Journal of The Korean Society of Clinical Toxicology

Original Articles

Clinical and Epidemiological Characteristics of Acute Poisoning Patients in South Korea in 2024: An In-Depth Sample Analysis Based on the National Emergency Department Information System: Hyein Park, Gyu Chong Cho, Yudong Sohn, Taejin Park, Youngsuk Cho; J Korean Soc Clin Toxicol. 2025;23(2):38-47. Published online December 31, 2025; DOI: https://doi.org/10.22537/jksct.2025.00006

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Abstract PDF: Purpose: This study aimed to examine the epidemiological characteristics and clinical patterns of acute poisoning patients presenting to emergency departments in Korea during 2024, using an in-depth medical record analysis of sampled cases from the National Emergency Department Information System.
Methods
This retrospective cohort study analyzed 3,686 acute poisoning patients selected through stratified random sampling from 98 emergency medical centers nationwide between January and December 2024. Data were collected through detailed medical record review, including demographic information, exposure circumstances, toxic substances, clinical presentations, treatment modalities, and outcomes.
Results
Among the 3,686 patients analyzed, females accounted for 58.46% and males for 41.54%. The most common age groups were patients in their 20s (16.66%), followed by those in their 50s (15.3%) and 40s (13.67%). Pharmaceuticals accounted for 72.3% of poisoning exposures, followed by gases (12.5%) and pesticides (7.0%). Benzodiazepines were the most frequently involved agents (18.7%), followed by other antidepressants (10.4%) and zolpidem (9.1%). Intentional poisoning occurred in 78.88% of cases. The admission rate was 41.51%, with 24.72% of patients requiring intensive care. Overall mortality was 2.33%, and pesticides accounted for 51.2% of deaths despite representing only 7% of total exposures.
Conclusion
This study provides updated epidemiological evidence on acute poisoning in Korea, demonstrating the persistent predominance of pharmaceutical agents and intentional exposures, as well as disproportionately high fatality rates associated with pesticide poisoning. These findings underscore the need for strengthened poison control systems and targeted prevention strategies.

Prediction of Hematotoxicity in Patients with Acute Valproic Acid Intoxication: Jiwon Lee, Kyungman Cha, Won Jung Jeong, Hwan Song, Byung Hak So; J Korean Soc Clin Toxicol. 2025;23(2):29-37. Published online December 31, 2025; DOI: https://doi.org/10.22537/jksct.2025.00002

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Abstract PDF: Purpose: Valproic acid is a drug used for the treatment of convulsive disorders and for mood stabilization. Acute intoxication can result in gastrointestinal disturbances, neurologic symptoms, and hematologic toxicity. This study aims to identify factors that may predict patient prognosis.
Methods
In this single-center retrospective observational study, medical records from January 1, 2013, to December 31, 2022, were reviewed. The initial clinical features, laboratory results, and serum valproic acid levels of patients with acute valproic acid intoxication who presented to the emergency department were analyzed. Patients were divided into two groups: those who developed hematologic toxicity (hematotoxicity group) and those who did not (non-hematotoxicity group).
Results
A total of 115 patients were included in the analysis, of whom 23 (20%) developed hematotoxicity. The median age of patients with hematotoxicity was 39 years (interquartile range [IQR], 32.0–50.5), which was significantly higher than in the non-hematotoxicity group (p=0.001). The Glasgow Coma Scale score was lower in the hematotoxicity group, with a median of 12 points (IQR, 9.0–14.5) (p=0.013). Intensive care unit admission was more frequent in the hematotoxicity group (p=0.003). Compared with the non-hematotoxicity group, patients with hematotoxicity had a higher incidence of pneumonia, acute kidney injury, rhabdomyolysis, metabolic acidosis, and hyperlactatemia (all p<0.001, except p=0.009 for hyperlactatemia). The initial serum valproic acid concentration was also higher in the hematotoxicity group, with a median of 121.6 μg/mL (IQR, 59.8–154.3) (p<0.001). Multivariate analysis showed that the odds ratio for hematotoxicity was 6.20 (p=0.018) in the presence of metabolic acidosis and 8.32 (p<0.001) when the initial valproic acid concentration exceeded 115.0 μg/mL.
Conclusion
In patients with suspected acute valproic acid poisoning, early evaluation of arterial pH and serum valproic acid concentration is essential for predicting the prognosis.

Development and Validation of a Virtual Patient Simulator for the Management of Acute Poisoning: An Assessment of Face and Content Validity: Ki Yong Kwon, Ji-Hoon Kim, Hyo Joon Kim; J Korean Soc Clin Toxicol. 2025;23(1):10-18. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00009

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Abstract PDF: Purpose: This study describes the development of a virtual reality simulator to train medical staff responsible for acute poisoning in early diagnosis and treatment and presents an evaluation of its face and content validity.
Methods
Five clinical toxicology experts identified calcium channel blocker poisoning, neuroleptic malignant syndrome, ethylene glycol poisoning, methemoglobinemia, and organophosphate poisoning as the focus of scenario development. A three-dimensional virtual reality environment was created using a video game engine, with interaction taking place via a head-mounted display and hand controllers. Emergency physicians assessed the simulator, and a questionnaire survey was conducted to evaluate its face and content validity using a 10-point scale. The collected data were descriptively analyzed.
Results
Eighteen emergency physicians with an average age of 43.9 years old with 11.3 years of experience, evaluated the simulator. Thirteen (72.2%) had no prior experience with immersive virtual reality. The simulator’s realism and ease of operation were highly rated, averaging 9 points. The initial diagnosis and treatment training effectiveness, educational content clarity, and feedback were given scores of 10 points in some scenarios. The simulator’s usefulness as a training tool was rated 9 points. The lowest score (8 points) was given for clarity of interaction in four scenarios. Positive feedback highlighted the value of experiencing rare poisoning cases and receiving feedback on treatment.
Conclusion
A virtual patient simulator with five scenarios was developed to train medical staff responsible for cases of acute poisoning in the initial diagnosis and treatment. Emergency physicians evaluated the simulator as realistic and stated that it would be effective in education.

Narcotics and Psychostimulants in Acute Overdose-Suspected Patients in Emergency Departments in Korea: Analysis of Toxicological Laboratory Data: Yoonsoo Kim, Jiwon Lee, Suncheun Kim, Arum Lee, Misuk Kim, Yun Hee Kim, Jung-In Ko, Bum-Jin Oh; J Korean Soc Clin Toxicol. 2025;23(1):1-9. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00007

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Abstract PDF: Purpose: Narcotic use and associated overdose deaths pose a serious public health threat worldwide. The use of psychostimulants, amphetamines and their derivatives, methamphetamine, ecstasy, or 3,4-methylenedioxy-methamphetamine (MDMA) is a significant challenge to the emergency department (ED). Although cases of illicit psychostimulant use have been reported in Korea, no reports with confirmative laboratory analyses have been reported. The objective of this study was to present data on ED patients who have used psychostimulants.
Methods
We used the 2019–2022 toxicological laboratory database of the National Medical Center, which includes data from six nationwide toxicological laboratories that support suspected acute poisoning patients in the ED. We analyzed demographics (age and sex), presenting mental status, and ethanol co-ingestion. The psychostimulant group was compared with the narcotic group, which contained patients who consumed narcotic drugs but not psychostimulants.
Results
Among 4,366 patients, narcotic drugs were detected in 2,239 patients (51.3%): 2,176 in the narcotic group, one who used cannabis, and 60 in the psychostimulant group. Psychostimulant cases were reported from 2019 to 2022 (13, 11, 25, and 11 each year). The psychostimulant group was younger (39.3±14.3 vs. 55.3±21.5 years), contained more female patients (45.0% vs. 21.1%), and had poorer mental status than the narcotic group (p<0.01). The cases of psychostimulant use were treated in 26 hospitals throughout Korea.
Conclusion
This is the first study reporting results from confirmative analyses of narcotic drug use in ED patients. Psychostimulant-related ED visits were observed throughout Korea.

Characteristics of Acute Toxic Alcohol Poisoning Patients in the Emergency Department: A Toxicological Laboratory Analysis of Ethylene Glycol and Methanol: Min Kyung Park, Emergency Vulnerable Area Regional Cooperation Team, Arum Lee, Misuk Kim, Yun Hee Kim, Jung-in Ko, Bum Jin Oh; J Korean Soc Clin Toxicol. 2025;23(1):19-27. Published online June 30, 2025; DOI: https://doi.org/10.22537/jksct.2024.00006

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Abstract PDF: Purpose: Toxic alcohol exposures are rare yet remain an ongoing and potentially lethal poisoning problem in Korea. Few studies have characterized the epidemiological features and blood substance levels in acutely intoxicated patients presenting to emergency departments (EDs). The objective of this study was to describe the characteristics of intoxicated patients for whom toxicological analyses were requested.
Methods
We reviewed demographic and analytical data from a toxicological laboratory operated by the National Medical Center between 2018 and 2022. In total, 1,244 cases from 35 EDs were analyzed.
Results
Of the analyzed cases, 108 cases (63 patients) tested positive for toxic alcohols, including methanol (MeOH), ethylene glycol (EG), and isopropyl alcohol. Sixty patients had a single toxic alcohol detected: 17 with MeOH and 43 with EG. Clinical features included a median age of 42 years, 63.3% male, 100% acute exposure events, 66.7% suicide attempts, and 50.0% ethanol co-ingestion. Median ingestion amounts were 255 mL (MeOH) and 365 mL (EG). Significant differences between MeOH and EG groups included ingestion of an unknown substance (41.2% vs. 69.8%, p=0.04), initial blood pH (7.33 vs. 7.20, p<0.01), and multiple substance ingestion (52.9% vs. 81.4%, p=0.03). Median blood concentrations were 255 mg/dL (MeOH) and 12 mg/dL (EG). Follow-up analyses occurred in 9 MeOH patients (52.9%, 15 tests) and 15 EG patients (34.9%, 30 tests).
Conclusion
This study presents the first confirmatory analytical data on toxic alcohol poisoning among ED patients in Korea, emphasizing ongoing cases around Seoul.

2023 Annual Report of the Seoul Poison Control Center: Su Jeong Yang, Sijin Lee, Su Jin Kim, Young Hoon Yoon, Sung Woo Lee, Seoul Poison Control Center; J Korean Soc Clin Toxicol. 2024;22(2):18-128. Published online December 31, 2024; DOI: https://doi.org/10.22537/jksct.2024.00010

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Abstract PDF: Purpose: The Korea University Anam Hospital Seoul Poison Control Center (Seoul PCC) has provided counseling services and poisoning prevention projects for the public and medical professionals since January 2022. This report summarizes the center’s performance and consultation data for 2023.
Methods
The Seoul PCC operates a helpline (1855-2221) on weekdays from 9 AM to 5 PM, along with chat and chatbot services via KakaoTalk, 1:1 online counseling through its website, and public engagement through social media. Data collected from January to December 2023 were analyzed in terms of case frequency, age, gender, location, reason for exposure, and substance type. Consultation requests from the general public were summarized, and information snapshots were utilized to present information on poisoning-related consultations.
Results
In 2023, the center handled 1,231 consultations, including 1,193 post-exposure and 38 non-exposure cases. Among post-exposure cases, 724 were from Seoul, 429 were from other areas, and 78 were from unspecified locations. Requests originated from the public (30.1%, n=359) and medical staff (69.9%, n=834). Frequently reported substances included medications (61.4%), common household products (13.5%), other household items (6.3%), synthetic toxicants (5.7%), and food (3.9%). Children under 12 accounted for 159 cases (13.3%), with exposures to common household products (45.9%), medications (27.7%), food (10.7%), and stationery/toys (11.5%).
Conclusion
From 2022 to 2023, consultations increased by 113.0%, with child exposures rising 82.7%. Medications remained the most common form of exposure across all ages, while common household products were the leading cause among children under 12. Most exposures were unintentional and occurred at home. In addition, most consultations concluded without a visit to a medical institution.

Review Article

Diagnosis and treatment of serotonin syndrome: Je Sung You, Sung Phil Chung; J Korean Soc Clin Toxicol. 2024;22(2):11-17. Published online December 31, 2024; DOI: https://doi.org/10.22537/jksct.2024.00008

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Abstract PDF: Serotonin syndrome is a drug-induced clinical syndrome caused by increased serotonin activity in the central nervous system. It occurs when starting a serotonergic drug, increasing its dose (including overdoses) or using a serotonergic drug in combination with other drugs. It manifests along a broad spectrum, ranging from mild side effects to life-threatening conditions. This condition should be suspected if patients have altered mental states, autonomic dysfunction, or neuromuscular symptoms such as clonus and tremor after using serotonergic drugs. Although the Hunter criteria have been widely used, new diagnostic criteria have recently been proposed to screen severe serotonin toxicity. It is necessary to differentiate it from neuroleptic malignant syndrome, which is associated with taking antipsychotic drugs that exert dopamine-antagonistic effects. If serotonin syndrome is suspected, the relevant drug should be stopped, and the patient should be treated with benzodiazepines. Severely ill patients with hyperthermia or neuromuscular symptoms require aggressive treatment. Serotonin receptor antagonists such as cyproheptadine or chlorpromazine have been tried as antidotes, but the level of evidence for their therapeutic effectiveness is very low.

Original Articles

Enteral nutrition in mechanically ventilated patients after organophosphate poisoning: Sang U Bark, Jeong Mi Moon, Byeng Jo Chun; J Korean Soc Clin Toxicol. 2024;22(1):1-9. Published online June 28, 2024; DOI: https://doi.org/10.22537/jksct.2024.00001

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Abstract PDF

Purpose: Nutritional therapy is a crucial component of therapy for critically ill patients, but there is a lack of nutritional support guidelines for organophosphate (OP) poisoning, likely due to the gastrointestinal effects of atropine, the main antidote for OP. This study investigated whether enteral nutrition (EN) during atropinization is acceptable for mechanically ventilated patients after OP poisoning.
Methods
This retrospective study classified 82 patients with OP poisoning according to whether they were fed during atropinization while on mechanical ventilation (MV). Data on the baseline characteristics, nutritional support, and clinical outcomes were compared. Univariate and multivariate regression models were constructed to analyze the associations between atropine administration for OP poisoning and feeding intolerance-related EN after adjustment for risk factors.
Results
Eighty-two patients received EN after 72 hours on MV, and 40 of them simultaneously received 2 mg/hr atropine for the first 120 hours after EN initiation. The overall incidence of feeding intolerance was 57.3% during the first 12 days after EN initiation and did not differ according to atropine administration. Appropriate atropinization during EN in regression model 1 and the dosage of atropine administered during EN and the duration of EN during atropinization in model 2 were not associated with feeding intolerance in patients on MV after OP poisoning.
Conclusion
Appropriate atropinization is not associated with feeding intolerance after EN provision in patients on MV after OP poisoning. This study will help establish nutritional guidelines for OP poisoning patients. More research on nutritional support is needed to validate our results.

Citations

Citations to this article as recorded by

The impact of early enteral nutrition on the acute phase of severe psychoactive substance poisoning: a prospective randomized clinical study
Nikita A. Yashin, Natalia S. Volobueva, Аnastasia L. Kosova, Leonid V. Arsentiev, Egor Yu. Strukov, Roman E. Lakhin, Aleksei V. Shchegolev
Clinical nutrition and metabolism.2025; 6(4): 181. CrossRef

Patterns of self-harm/suicide attempters who visited emergency department over the past 10 years and changes in poisoning as a major method (2011–2020): Kyu Hyun Pai, Sung Woo Lee, Su Jin Kim, Kap Su Han, Juhyun Song, Sijin Lee, Ji Hwan Park, Jeijoon Song; J Korean Soc Clin Toxicol. 2023;21(2):69-80. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00019

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Abstract PDF

Purpose: Suicide ranks among the top causes of death among youth in South Korea. This study aimed to identify the characteristics of suicidal individuals treated at emergency departments between 2011 and 2020.
Methods
A retrospective analysis was conducted using data from January 2011 to December 2020 in the Injury Surveillance Cohort, a prospective registry. Patients’ sex, age, mortality, methods of self-harm, and previous suicide attempts were analyzed. The methods of self-harm were categorized into falls, asphyxiation, blunt injuries, penetrating injuries, poisoning, and others. Sub-groups with and without poisoning were compared.
Results
The proportion of self-harm/suicide attempts increased from 2.3% (2011) to 5.0% (2020). The mortality rate decreased from 10.8% (2011) to 6.3% (2020). Poisoning was the most common method (61.7%). Mortality rates ranged from 42.0% for asphyxiation to 0.2% for blunt injuries. Individuals in their 20s showed a marked increase in suicide/self-harm attempts, especially in the last three years. A large proportion of decedents in their 70s or older (52.6%) used poisoning as a method of suicide. The percentage of individuals with two or more previous attempts rose from 7.1% (2011) to 19.7% (2020). The death rates by poisoning decreased from 7.7% (2011) to 2.5% (2020).
Conclusion
Our findings underscore the urgent need for targeted interventions and suicide prevention policies. Managing and reducing suicide and self-harm in emergency settings will require a focus on poisoning, the 10–29 age group, and the elderly. This paper will be valuable for future policies aiming to reduce the societal burden of suicide and self-harm.

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Trauma Patterns and Psychiatric Profiles in Suicide Attempts at a Regional Trauma Center in South Korea: A Retrospective Single-Center Study
Young Un Choi, Ji Young Hyun, Seongyup Kim, Keum Seok Bae, Jae Sik Chung, Il Hwan Park, Chan Young Kang, Tae Hui Kim, Chun Sung Byun
Journal of Clinical Medicine.2025; 14(12): 4218. CrossRef
Development of a Web Application for Simulating Plasma Drug Concentrations in Patients with Zolpidem Intoxication
Hwa Jun Cha, Sungpil Han, Kwan Cheol Pak, Hyungsub Kim
Pharmaceutics.2024; 16(5): 689. CrossRef

Utility of the APACHE II score as a neurological prognostic factor for glufosinate-intoxicated patients with alert mental status: Rok Lee, Tae Yong Shin, Hyung Jun Moon, Hyun Jung Lee, Dongkil Jeong, Dongwook Lee, Sun In Hong, Hyun Joon Kim; J Korean Soc Clin Toxicol. 2023;21(2):135-142. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00018

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Abstract PDF: Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status.
Methods
This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups.
Results
There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027–1.844), 1.017 (95% CI, 1.002–1.032), and 0.196 (95% CI, 0.040–0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746–0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652–0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527–0.722).
Conclusion
The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.

A retrospective analysis of toxic alcohol poisoning: Jin Kim, Yu Jin Lee, Tae Kyu Ahn, Soo Kang; J Korean Soc Clin Toxicol. 2023;21(2):143-150. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00014

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Abstract PDF Supplementary Material

Purpose: This study aimed to compare the clinical features of methanol and ethylene glycol poisoning.
Methods
This single-center retrospective observational study included patients with toxic alcohol poisoning who visited a regional emergency medical center. Patients with methanol and ethylene glycol poisoning from January 2004 to June 2023 were selected for the study using diagnostic codes.
Results
Twenty-two patients with toxic alcohol poisoning visited during the study period, with 11 patients for each category. Compared to methanol poisoning, ethylene glycol poisoning patients were more likely to have consumed alcohol for suicidal purposes (n=4 [36.36%] vs. n=8 [72.73%]) and were more likely to be drowsy (n=0 vs. n=6 [54.55%], p=0.016). The anion gap (25.43±8.35 mmol/L vs. 13.22±6.23 mmol/L, p=0.001) and lactic acid levels (1.785 [1.3–2.785] mmol/L vs. 9.90 [4.20–11.81] mmol/L, p=0.007) were higher in ethylene glycol poisoning patients than in methanol poisoning patients. Among alcohol dehydrogenase blockers, oral ethanol was administered to 10 patients (45.45%) (n=4 [36.36%] vs. n=6 [54.55%]), and intravenous ethanol was administered to six patients (n=4 [36.36%] vs. n=2 [18.18%]). Fomepizole was administered to two patients (9.09%) each, and renal replacement therapy was non-significantly more common in patients with ethylene glycol poisoning (n=8 [72.73%] vs. n=3 [27.27%], p=0.128). Three patients had delays in diagnosis and treatment, and while there were no fatalities, one patient was left with permanent vision damage.
Conclusion
Because these are uncommon types of poisoning and the clinical presentation is difficult to recognize early, healthcare providers should be familiar with toxic alcohol types and screen for them to ensure proper diagnosis and treatment.

Citations

Citations to this article as recorded by

Characteristics of Acute Toxic Alcohol Poisoning Patients in the Emergency Department: A Toxicological Laboratory Analysis of Ethylene Glycol and Methanol
Min Kyung Park, Arum Lee, Misuk Kim, Yun Hee Kim, Jung-in Ko, Bum Jin Oh
Journal of The Korean Society of Clinical Toxicology.2025; 23(1): 19. CrossRef

Predicting serum acetaminophen concentrations in acute poisoning for safe termination of N-acetylcysteine in a resource-limited environment: Dahae Kim, Kyungman Cha, Byung Hak So; J Korean Soc Clin Toxicol. 2023;21(2):128-134. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00013

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Abstract PDF: Purpose: The Prescott nomogram has been utilized to forecast hepatotoxicity from acute acetaminophen poisoning. In developing countries, emergency medical centers lack the resources to report acetaminophen concentrations; thus, the commencement and cessation of treatment are based on the reported dose. This study investigated risk factors that can predict acetaminophen detection after 15 hours for safe treatment termination.
Methods
Data were collected from an urban emergency medical center from 2010 to 2020. The study included patients ≥14 years of age with acute acetaminophen poisoning within 15 hours. The correlation between risk factors and detection of acetaminophen 15 hours after ingestion was evaluated using logistic regression, and the area under the curve (AUC) was calculated.
Results
In total, 181 patients were included in the primary analysis; the median dose was 150.9 mg/kg and 35 patients (19.3%) had acetaminophen detected 15 hours after ingestion. The dose per weight and the time to visit were significant predictors for acetaminophen detection after 15 hours (odds ratio, 1.020 and 1.030, respectively). The AUCs were 0.628 for a 135 mg/kg cut-off value and 0.658 for a cut-off 450 minutes, and that of the combined model was 0.714 (sensitivity: 45.7%, specificity: 91.8%).
Conclusion
Where acetaminophen concentrations are not reported during treatment following the UK guidelines, it is safe to start N-acetylcysteine immediately for patients who are ≥14 years old, visit within 15 hours after acute poisoning, and report having ingested ≥135 mg/kg. Additional N-acetylcysteine doses should be considered for patients visiting after 8 hours.

Comparison of hyperbaric oxygen therapy pressures for acute carbon monoxide poisoning: Jeong Yun Kim, Jihye Lim, Sung Hwa Kim, Sang Il Han, Yong Sung Cha; J Korean Soc Clin Toxicol. 2023;21(2):117-127. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00012

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Abstract PDF: Purpose: No consensus currently exists regarding the maximal pressure of hyperbaric oxygen (HBO₂) therapy performed within 24 hours of acute carbon monoxide (CO) poisoning. This study aimed to evaluate the difference in therapeutic effects according to the first HBO₂ pressure (3.0 atmospheres absolute [ATA] vs. 2.8 ATA).
Methods
We used prospectively collected registry data on CO poisoning at a tertiary academic hospital in the Republic of Korea. Adult patients with acute CO poisoning treated with HBO₂ within 24 hours after arrival at the emergency department and without the use of additional HBO₂ after 24 hours between January 2007 and February 2022 were included. Data from 595 patients were analyzed using propensity score matching (PSM). Patients with mild (non-intubated) and severe (intubated) poisoning were also compared. Neurocognitive outcomes at 1 month after CO poisoning were evaluated using the Global Deterioration Scale combined with neurological impairment.
Results
After PSM, the neurocognitive outcomes at 1-month post-CO exposure were not significantly different between the 2.8 ATA (110 patients) and 3.0 ATA (55 patients) groups (p=1.000). Similarly, there was also no significant difference in outcomes in a subgroup analysis according to poisoning severity in matched patients (165 patients) (mild [non-intubated]: p=0.053; severe [intubated]: p=1.000).
Conclusion
Neurocognitive sequelae at 1 month were not significantly different between HBO₂ therapy pressures of 2.8 ATA and 3.0 ATA in patients with acute CO poisoning. In addition, the 1-month neurocognitive sequelae did not differ significantly between intubated and non-intubated patients.

Changes in the characteristics of acute carbon monoxide poisoning patients who visited the emergency department during the COVID-19 pandemic: Jun bo Sim, Tae kyu Ahn, Hyun Kim; J Korean Soc Clin Toxicol. 2023;21(2):108-116. Published online December 29, 2023; DOI: https://doi.org/10.22537/jksct.2023.00008

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Abstract PDF: Purpose: This study investigated the differences between patients with acute carbon monoxide (CO) poisoning who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic.
Methods
This was a single-center retrospective observational study. Patients with CO poisoning who visited the ED during the period from February 2020 to January 2023 were classified as the COVID-19 pandemic group, and those from February 2019 to January 2020 were classified as the non-pandemic group. Patients’ medical records were reviewed, their demographic and clinical characteristics were compared, and the length of stay in ED was checked. The time from admission to the ED to the start of hyperbaric oxygenation (HBO) was defined as the door-to-HBO time, and this parameter was compared between both groups.
Results
In total, 672 patients were included in this study. The proportion of intentional poisoning was significantly higher in the COVID-19 pandemic group than in the non-pandemic group (p=0.028). The proportion of intentional poisoning significantly increased in the 20- to 29-year-old age group during the COVID-19 pandemic (p<0.001). In addition, it took longer to initiate HBO in the COVID-19 pandemic group than in the non-pandemic group (p=0.001).
Conclusion
These findings suggest that pandemics of infectious diseases, such as COVID-19, increase the proportion of intentional CO poisoning, and it may take longer to initiate HBO after visiting the ED. Efforts will be needed to decrease intentional CO poisoning and length of stay in ED.

Poisoning patients’ clinical features according to the blood level of propranolol: Sungheon Kim, Byung Hak So, Hyung Min Kim, Kyeong Man Cha, Hwan Song, Won Jung Jeong; J Korean Soc Clin Toxicol. 2023;21(1):56-63. Published online June 30, 2023; DOI: https://doi.org/10.22537/jksct.2023.00010

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Abstract PDF: Purpose: Propranolol is widely prescribed to psychiatric patients to control adrenergic symptoms. However, propranolol poisoning can be fatal due to cardiovascular complications. We analyzed associations between blood levels of propranolol and patients’ clinical features, with the aim of predicting progression to severe complications.
Methods
Data were collected from patients aged 18 years or older who presented to the emergency department with propranolol poisoning between January 2016 and May 2022. We retrospectively analyzed their medical records and compared blood levels of propranolol between those who had cardiovascular complications and those who did not.
Results
Two hundred patients were included in this study. The blood levels of propranolol were significantly higher in patients with hypotension, bradycardia, and prolonged QT intervals, with median values of 247.0 ng/mL (interquartile range [IQR], 56.5–333.8 ng/mL), 275.8 ng/mL (IQR, 154.3–486.4 ng/mL), and 159.0 ng/mL (IQR, 33.9–310.8 ng/mL), respectively. In the predictive analysis of cardiovascular complications using a receiver operating characteristic curve, the area under the curve was 0.729 with a cut-off value of 72.40 ng/mL (sensitivity, 0.667; specificity, 0.819). In addition, the correlation coefficient between blood levels and the amount of drug described during the history-taking at the time of presentation was 0.634, which was found to have a significantly higher relationship.
Conclusion
Because blood levels of propranolol can be used as predictors of exacerbation in patients with propranolol poisoning, patients with blood levels above 72.40 ng/dL require careful treatment and observation from their initial presentation at the emergency department.

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