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- Clinical Experience with Continuous Renal Replacement Therapy as a Method of Extracorporeal Elimination and as performed by Emergency Room Physicians for Patients with Poisoning
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Jung-Hwan Ahn, Sang-Cheon Choi, Yoon-Seok Jung, Young-Gi Min
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J Korean Soc Clin Toxicol. 2009;7(2):150-155. Published online December 31, 2009
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Abstract
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- Purpose: Extracorporeal elimination of drugs is a critical part of managing poisonings, although the indications and optimal method remain a matter of debate. The aim of this study is to report our clinical experiences with continuous renal replacement therapy (CRRT), as performed by emergency room physicians, as method of extracorporeal drug elimination in patients with poisoning. Methods: This study was a retrospective study of the consecutive patients who underwent CRRT, as performed by an emergency room physician, for acute poisoning. The patient characteristics, the kinds of drugs and the method of extracorporeal elimination were analyzed by reviewing the patients' charts. Results: During eleven months, 26 patients with acute poisoning underwent extracorporeal elimination (2 patients; intermittent hemodialysis, 24 patients; CRRT). The mean time from the decision to performing extracorporeal elimination was $206.0{pm}36.8$ minutes for intermittent hemodialysis, $62.9{pm}8.5$ minutes for continuous venoveno-hemodiafiltration (CVVHDF) and $56.6{pm}6.8$ minutes for charcoal hemoperfusion. For the patients with CRRT, CVVHDF was conducted in 10 patients (3 patients; valproic acid, 2 patients; Lithium, 1 patient; salicylates, 1 patient; methanol) and charcoal hemoperfusion by using CRRT was done in 14 patients (13 patients; paraquat, 1 patient; dapsone). For the 12 patients who required hemodialysis due to severe poisoning, 7 patients underwent CRRT because of their unstable vital signs. Conclusion: CRRT was an effective method of extracorporeal drug elimination in patients with acute poisoning, and especially for the cases with unstable vital sign and for those patients who required an early start of extracorporeal elimination according to the characteristics of the drug. (ED note: the writing of the abstract was not clear. Check it carefully.)
- Salicylate Poisoning After Accidental Ingestion of Chinese Medicated Oil
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Soo-Youl Lee, Ji-Yeong Ryu, Gyu-Chong Cho, Ji-Young You
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J Korean Soc Clin Toxicol. 2007;5(2):138-141. Published online December 31, 2007
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Abstract
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- Because of the ready availability of aspirin, salicylate poisoning remains a common problem in many countries. Another potential source of salicylate poisoning is medicated oil containing methyl salicylate (oil of wintergreen). Methyl salicylate poses a much greater safety threat than aspirin tablets because of its liquid, concentrated form and high lipid solubility. Because of this danger, the toxic potential of medicated oil containing methyl salicylate should be fully appreciated both by physicians and by the general public. We encountered two cases of salicylate poisoning resulting from accidental ingestion of Chinese medicated oil. We report these cases along with a review of the literature.
- Transient Change of Electrocardiogram in Two Young Women With Salicylate Intoxication - Two Cases Report -
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Je-Sung You, Jong-Woo Park, Young-Hwan Choi, Young-Soon Cho, Kwang-Hyun Cho, Jun-Seok Park, Sung-Pil Chung, Hahn-Shick Lee
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J Korean Soc Clin Toxicol. 2006;4(1):44-47. Published online June 30, 2006
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Abstract
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- Symptoms of aspirin overdose may vary from acid-base disturbance, electrolyte abnormality, non-cardiogenic pulmonary edema, chemical hepatitis, seizure to cardiac toxicity. Cardiac adverse effects from aspirin are uncommon but there are reports of arrhythmia, cardiopulmonary arrest, and myocardial infarction. We report 2 cases of young women with aspirin overdose who exhibited ischemic changes on their ECGs a few hours after the ingestion with spontaneous recovery in a few days. First case, a 29 year old woman, presented to the emergency department 6 hours after ingesting 250 tablets of aspirin (325 mg/T). On examination, the temperature was $36.3^{circ}C$: blood pressure, 105/72mmHg; Pulse, 111/min and respiratory rate, 24/min. Second case, a 27 year old woman, an hour after ingesting 60 tablets (325mg/T). On examination, the temperature was $36.0^{circ}C$: blood pressure, 102/72 mmHg; pulse, 89/min and respiratory rate, 25/min. In both cases, ECG after 6 hours of ingestion had sinus tachycardia and developed T wave inversion on the anterior leads in the following ECGs. Their initial serum salicylate levels after 6 hours of ingestion were 71.2 mg/dL and 28.4 mg/dL respectively. These salicylate levels were resolving when these ECGs were observed. The ECG changes resolved in the following days and they were discharged without any further symptoms. Further studies are needed, but for the time being, when dealing with salicylate overdose, transient cardiac depression should be kept in mind to avoid adverse ischemic cardiac events.