Journal of The Korean Society of Clinical Toxicology

Cardiac arrest and severe encephalopathy following e-cigarette nicotine intoxication: a case report: Park Jinwon, Yun Sunghyun; J Korean Soc Clin Toxicol. 2022;20(2):82-85. Published online December 31, 2022; DOI: https://doi.org/10.22537/jksct.2022.20.2.82

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Traditionally, most cases of nicotine poisoning have been due to ingestion of nicotine pesticides. However, the increasing use of electronic cigarettes (e-cigarettes) has resulted in both intentional and unintentional exposure to concentrated liquid nicotine or “eliquid” leading to an increase in nicotine poisoning cases. However, fatalities following the ingestion of the e-liquid are extremely rare. We report a rare case of cardiac arrest and severe encephalopathy following the intentional ingestion of e-liquid. We present the case of a 20-year-old woman who intentionally ingested liquid nicotine intended for e-cigarette use. She was found in asystole and experienced a return of spontaneous circulation (ROSC) after undergoing approximately 46 mins of cardiopulmonary resuscitation. Her plasma nicotine levels were >500 ng/ml. Despite aggressive supportive care, she was found to have encephalopathy consistent with severe anoxic brain injury on magnetic resonance imaging. In recent times, there have been some reports of deaths following liquid nicotine ingestion. Our case illustrates the potential for fatal nicotine toxicity from ingestion of e-cigarettes.

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A Systematic Review on Health Impact of Electronic Cigarettes in South Korea
Eunsil Cheon, Hana Kim, Naeun Kang, Susan Park, Sung-il Cho, Jieun Hwang
Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(2): 29. CrossRef

Symptomatic Hypocalcemia Associated with Dioscorea tokoro Toxicity: Jae Chol Yoon, Jae Baek Lee, Tae Oh Jeong, Si On Jo, Young Ho Jin; J Korean Soc Clin Toxicol. 2019;17(1):42-45. Published online June 30, 2019; DOI: https://doi.org/10.22537/jksct.2019.17.1.42

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Abstract PDF: Dioscorea tokoro has long been used in Korean traditional medicine as a pain killer and anti-inflammatory agent. A 53-year-old male who consumed water that had been boiled with raw tubers of D. tokoro as tea presented with numbness and spasm of both hands and feet. Laboratory results showed hypocalcemia, hypoparathyroidism, and vitamin D insufficiency. During his hospital stay, colitis, acute kidney injury, and toxic encephalopathy developed. The patient received calcium gluconate intravenous infusion and oral calcium carbonate with alfacalcidol. His symptoms improved gradually, but hypocalcemia persisted despite the calcium supplementation. We suggest that ingestion of inappropriately prepared D. tokoro can cause symptomatic hypocalcemia in patients with unbalanced calcium homeostasis.

Delayed Continuous Venovenous Hemodiafiltration in Chronic Lithium Intoxication: Tae Su Kim, Yong Sung Cha, Hyun Kim, Oh Hyun Kim, Kyoung Chul Cha, Kang Hyun Lee, Sung Oh Hwang; J Korean Soc Clin Toxicol. 2013;11(1):28-30. Published online June 30, 2013

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Abstract PDF: A 66-year-old male with chronic alcoholism presented with tremor, gait disturbance, memory impairment, insomnia, decreased appetite, and confusion. The patient had been taking lithium daily for treatment of bipolar disorder. Brain CT showed no specific abnormality, and serum lithium and ammonia levels were 3.63 mEq/L (therapeutic range, 0.6~1.2 mEq/L) and $85{mu}g/dL$ (reference range: $19{sim}54{mu}g/dL$), respectively. Therefore, the initial differential diagnosis included chronic lithium intoxication, hepatic encephalopathy, Wernicke encephalopathy, or alcohol withdrawal syndrome. Even with the provision of adequate hydration, the patient's neurologic status did not show improvement, so that lactulose enema, thiamine replacement, and continuous venovenous hemodiafiltration (CVVHDF) were started on the third admission day. By the fifth admission day he had made a rapid neurologic recovery, and was discharged on the 20th admission day. Therefore, CVVHDF might be a treatment for patients with chronic lithium intoxication, because, even if serum lithium concentration is normal, lithium concentration in the brain may be different from that of the serum.

A Case of Delayed Carbon Monoxide Encephalopathy: Sung Hyun Yun, Hyun Min Jung, Hwan Seok Kang, Ji Hye Kim, Seung Baik Han, Jun Sig Kim, Jin Hui Paik; J Korean Soc Clin Toxicol. 2013;11(1):41-45. Published online June 30, 2013

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Abstract PDF: Following are brief statements about the delayed encephalopathy of a patient who recovered without disturbance of consciousness after acute carbon monoxide poisoning. A 72-year-old male was found without consciousness at home and then visited the ER center. Later we learned that the patient was using briquettes as a household heating source. Blood carbon monoxide hemoglobin level was 17.5%. As carbon monoxide poisoning was uncertain after the first interview with the patient, hyperbaric oxygen therapy was not administered at the early stage. After supplying 100% oxygen, the patient recovered consciousness, however, the strength of the lower limb muscle had decreased to class II. The patient showed continued weakening of the lower limb muscle and an increase of CPK; therefore, he was diagnosed as carbon monoxide intoxication and rhabdomyolysis and then admitted to the intensive care unit (ICU) for conservative treatment. During the hospitalization period, continued weakening of the lower limb muscle was observed and he was diagnosed as myopathy after EMG/MCV. However, he suddenly showed altered mentality on the 20th day of hospitalization, and underwent brain MRI. T2 weighted MRI showed typically high signal intensity of both globus pallidus and periventricular white matter; therefore, he was diagnosed as delayed carbon monoxide encephalopathy. This case showed delayed encephalopathy accompanied by rhabdomyolysis and myopathy of a patient who recovered without disturbance of consciousness.

Reversible Metronidazole-induced Encephalopathy: Ki-Hwan Ji, Jeong Lee, Chang-Ho Yun, Choong-Kun Ha; J Korean Soc Clin Toxicol. 2006;4(2):131-136. Published online December 31, 2006

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Abstract PDF: Metronidazole is an antimicrobial drug widely used against various types of infectious agents, including protozoa, amoeba, Helicobacter pylori, and anaerobes. Metronidazole may produce some adverse effects on hematologic, immunologic, neurologic and other systems. We report a case of reversible metronidazole-induced encephalopathy. The toxic dose of metronidazole and the onset of encephalopathy were variable. Two patients showed abnormally high signal intensity in the bilateral dentate nucleus of cerebellum, and characteristic abnormalities were detected by brain magnetic resonance imaging (MRI) and T2-weighted images, fluid-attenuated inversion recovery images and/or diffusion weighted imaging (DWI). Discontinuation of metronidazole resulted in the improvement of the neurologic symptoms over a period of two to three weeks. We followed up the brain MRI with DWI in one case following obvious clinical improvement, and the previously detected lesion had disappeared.

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