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.

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.

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.

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.

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.

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.

Various symptoms manifest after organophosphate intoxication due to muscarinic, nicotinic, and central nervous system effects. Complications are common, and morbidity occurs due to respiratory center depression, cardiovascular complications, aspiration pneumonia, general weakness, and neurological symptoms. Some studies have reported a statistically significant association between organophosphate intoxication and deep vein thrombosis. However, cases of pulmonary thromboembolism (PTE) resulting from organophosphate poisoning are very rare. A 45-year-old male patient was transferred to our hospital after ingesting an unknown amount of an insecticide and receiving 6 L of gastric lavage at a local hospital. Other than nausea, no symptoms (e.g., dyspnea) were present, but a hemodynamic test showed an elevated lactic acid level, and metabolic acidosis worsened over time. Accordingly, we conducted initial treatment including continuous renal replacement therapy. After 7 hours, the poisoning analysis result was confirmed, and lambda-cyhalothrin and chlorpyrifos (0.441 µg/mL and 0.401 µg/mL, respectively) were detected. We introduced pralidoxime. Although no increase in pseudocholinesterase was found during hospitalization, continuous renal replacement therapy and pralidoxime were discontinued because the patient did not show symptoms of intermediate syndrome, including dyspnea and altered consciousness. The patient complained of abdominal pain on hospital day 8. Abdominal computed tomography was performed to evaluate the possibility of a corrosive injury to the stomach or esophagus, and we confirmed PTE. The D-dimer level was 1.96 mg/L (normal range, 0–0.55 mg/dL). A radiologic examination showed a PTE in the main pulmonary artery leading to the segmental pulmonary artery. After heparinization, the patient was discharged after being prescribed a vitamin K-independent oral anticoagulant. Through this case, we would like to emphasize the need for a thorough evaluation of clinical symptoms because atypical symptoms can occur after poisoning with organophosphate pesticides.

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.

Purpose: The Korea University Anam Hospital Seoul Poison Control Center (SeoulPCC) was established in accordance with Seoul Metropolitan Government Ordinance No. 7524 “Seoul Metropolitan Government Ordinance on the Prevention of Toxic Substances Poisoning and Accident Safety.” Herein, the center’s annual performance in terms of project results and consultation information for 2022 are reported. Methods: SeoulPCC operates a helpline (Help Call, 1855-2221) that the general public can use from 9:00 AM to 5:00 PM on weekdays, as well as chatting and chatbot counseling through KakaoTalk’s “Seoul Poison Control Center,” and one-on-one online counseling through the website. Additionally, it has constructed a system for communicating with the general public through social media. Poisoning disease information collected from SeoulPCC from January to December 2022 was analyzed according to the number of requests, age of exposure, gender, location, and reason. Requests from the general public were summarized, and a brief image presenting information on poisoning disease-related consultations was produced. Results: SeoulPCC has a database containing information on 188,065 toxic substances collected by public institutions and provides this information to the general public and medical staff through its website. In 2022, consultations were performed through phone calls and SNS (social networking service) for 577 cases of poison information and first aid treatment due to exposure to toxic substances. There were 1,431 instances of providing poison information services. The annual requests included 512 exposure cases and 65 non-exposure cases. Furthermore, 366 cases were in Seoul, 145 cases were outside of Seoul, and 66 had an unknown location. The exposure cases included 161 requests from the general public and 351 requests from medical staff. Conclusion This is the first annual report in Korea to analyze the occurrence of poisoning based on consultations. It is of major significance that this report serves as a starting point for identifying and tracking the aspects and characteristics of poisoning cases in the pre-hospital stage. In the future, poisoning-related disease information provided through consultations and at the emergency room should be linked, and through real-time collection and analysis, this information should be used as basic data for poisoning disease management policies.

Purpose: The purpose of this study was to determine whether deoxyhemoglobin changes were associated with admission duration in carbon monoxide (CO)-poisoned patients. Methods: This retrospective study included 181 patients who were able to breathe by themselves after CO poisoning. Arterial blood gas analysis was performed to measure their deoxyhemoglobin levels. Their baseline characteristics and clinical outcomes during hospitalization in the emergency department (ED) were collected and compared. To assess changes in deoxyhemoglobin levels, blood samples were taken immediately after patients presented to the ED and then again after 6 hours. For statistical analysis, logistic regression was utilized to determine the effect of deoxyhemoglobin changes on admission duration. Results: The incidence rates of hypocapnia and hypoxemia at presentation after acute CO poisoning were 28.7% and 43.6%, respectively. Moreover, the magnitude of increasing deoxyhemoglobin levels in patients with hypoxemia (2.1 [1.7–3.1], p<0.001) and changes in deoxyhemoglobin levels appeared to have an impact on the length of hospitalization in the ED (odds ratio, 1.722; 95% confidence interval, 0.547–0.952; p<0.001). Conclusion In patients with acute CO poisoning, deoxyhemoglobin levels appeared to increase in those with hypoxemia, which in turn was associated with prolonged hospitalization.