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- Analysis of Death Due to Poisoning in the National Capital Region (2014-2016)
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Meejung Park, Jongsin Park, Sangki Lee, Sangwhan In
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J Korean Soc Clin Toxicol. 2017;15(2):101-106. Published online December 31, 2017
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DOI: https://doi.org/10.22537/jksct.2017.15.2.101
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- Purpose: This study examined the patterns of drugs, poisons, and chemicals detected in autopsy samples performed in the Seoul Institute and other regional forensic offices of the National Forensic Service (NFS) between 2014 and 2016. Methods: The investigation carried out using the laboratory information management system. Forensic toxicological identification and quantitation were performed in autopsy samples, including heart blood, peripheral blood, liver, kidney, vitreous humor and etc. Gas chromatography/mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) were used to analyze the drugs and poisons. Results: Forensic autopsies were performed on 9,674 cases in this period. Based on the autopsy reports, 699 cases (7.2%) were considered as unnatural deaths caused by fatal intoxication. The number of male deaths was higher than that of female deaths, with the age of 50-59 being the most common age group. Conclusion: Drugs comprised the largest number of deaths due to poison, followed by alcohol, agrochemicals, drug with alcohol, carbon monoxide, and cyanide, in that order. Zolpidem was the most frequently used drug in all drug-related intoxication cases.
- The Experiences of the Emergency Antidote Stock and Delivery Service by the Korean Poison Information Center
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So Young Park, Bum Jin Oh, Chang Hwan Sohn, Ru Bi Jeong, Kyoung Soo Lim, Won Kim, Seung Mok Ryoo
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J Korean Soc Clin Toxicol. 2013;11(1):9-18. Published online June 30, 2013
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- Purpose: Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide stocking and delivery system for emergency antidotes in Korea. We report on a two-year experience of a nationwide stocking and delivery trial for emergency antidotes at emergency departments in Korea. Methods: An expert panel of clinical toxicologists reviewed and made a list of 15 stocked antidote. These antidotes were purchased or imported from other countries and delivered from 14 antidote stocking hospitals nationwide 24 hours per day, seven days per week. Results: From August 1, 2011 to April 30, 2013, 177 patients with acute poisoning, with a median age of 48.5 years, were administered emergency antidotes. The causes of poisoning were intentional in 52.0% and 88.0% were intentional as a suicide attempt. Regarding clinical severity, using the poisoning severity score, 40.7% of patients had severe to fatal poisoning and 39.0% had moderate poisoning according to clinical severity. The most frequent presenting symptom was neurologic deficit, such as altered mentality (62.7%). alerted mentality (62.7%). Emergency antidotes were administered as follows: methylene blue (49 cases), flumazenil (31), N-acetylcysteine (25), glucagon (17), 100% ethanol (15), cyanide antidote kit (12), anti-venin immunoglobulin (5), pyridoxine (4), hydroxocobalamine (2), and deferoxamine (1). The median time interval from antidote request to delivery at the patient's bedside was 95 minutes (interquartile range 58.8-125.8). Conclusion: Findings of this study demonstrated the possibility of successful operation of the nationwide system of emergency antidotes stocking and delivery in Korea.
- Survey of the Antidote Stocking in the Emergency Medical Centers in Korea
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Je-Sung You, Eui-Chung Kim, Hahn-Shick Lee, Seung-Ho Kim, Sung-Pil Chung
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J Korean Soc Clin Toxicol. 2007;5(2):106-111. Published online December 31, 2007
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- Purpose: Inadequate hospital stocking and unavailability of essential antidotes is a worldwide problem. The purpose of this study was to determine the adequacy of antidote stocks in Korean hospitals based on a modified version of US antidote stocking guidelines. Methods: Both written and telephone surveys to collect information on hospital demographics and antidote stocking were given to the emergency departments or hospital pharmacies of 117 hospitals with emergency medical centers. The twenty antidotes included in the survey were taken from year 2000 US antidote stocking guidelines, except for activated charcoal and black widow spider antivenin. Antidote stocks were compared by hospital size, geographic location, and type of emergency medical center. Results: Complete responses were received from all hospitals. A mean of $12.4{pm}2.9$ antidotes were adequately stocked per hospital. All hospitals stocked atropine, $CaCl_2$ naloxone, and sodium bicarbonate. However, digoxin Fab fragment (16%), cyanide kits (15%), EDTA (10%), BAL (9%), and fomepizole (1%) were not uniformly stocked. Large and teaching hospitals were significantly more likely to stock greater numbers of antidotes. Conclusions: Korean hospitals as a group do not have adequate antidote stocks. Korean stocking guidelines and an antidote management system are recommended in order to correct these deficiencies.
- Treatment with the Taylor Cyanide Antidote Package after Cyanide Poisoning: Case Report
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Beam-Gyu Cho, Han-Joo Choi, Yang-Soo Jang, Tae-Yang Shin, Kang-Hyun Lee, Sung-Oh Hwang, Hyun Kim
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J Korean Soc Clin Toxicol. 2007;5(1):57-60. Published online June 30, 2007
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- Cyanide has been well known from antiquity. Cyanide poisoning causes histotoxic hypoxia--inhibition of mitochondrial cytochrome oxidase with disruption of the ability of cells to use oxygen. The mortality rate is 95% within 30 minutes. Acute cyanide poisoning is mostly the result of attempted suicide, and because of the high doses typically employed it usually is lethal within minutes. Also acute cyanide poisoning leads to a very poor prognosis because medical personnel can't detect cyanide intoxication and so many hospital haven't antidote. We report two cases of cyanide poisoning which responded well to treatment with the Taylor cyanide antidote package.
- A Case of Hydrogen Cyanide Inhalation at Working -A Case Report-
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Yang-Weon Kim, Young-Jin Eom
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J Korean Soc Clin Toxicol. 2006;4(1):55-57. Published online June 30, 2006
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- Cyanides and Hydrogen cyanide are used in production of chemicals, electroplating, photographic development, making plastics, fumigating ships, and some mining processes. We experienced of Hydrogen cyanide inhalation injury. A 45-year-old man worked at electroplating. As soon as he mixed sodium cyanide with acid, cyanide produced hydrogen cyanide, occasionally he inhaled Hydrogen cyanide and he lost his consciousness. He was moved to near hospital and took emergency treatment and then was transferred to our hospital. On arrival he had severe dyspnea, metabolic acidosis, and tachycardia. After he was treated with supportive method he recovered his consciousness in 20 hours at emergency room.
- Parkinsonism after Cyanide Intoxication: A Case Report
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Joo-Hyun Suh, Eun-Kyung Eo
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J Korean Soc Clin Toxicol. 2004;2(2):137-140. Published online December 31, 2004
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- Acute cyanide poisoning is usually the result of attempted suicide which is often lethal within minutes or leads to a very poor prognosis after delayed and inadequate treatment. It affects the cerebral structures with the highest oxygen requirement, such as the basal ganglia, the cerebral cortex. We experienced a-45-year-old man who ingested Potassium Cyanide. He was stuporous. In 25 minutes, respiratory arrest developed and cardiopulmonary resuscitation was done. After return of spontaneous circulation, he admitted to intensive care unit, and conservative treatment was started. The clinical status was improved by degrees, but he couldn't perform daily activity like before. Minimal limitation of movement and memory deficit were left. In magnetic resonance imaging, which taken at the 11th day after admission, there were both basal ganglia and folia of cerebellum abnormality.
- Chemical Asphyxiants - Cyanides and Hydrogen Sulfides
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Yang Ho Kim, Young Hee Choi, Choong Ryeol Lee, Ji Ho Lee, Cheolln Yoo, Hun Lee
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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.
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