Journal of The Korean Society of Clinical Toxicology

Continuous Control of Acetaminophen Poisoning after Implementation of Regulation for Ease Access of Acetaminophen: Cohort Study from Emergency Department Based in-depth Injury Surveillance: Seung Jik Jo, Hyun Young Gang, Si Jin Lee, Gyu Hyun Bae, Eui Jung Lee, Kap Su Han, Su Jin Kim, Sung Woo Lee; J Korean Soc Clin Toxicol. 2020;18(2):57-65. Published online December 31, 2020; DOI: https://doi.org/10.22537/jksct.2020.18.2.57

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Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). Conclusion: Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

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Analysis of 2011-2020 intentional drug poisoning in children and adolescents
Jin Seok Park, Jin Seong Cho, Jae-Hyug Woo, Jae Ho Jang, Woo Sung Choi, Yong Su Lim, Jea Yeon Choi
Pediatric Emergency Medicine Journal.2023; 10(4): 132. CrossRef

Unintentional Pharmaceutical Poisoning in the Emergency Department: Hyo Rim Jo, Choung Ah Lee, Ju Ok Park, Bo Na Hwang; J Korean Soc Clin Toxicol. 2018;16(2):116-123. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.116

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Abstract PDF: Purpose: The social environment of easy access to medicines and arbitrary personal decisions leading to overdose aggravate unintentional medicine poisoning. This study aimed to investigate the characteristics of patients who visited emergency departments with unintentional medicine poisoning and reasons for poisoning based on age group. Methods: We retrospectively collected patients who experienced unintentional medicine poisoning based on data from the national injury surveillance system between 2013 and 2016. Subjects were classified into three groups based on age (0-14 years, 15-64 years, and ${geq}65;years$). We identified sex, insurance, time of poisoning, place, alcohol co-ingestion, hospitalization, death, and reason for poisoning in each age group. Results: A total of 27,472 patients visited an emergency department with poisoning during the study period; 1,958 patients who experienced unintentional poisoning were enrolled in this study. Respiratory medicine was the most frequent medicine in those younger than 15 years of age, and sedatives and antipsychotic drugs were the most common in patients older than 15 years of age. In total, 35.1% of patients older than 65 years were hospitalized. The most common reasons for poisoning were careless storage of medicine in those younger than 15 years of age and overdose due to arbitrary decisions in those older than 15 years of age. Conclusion: Unintentional medicine poisoning has distinct characteristics based on age group, and strategies to prevent poisoning should be approached differently based on age.

A Case of Mental Change in a Patient Who Received a Zoletil Injection: Yeong Ki Lee, In Gu Kang, Cheol Sang Park, Seok Jin Heo, Youn Seok Chai, Seong Soo Park, Jae Kwang Lee, Hyun Jin Kim, Won Joon Jeong; J Korean Soc Clin Toxicol. 2013;11(1):23-27. Published online June 30, 2013

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Abstract PDF: Zoletil is a non-opioid, non-barbiturate animal anesthetic and proprietary combination of two drugs, a dissociative anesthetic drug, tiletamine, with the benzodiazepine anxiolytic drug, zolazepam. Zoletil has greater potency than ketamine. Zoletil is abused for recreational purposes, especially by people with easy access to medicine. However, in Korea, it is available over-the-counter. Here we report on a case of an 83-year-old woman who received injection of seven vials of "Zoletil 50" by her daughter and presented with an altered mental change. Her mental state was stupor and vital sign was hypotension, bradycardia. Her blood tests indicated metabolic and respiratory acidosis and hyperkalemia. She was treated with intravenous naloxone and flumazenil but was not responsive. She was admitted to the ICU and treated with supportive therapy. Her mental state showed transient recovery, however, her clinical manifestation worsened and she expired.

Two Cases of Alocasia Intoxication: Dae Han Wi; J Korean Soc Clin Toxicol. 2012;10(2):122-125. Published online December 31, 2012

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Abstract PDF: Alocasia was originally distributed throughout subtropical and tropical areas. Recently, in Korea, it has been used in air cleaners and in control of humidity. Despite easy access in Korea, there are few reports on Alocasia toxicity. We report on two cases of Alocasia intoxication. One patient was a 16-month-old male, who was admitted with a complaint of irritability after biting leaves of Alocasia. Four hours later, he was discharged without any symptoms. Another patient, a 52-year-old female, complained of oral pain, numbness on the perioral area, dysphonia, swallowing difficulty, and chest and abdominal pain after eating root stuck of alocasia odora. She underwent gastrointestinal fibroscopy (GIF) due to lasting chest and abdominal pain. Finding on GIF showed erythema and swelling in the aryepiglottic fold and larynx. Her symptoms lasted 13 days; she was then discharged without any complications or sequelae.

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