligent in failing to perform an act which he/she had a duty to perform.
Interaction effect of Chemical Mixtures
Jong Han Leem, Joo-Youn Shin, Yong-Kyu Kim
J Korean Soc Clin Toxicol. 2005;3(1):11-16.   Published online June 30, 2005
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Chemical mixtures of components, each of which are present at less than guidance concentrations, may be hazardous due to additivity, interactions, or both. Toxicological interactions may increase the health hazard above what would be expected from an assessment of each component singly, or all components additively. So chemical mixture are a particular issue in public health. There are several approach to assess whether there are additivity or interaction in assessing toxicological effects, such as, components-based approach, physiologically-based pharmacokinetic /pharmacodynamic(PBPK/PD) models, hazard index method, and weight-of evidence method. If we consider interaction or additivity effects in assessing the health effects of chemcial mixtures, we can get more accurate information about toxicological effects and dose-response relationship in chemical mixtures.
Effect of Dialysis and Perfusion on Phosphamidon in vitro
Sae Yong Hong, Hyo Wook Gil, Jong Oh Yang, Eun Young Lee
J Korean Soc Clin Toxicol. 2005;3(1):17-21.   Published online June 30, 2005
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Purfose: This study was to observe the phosphamidon reduction rate after haemoperfusion (HP) and Hemodialysis (HD) in vitro. Methods: We started off by measuring the clearance of HD and HP for the phosphamidon in vitro. Phosphamidon was measured hourly by High-pressure liquid chromatography. Results: Phosphamidon clearance was effectiveness in HP and HD. Phosphamidon reduction rate was no difference between HD and HP; $64\%$ versus $91.\%1$ at starting, $82.2\%$ versus $80.2\%$ at 1 hours, $82.2\%$ versus $73.8\%$ at 2 hours, $34.4\%$ versus $14.0\%$ at 3 hours, $14.1\%$ versus $27.4\%$ at 4 hours, $0\%$ versus $3.3\%$ at 5 hours. Conculsion: Extracorporeal elimination of phosphamidon is effective by hemoperfusio and hemodialysis in vitro. We suggest hemoperfusion may be effective in organophsphate intoxication patients.
The Clinical Investigation of Gastric Lavage in Patients with Acute Poisoning
Taek Geun Ok, Jun Hwi Cho, Chan Woo Park, Seung Whan Cheon, Seung Yong Lee, Sung Eun Kim, Ki-Hoon Choi, Ji Hoon Hae, Jeong Yeul Seo, Hee Cheol Ahn, Moo Eob Ahn, Byung Ryul Cho, Yong Hoon Kim
J Korean Soc Clin Toxicol. 2005;3(1):22-26.   Published online June 30, 2005
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The majority of acute toxic poisoning occur via oral route. The most important emergency treatment of acute poisoning are gastric lavage. Gastric lavage should be considered a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 mins of ingestion. But, gastric lavage does not consist properly in the cases of emergency situation or an inexperienced doctors treat. The purpose of this study was to determine whether gastric lavage is performed properly. Eighty patients were enrolled in the study in 12-month period from January to December 2002. A retrospective chart review was performed on patients identified as drug overdose who admitted to ER. To assess whether there was a subgroup of patients who may have been candidates for the initiation of gastric lavage in the ER, the patients divided in two groups by time interval from toxin ingestion to ER arrival. The group 1 that admit within 60 minutes after drug ingestion was 38 cases ($47.5\%$), and the group 2 patient who admitted after 60 minutes was 42 cases ($52.5\%$). The average age was $44pm19$ years in group 1, and $48pm24$ years in group 2. There were no differences in sexual distribution of two groups. The mean time interval was $49pm20$ minutes in the group $1,258pm190$ minutes in the group 2. Only thirty ($37.5\%$) of the patients had an overdose for which the treatment of gastric lavage was potentially feasible according to guideline. The correctly performed gastric lavage was 18 ($47.4\%$) in group 1, 12 ($28.6\%$) in group 2. We must enforce education about the gastric lavage, and do so that may treat according to guideline.
Analysis of Patients with Acute Carbon Monoxide Poisoning in one Hospital
Kyung Hwan Kim, Ah Jin Kim, Dong Wun Shin, Jun Young Rho
J Korean Soc Clin Toxicol. 2005;3(1):27-32.   Published online June 30, 2005
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Purpose: The frequency of carbon monoxide poisoning has been decreased in the interior of the Korea. But occasionally it is occurred and the risk of exposure is high in working place so far. Because of the characteristics of gas, the detection of exposure and poisoning could be delayed and fatality is high. We should apprehend of carbon monoxide poisoning. So we would report analysis of patients with carbon monoxide poisoning. Methods: A retrospective review of CO poisoned patients visited emergency department from January 2000 to December 2004 was conducted. Results: 24 patients were enrolled. Their average of age was $37.6pm20.9$ years old and COHb was $19.4pm13.32\%$. The blood level of initial COHb and mental status on arrival were not correlated each other. The blood level of initial COHb and loss of consciousness were not correlated, too. Initial electrocardiography (EKG) was not correlated with cardiac enzymes such as CK-MB and troponin I. But base excess was correlated with mental status on arrival and complication such as rhabdomyolysis. Hyperbaric oxygen therapy was correlated with base excess and mental status on arrival. Conclusion: The clinical features of carbon monoxide poisoning are nonspecific. For proper diagnosis, it is important that we should consider patient's environment and take patient's history carefully. The blood level of initial COHb does not reflect severity of poisoning accurately. So We should determine the treatment of choice depending on patient's status.
Trends Analysis of Suicidal Poisoning in Korea- Comparison before and after the IMF Crisis and the Economic Recession
Won Jae Lee, Kyu Nam Park, Seung Pil Choi, Mi Jin Lee
J Korean Soc Clin Toxicol. 2005;3(1):33-39.   Published online June 30, 2005
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Purpose: Nowadays the Korean society is in the center of time of the social change. Because of dissociation of traditional family, IMF (International Monetary Fund) crisis and economic recession, the mortality rate of suicidal attempts are increasing annually. The majority of suicidal attempts were by poisoning considering the characteristics of korean society. Therefore we studied to find out the characteristics of suicidal poisoning before and after social economic stress, and to suggest the direction for the proper management. Methods: We reviewed medical records of 547 patients of suicide by poisoning who visited the emergency medical centers of St. Mary's hospitals from 1997 to 2004. For the annual trends analysis, we analyzed the demographic and toxicologic data of these patients compared with before and after IMF crisis (1998) and the economic recession ($2003~2004$). Results: At the time of IMF and the economic recession, the number of suicidal poisoning increased, especially in fifth decade. The refusal rate of toxicological emergency treatment increased. Also the mortality rate and the admission rate to ICU (Intensive Care Unit) increased during the same period. In the result of the comparison analysis, clinical severity and mortality of social problem group were higher. However they couldn't be treated appropriately because of financial problem and the family indifference. Conclusion: At the economic recession period, the severity of suicidal poisoned patients was high. But the refusal rate of toxicologic treatment also increased, so the patients had lost the chance for proper toxicologic treatment. Therefore they would be supported by medical institution and public health.
A Case of Pulmonary Injuny Induced by Accidental Exposure to High Level of Nitrogen Dioxide ($NO_2$)
Jin Hyuck Chang, Do Youn Kim, Young Kim, Yoon Soo Chang, Hyung Jung Kim, Chul Min Ahn, Sung Kyu Kim, Tae Hoon Kim
J Korean Soc Clin Toxicol. 2005;3(1):40-44.   Published online June 30, 2005
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Nitrogen dioxide ($NO_2$), which produced during the process of silage, metal etching, explosives, rocket fuels, welding, and by-product of burning of fossil fuels, is one of major components of air pollutant. Accidental exposure of high level of $NO_2$ produces cough, dyspnea, pulmonary edema which may be delayed $4~12$ hours and, in $2~6$weeks, bronchiolitis obliterans. We experienced a case of acute pulmonary injuny induced by industrial exposure to high level of $NO_2$ during repair of $NO_2$ pipeline in a refinery. A 55-year-old man experienced nausea and severe dyspnea in 6 hours after $NO_2$ inhalation. Initial blood gas examination revealed severe hypoxemia accompanying increased alveolar-arterial O2 difference. Radiological examination showed diffuse ground glass opacities in both lung fields. Clinical symptoms and laboratory findings, including radiological study and pulmonary function test were improved with conservative treatment using inhaled oxygen and bronchodilator. and there was no evidence of bronchial fibrosis and bronchiolitis obliterance in chest high resolution computed tomography performed 6 weeks after exposure. Here, we report a case of $NO_2$ induced acute pulmonary injuny with a brief review of the relevant literature.
Death after Ingestion of MCPP -A Case Report-
Byung Hak So, Won Jae Lee, Byoung Yong Shim, Hoon-Kyo Kim, Chi Hong Kim
J Korean Soc Clin Toxicol. 2005;3(1):45-47.   Published online June 30, 2005
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MCPP (2-(2-methyl-4-chlorophenoxy)propionic acid; mecoprop), a hormonal weedkiller has been widely used. Although chronic exposure is generally considered to be mildly toxic to man, acute intoxication can be severe and should thus be taken seriously. We report the case of a patient who died after ingestion of MCPP. A 64-year-old man ingested about 400 ml of $50\%$ MCPP solution. He was stuporous and had an inadequate respiration. He had an hypotension which did not respond to vasopressors and died about twelve hours after ingestion.
Diagnostic Radioopacity in Chloroform Ingestion -A Case Report-
Sung Woo Lee, Sung Hyuk Choi, Yun Sik Hong, Su Jin Kim, Sung Woo Moon, Jun Dong Moon, Sang Hyun Jung, Jong Su Park
J Korean Soc Clin Toxicol. 2005;3(1):48-51.   Published online June 30, 2005
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Diagostic imaging can help in management of toxicologic emergencies. We report a patient who presented to the emergency department with coma and suppressed respiration after ingestion of unknown substance. We documented chloroform with radiopaque material in bowel on abdominal radiograph. We used activated charcoal and laxative to decontaminate bowel. Hepatotoxicity occurred on 3rd admission day and elevation of liver enzyme reached peak level on 5th admission day. The patient received hemoperfusion, N-acetylsystein and supportive cares. The patient was improved from hepatic dysfunction and discharged without complication on 11th admission day. Radiograph in toxicology may confirm a diagnosis and assist in therapeutic intervention.
Korean Rosebay Intoxication -2 Case Reports-
Ho Kwon Kim, Tae O Jeong, Young Ho Jin, Jae Baek Lee
J Korean Soc Clin Toxicol. 2005;3(1):52-55.   Published online June 30, 2005
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The plant Korean rosebay are members of the Ericaceae(Heath) family and may contain grayanotoxins, which exert toxic effects by binding to sodium channels in cell membranes. We had experience of 2 cases of Korean rose bay intoxication, who exposed to Rhododendron mucronulatum. Patients were presented to our ED with nausea and vomiting, hypotension, and dizziness or depressed mentation. The patients were performed monitoring and supportive treatment and were fully recovered within 48hours. Korean rose bay intoxication should be considered in patients with clinical evidence of gastrointestinal irritation, cardiac arrhythmias, and/or neurologic signs without identifiable causes, especially in spring or early summer.
A Case of Cantharidin Poisoning after the Ingestion of Herbal Medicine
Ho Jin Ji, Hyun Kim, Sun Hyu Kim, Sung Bum Oh, Joong Bum Moon, Kang Hyun Lee, Sung Oh Hwang
J Korean Soc Clin Toxicol. 2005;3(1):56-59.   Published online June 30, 2005
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Blister beetles produce cantharidin, which is toxic to people and animals. Cantharidin has been believed to be an aphrodisiac and an abortifacient based on its tendency to cause marked irritation to the genitourinary system leading to priapism in men and pelvic congestion in women for many years. Cantharidin was used by oriental traditional medicine for more than 2000 years. Typical signs related to cantharidin ingestion are gastrointestinal tract and urinary tract irritation, endotoxemia, shock and myocardial dysfunction. Cantharidin is a severe irritant to epithelial linings (gastrointestinal tract, urinary tract, and skin) and develop systemic inflammatory response syndrome. We report a case of corrosive esophagogastritis and acute renal failure by ingestion of cantharidin.
Reactive Airways Dysfunction Syndrome (RADS) from Chlorine Gas Releasing Cleaning Agents
Kwang-Hyun Cho, Seung-Hwan Kim, Young-Soon Cho, Hahn-Shick Lee, Joon-Seok Park
J Korean Soc Clin Toxicol. 2005;3(1):60-62.   Published online June 30, 2005
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A previously healthy 57-year-old woman with dyspnea and wheezing presented to the emergency department a few minutes after exposure to unknown gas from mixing bleach (sodium hypochlorite) and cleaning agent (hydrochloric acid) at work place. Initial physical examination revealed severe wheezing on both whole lung fields, but the chest radiograph was normal. Arterial blood gas analysis showed only moderate hypoxemia. The patient was treated with oxygen, $eta$adrenergic bronchodilators, antihistamines and corticosteroids, after then symptoms were improved. And the patient discharged against medical advice. We report a rare case of reactive airways dysfuntion syndrome from chlorine gas exposure.
Hypokalemic Muscular Paralysis Causing Acute Respiratory Failure in a Chronic Glue Sniffer
Yoon-Hee Choi, Dong-Hoon Lee, Eun-Kyung Eo
J Korean Soc Clin Toxicol. 2005;3(1):63-66.   Published online June 30, 2005
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Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. It is known to be toxic to the nervous system, hematopoietic system, and causes acid-base and electrolyte disorders. Acute respiratory failure with hypokalemia and rhabdomyolysis with acute renal failure should be considered as potential events in protracted glue sniffing. We reported the case of 26-year-old woman was admitted to the emergency department with the development of respiratory failure and altered mentality due to hypokalemia after chronic glue sniffing. She was weaned from the ventilator 3 days later after potassium and sodium bicarbonate replacement and was discharged without respiratory symptoms and other complications.
A Case of Recurrent Ventricular Tachycardia after Pimozide and Haloperidol Overdose
Jin-Hee Jung, Hye-Young Jang, Eun-Kyung Eo
J Korean Soc Clin Toxicol. 2005;3(1):67-70.   Published online June 30, 2005
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Pimozide and haloperidol are typical antipsychotics. They share a similarity in pharmacotherapeutic and adverse effect profiles. Cardiovascular effects may be seen as alterations in heart rate, blood pressure, and cardiac conduction. Conduction disturbances may occur ranging from asymptomatic prolongation of the QT interval to fatal ventricular arrhythmia. So in the case of anti psychotics overdose, the patient must be carefully monitored by continuous electrocardiography (ECG). We experienced a 34-year-old woman of schizophrenia with recurrent ventricular tachycardia after pimozide and haloperidol overdose. Initially she was slightly drowsy, however her ECG showed normal sinus rhythm. After 6 hours on emergency department entrance, her ECG monitoring showed ventricular tachycardia and we successfully defibrillated. There were five times events of ventricular arrhythmia during the in-hospital stay. She was discharged 5 days later without any other complications.

JKSCT : Journal of The Korean Society of Clinical Toxicology