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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Effect of ETCO2 monitoring of poisoning patients with decreased mental state in ED
Yong Hee Kwon, Byung Hak So, Won Jung Jeong
J Korean Soc Clin Toxicol. 2021;19(1):44-50.   Published online June 30, 2021
DOI: https://doi.org/10.22537/jksct.2021.19.1.44
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Purpose: This study aimed to analyse the effect of End-Tidal Carbon Dioxide (ETCO2) monitoring on patients who had been poisoned and presented in the emergency department with decreased consciousness. Methods: The data of patients over 18 years old presenting with poisoning from 2016 to 2020 was collected from the emergency department. We retrospectively analyzed their medical records, and defined patients with a Glasgow Coma Scale (GCS) score of 9 or less as having decreased consciousness. We divided the patients into two groups, one with ETCO2 monitoring and the other without, and the difference between the two groups was compared. Results: 168 patients participated in this study and 83 (49.4%) of them belonged to the ETCO2 monitoring group. In this group, the interval between arterial blood tests was statistically significantly longer and the rate of intubation was lower. In addition, in the monitoring group, the incidence of pneumonia and the rate of poor prognosis was not significantly higher. Conclusion: Although ETCO2 monitoring does not directly affect the prognosis of poisoned patients with decreased consciousness, it should be actively done as it can help to adequately treat patients while avoiding invasive techniques or unnecessary intubation.
PaCO2 at Early Stage is Associated with Adverse Cardiovascular Events in Acute Carbon Monoxide Poisoning
Keun Mo Yang, Byeong Jo Chun, Jeong Mi Moon, Young Soo Cho
J Korean Soc Clin Toxicol. 2019;17(2):86-93.   Published online December 31, 2019
DOI: https://doi.org/10.22537/jksct.2019.17.2.86
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Purpose: The objective was to determine the association between PaCO2 and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients. Methods: This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 hours later. The baseline characteristics and clinical course during hospitalization were collected and compared. The mean PaCO2 during the first 6 hours after presentation was calculated. Results: The incidence rates of moderate (30 mmHg< PaCO2 <35 mmHg) or severe (PaCO2 ≤30 mmHg) hypocapnia at presentation after acute CO poisoning were 40.7% and 26.8%, respectively. The mean PaCO2 during the first 6 hours was 33 (31-36.7) mmHg. The incidence of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total ranges of PaCO2 variables. In multivariate regression analysis, mean PaCO2 was independently associated with ACVEs (OR 0.798 (95% CI 0.641-0.997)). Conclusion: Mean PaCO2 during the first 6 hours was associated with increased ACVEs. Given the high incidence of ACVEs and PaCO2 derangement and the observed association between PaCO2 and ACVEs, this study suggests that 1) PaCO2 should be monitored at the acute stage to predict and/or prevent ACVEs; and 2) further study is needed to validate this result and investigate early manipulation of PaCO2 as treatment.
A Case of Acute Poisoning with Dry Ice
Soon-Young Hwang, Jin-Hee Jung, Eun-Kyung Eo
J Korean Soc Clin Toxicol. 2007;5(1):43-45.   Published online June 30, 2007
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AbstractAbstract PDF
Carbon dioxide is the fourth most abundant gas in the earth's atmosphere, and it is widely used in the chemical industry. Solid carbon dioxide is commonly known as dry ice. At low concentration, carbon dioxide appears to have little toxicological effect. At higher concentrations, however, it can produce an increased respiratory rate, tachycardia, cardiac arrhythmia, loss of consciousness, convulsion, and even death. Management of carbon dioxide poisoning requires the immediate removal of an individual from the toxic environment and administration of oxygen. It is important to know the concentration of carbon dioxide to which a patient has been exposed. We report a case of acute poisoning from solid carbon dioxide in a patient presenting with drowsiness and diminished mental capacity when she arrived in the emergency department. She recovered completely after administration of oxygen with conservative treatment.

JKSCT : Journal of The Korean Society of Clinical Toxicology