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.

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.

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.

Licorice is a perennial herb belonging to the legume family that mainly grows in northeastern China, Mongolia, Siberia, and other regions. It is used in traditional medicine in the form of dried roots in the East and the West. The main active component of licorice, glycyrrhizin, is known to produce mineralocorticoid effects when consumed chronically, which can lead to apparent mineralocorticoid excess syndrome. Herein, we present the case of a 72-year-old woman who was admitted to the emergency room with severe generalized weakness and difficulty keeping her neck upright, which had developed after daily consumption of licorice-infused water for the past 2 months. Blood tests revealed metabolic alkalosis and severe hypokalemia, and an electrocardiogram showed ventricular bigeminy. The patient was treated with daily potassium and spironolactone supplements, leading to a significant improvement in muscle strength after a week. One week later, the patient was discharged, showing rare ventricular premature contractions on electrocardiography, but with no specific complaints. Chronic licorice ingestion leading to hypokalemia and muscle weakness can be life-threatening, necessitating the discontinuation of the causative agent, close monitoring, and cautious supplementation of potassium and spironolactone as treatment.

Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits. Methods: A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department. Results: The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm. Conclusion Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.