On February 21, 2013, 6 elderly people collapsed abruptly after eating bean sprout bibimbab (boiled rice mixed with bean sprouts and seasoned with soybean sauce) at a countryside restaurant in the Chungbuk Province, Korea. Minutes after eating the meal, all of the patients lapsed into a state of stupor. Respiratory arrest developed in 2 patients; and one of two patients died of cardiac arrest. The autopsy identified methomyl and methanol in the deceased patient's gastric contents and in the remaining soybeanbean sauce seasoning. Five of the 6 patients ingested one spoonful of the soybeanbean sauce seasoning and survived, while one patient who died of cardiac arrest, ingested approximately two spoons. Symptoms of toxicity presented quickly in the subjects and progressed rapidly, including chest tightness, an unusual sensation in the pit of the stomach, dizziness, ataxia, and finally, collapse. Three patients who drank ethanol with the meal experienced only mild toxic symptoms. Our analysis of the clinical observations in these cases suggests that ingestion of methomyl pesticide and the additive toxicity of methanol may have been responsible for the intoxication.
Aged ; Cholinesterase Inhibitors/poisoning ; *Disease Outbreaks ; Ethanol ; Female ; Foodborne Diseases/*epidemiology ; Humans ; Insecticides/*poisoning ; Male ; Methanol/*poisoning ; Methomyl/*poisoning ; Republic of Korea/epidemiology

BACKGROUND: In korea the agricultural community widely uses organophosphorous, and organophosphorous poisonings are increasing every year. We compared change in activity of acetylcholinesterase and pseudocholinesterase by organophosphorous and by the interaction of ethanol and organophosphorous. We also compared the effect of reversible anticholinesterase drugs, physostigmine and neostigmine. The object of this study is to investigate the effects of several anticholinesterase drugs and on how ethanol influences the activity of cholinesterase. MATERIALS AND METHODS: Fifteen male university students were randomly selected, and blood samples were taken from the antecubital vein. The acetylcholinesterase in the RBC and the pseudocholinesterase in the serum were extracted and separated. The enzyme activity change was measured by the electrometric method. After adding acetylcholine, the pH change was measured with a pH meter. RESULTS AND CONCLUSION: Our results indicated that reversible anticholinesterase drugs decreased the cholinesterase activity more efficiently than organophosphorous. The acetyl cholinesterase and pseudocholinosterase activity were decreased by ethanol. When ethanol was added, oxime a cholinesterase activator, increased acetylcholinesterase activity but dose not increased pseudocholinesterase activity.
Acetylcholine ; Acetylcholinesterase ; Cholinesterase Inhibitors ; Cholinesterases* ; Ethanol* ; Humans ; Hydrogen-Ion Concentration ; Korea ; Male ; Neostigmine ; Physostigmine ; Poisoning ; Pseudocholinesterase ; Veins

Ethylene glycol is a widely used and readily available substance. Ethylene glycol ingestion does not cause direct toxicity; however, its metabolites are highly toxic and can be fatal even in trace amounts. Poisoning is best diagnosed through inquiry, but as an impaired state of consciousness is observed in most cases, poisoning must be suspected when a significantly elevated osmolar gap or high anion gap metabolic acidosis is found in blood tests. Hemodialysis and alcohol dehydrogenase inhibitors such as ethanol and fomepizole are a part of the basic treatment, and timely diagnosis and treatment are crucial because any delays can lead to death. However, there are few reported cases in Korea, and no report on the use of fomepizole. Herein, we report a case of acute renal failure caused by ethylene glycol poisoning that was treated with fomepizole and hemodialysis and present a literature review.
Acid-Base Equilibrium ; Acidosis ; Acute Kidney Injury* ; Alcohol Dehydrogenase ; Consciousness ; Diagnosis ; Eating ; Ethanol ; Ethylene Glycol* ; Hematologic Tests ; Korea ; Poisoning ; Renal Dialysis ; Renal Replacement Therapy*

BACKGROUND/AIMS: It is well known that alcohol enhances the toxicity of CCl4. We tried to establish an alcoholic liver cirrhosis model by administration of alcohol and CCl4 to rats. We also wanted to know the hepatoprotective effect of low doses of lipopolysaccharide(LPS) in this animal model. METHODS: Of 20 female adult rats, 8 were ingested with alcohol ad libitum(group 1) Another 6 were ingested with 10% alcohol and 50% 1mL/kg CCl4 intragastrically by Sonde twice a week(group 2) The remaining 6 were ingested with 10% alcohol, CCl4, and 0.1mg/kg LPS intraperitoneally twice a week(group 3) The fibrosis was evaluated semiquantitatively on a scale of 0(none) to 3(cirrhosis). RESULTS: 1) After 10 weks, septal fibrosis or cirrhosis was produced in 9 out of 12 rats in groups 2 and 3 but there was no fibrotic change in group 1. 2) There was no significant difference in pathological grading between groups 2 and 3. CONCLUSIONS: Hepatic fibrosis or cirrhosis can be sufficiently induced by alcohol and repetitive CCl4 ingestion for 10 weeks. We can not prove the hepatoprotective effect of low dose LPS by semiquantitative evaluation of pathological grading.
Animals ; Carbon Tetrachloride Poisoning/*complications ; English Abstract ; Ethanol/*toxicity ; Female ; Lipopolysaccharides/*administration & dosage ; Liver/pathology ; Liver Cirrhosis, Alcoholic/pathology/*prevention & control ; Rats ; Rats, Sprague-Dawley

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Institute Scientific Investigation(NISI), requested by every kind of law enforcement agencies during the year of 2004. NISI is located in Seoul, Korea and has three branches throughout the country. The Seoul NISI covers all legal autopsies in Seoul City, Incheon City and Kyunggi Province and some cases referred from other regions. This report aims to analyse various aspects of 3,051 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 2,214 cases(73%) and that of female 837(27%). Male was over twice more than female. The forties were 899 cases(29.5%), the thirties 561(18.4%), and these two decades occupied 47.9%. 2. Unnatural deaths were 1,816 cases(59.5%), natural 1,104(36.2%), and the unknown 131(4.3%). Among 1,816 unnatural deaths, suicide was 513(28.2%), homicide 414(22.8%), accident 505(27.8%), and the unclear 384(21.2%). Homicide occupied 38.4% of trauma, 62.9% of blunt force injury excluding traffic and fall-down injury, and 82.7% of sharp force injury. The homicide rate in asphyxia was 31.1%, but it went up to 67.7% excluding hanging. It showed only 0.4% percent of homicide in poisoning. 3. Traumatic deaths were 779 cases, occupying 42.9% of 1,816 unnatural deaths, followed by poisoning deaths(286 cases) and asphyxial deaths(283 cases). Blunt trauma was 240 cases(30.8%) and the leading cause of death in traumatic death. Poisoning was 286 cases, among which the ethanols were dominant( 76cases). Thermal injuries were 162 cases, electrocution 27 cases, and starvation/neglect 7 cases and 17 cases were directly due to medical procedures. 4. Among 1,104 natural deaths, heart diseases were 522 cases(47.3%), and vascular diseases 182(16.5%), and these two categories were added up to 704(63.8%). 5. Child deaths under the age of 10 were 147 cases. Homicide was 31 cases(51.7%) out of 60 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 48 cases(32.7%).
Asphyxia ; Autopsy* ; Cause of Death ; Child ; Ethanol ; Female ; Gyeonggi-do ; Heart Diseases ; Homicide ; Humans ; Incheon ; Infant, Newborn ; Korea ; Law Enforcement ; Male ; Parturition ; Poisoning ; Seoul ; Suicide ; Vascular Diseases

PURPOSE: In the management of acute poisoning, the anion gap and the osmol gap are easily derived from serum laboratory findings and arterial blood gas analysis. The anion gap is known to be increased by the effects of the toxic material itself and secondary complications or by an exacerbation of an underlying illness. The osmol gap can be increased by the presence of osmotically active materials in the body, such as alcohol, glycols and mannitol. This study was proposed to investigate the significance of an increased anion gap in acutely poisoned patients and the effect of alcohol ingestion in increasing the osmol gap, which might help to understand the significance of an increased osmol gap in acutely poisoned patients. METHODS: A retrospective chart review of poisoned patients who had visited the emergency departments of the Anam and the Ansan hospitals of Korea University was used in this study. Serum laboratory findings and arterial blood gas analysis were used to measure the anion gap and the osmol gap. Patients were categorized into a non anion-gap group versus a high anion-gap group and a normal osmolgap group versus a high osmol-gap group. Frequency of toxidrome, blood pH and drinking history were included to evaluate the relations between the groups. RESULTS: Of 204 patients, 195 patients who completed the tests were included in the study. In the 99 patients with a high anion-gap, 38 (38.38%) patients showed development of toxidrome. In the 96 patients with a non anion-gap, only 15 (15.62%) patients showed toxidrome. Forty-six (80.7%) of the 57 patients with a high osmol-gap and 20 (22.2%) of the 90 patients with a normal osmol-gap had a history of drinking. CONCLUSION: In poisoned patients, the group with a higher anion gap showed a higher frequency of toxidrome. This suggests that in the management of a poisoning victim with an uncertain history, should a high anion gap be found, an intense observation and evaluation is necessary to identify the cause. An increase in the osmol gap in poisoned patients is generally considered to be from alcohol ingestion. Thus, for a patient with an increased osmol gap, measurement of the serum ethanol level should be done to exclude the effect of alcohol.
Acid-Base Equilibrium* ; Blood Gas Analysis ; Drinking ; Eating ; Emergency Service, Hospital ; Ethanol ; Glycols ; Gyeonggi-do ; Humans ; Hydrogen-Ion Concentration ; Korea ; Mannitol ; Poisoning* ; Retrospective Studies

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Institute Scientific Investigation (NISI), requested by every kind of law enforcement agencies during the year of 2003. NISI is located in Seoul, Korea and has three branches throughout the country. The Seoul NISI covers all legal autopsies in Seoul City, Incheon City and Kyunggi Province and some cases referred from other regions. This report aims to analyse various aspects of 3,167 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 2,311 cases (73%) and that of female 856 (27%). Male was over twice more than female. The forties were 838 cases (26.5%), the thirties 700 (22.1%), and these two decades occupied 48.6%. 2. Unnatural deaths were 1,941 cases (61.3%), natural 1,133 (35.8%), and the unknown 93 (2.9%). Among 1,941 unnatural deaths, suicide was 522 (26.9%), homicide 457 (23.5%), accident 576 (29.7%), and the unclear 386 (19.9%). Homicide occupied 37.1% of trauma, 57.4% of blunt force injury excluding traffic and fall-down injury, and 81.9% of sharp force injury. The homicide rate in asphyxia was 35.5%, but it went up to 69.6% excluding hanging. It showed only 1.0% percent of homicide in poisoning. 3. Traumatic deaths were 902 cases, occupying 46.5% of 1,941 unnatural deaths, followed by poisoning deaths (289 cases) and asphyxial deaths (286 cases). Blunt trauma was 324 cases (35.9%) and the leading cause of death in traumatic death. Poisoning was 289 cases, among which the ethanols were dominant (99cases). Thermal injuries were 192 cases, electrocution 24 cases, and starvation/neglect 11 cases. and 15 cases were directly due to medical procedures.4. Among 1,133 natural deaths, heart diseases were 490 cases (43.2%), and vascular diseases 210 (18.5%), and these two categories were added up to 700 (61.7%). 5. Child deaths under the age of 10 were 135 cases. Homicide was 42 cases (63.6%) out of 60 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 52 cases (38.5%).
Asphyxia ; Autopsy* ; Cause of Death ; Child ; Ethanol ; Female ; Gyeonggi-do ; Heart Diseases ; Homicide ; Humans ; Incheon ; Infant, Newborn ; Korea ; Law Enforcement ; Male ; Parturition ; Poisoning ; Seoul ; Suicide ; Vascular Diseases

BACKGROUND: Methyl alcohol poisoning has been mainly reported in community. Two cases of methyl alcohol poisoning occurred in a small-sized subcontracted factory which manufactured smartphone parts in Korea. CASE PRESENTATION: One young female patient presented with dyspnea and visual disturbance. Another young male patient presented with visual disturbance and myalgia. They treated with sodium bicarbonate infusion and hemodialysis for metabolic acidosis. In addition, he received ethyl alcohol per oral treatment. Her and his urinary methyl alcohol concentration was detected as 7.632 mg/L, 46.8 mg/L, respectively, although they were treated hemodialysis. Results of the working environment measurement showed that the concentration of methyl alcohol (1030.1–2220.5 ppm) in the air exceeded the time weighted average (200 ppm). They were diagnosed with optic neuropathy due to methyl alcohol poisoning and still have visual impairment. CONCLUSIONS: Workers who hired as dispatched employees in a small-sized subcontracted factory were exposed to high concentrations of methyl alcohol. The workplace had poor ventilation system. In addition, workers did not wear proper personal protect equipment. Working environment measurement and annual chekups for workers were not performed. They were in a blind spot to occupational safety and health. More attention is needed to protect vulnerable workers’ health.
Acidosis ; Aluminum* ; Dyspnea ; Ethanol ; Female ; Humans ; Inhalation* ; Korea ; Male ; Methanol* ; Myalgia ; Occupational Health ; Optic Disk ; Optic Nerve Diseases ; Poisoning ; Renal Dialysis ; Smartphone ; Sodium Bicarbonate ; Ventilation ; Vision Disorders

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Institute Scientific Investigation (NISI), requested by every kind of law enforcement agencies during the year of 2005. NISI is located in Seoul, Korea and has three branches throughout the country. The Seoul NISI covers all legal autopsies in Seoul City, Incheon City and Kyunggi Province and some cases referred from other regions. This report aims to analyse various aspects of 2,851 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 2,007 cases (70.4%) and that of female 844 (29.6%). Male was over twice more than female. The forties were 807 cases (28.3%), the thirties 573 (20.1%), and these two decades occupied 48.4%. 2. Unnatural deaths were 1,716 cases (60.2%), natural 1011 (35.5%), and the unknown 124 (4.3%). Among 1,716 unnatural deaths, suicide was 497 (29.0%), homicide 426 (24.9%), accident 510 (29.6%), and the unclear 283 (16.5%). Homicide occupied 42.0% of trauma, 75.6% of blunt force injury excluding traffic and fall-down injury, and 85.5% of sharp force injury. The homicide rate in asphyxia was 31.1%, but it went up to 60.1% excluding hanging. It showed only 0.4% percent of homicide in poisoning. 3. Traumatic deaths were 716 cases, occupying 41.7% of 1,716 unnatural deaths, followed by asphyxial deaths(296 cases). Blunt trauma was 205 cases (28.6%) and the leading cause of death in traumatic death. Poisoning was 229 cases, among which the ethanols were dominant (58cases). Thermal injuries were 198 cases, electrocution 20 cases, and starvation/neglect 14 cases. and 18 cases were directly due to medical procedures. 4. Among 1,011 natural deaths, heart diseases were 481 cases (47.6%), and vascular diseases 193 (19.1%), and these two categories were added up to 674 (66.7%). 5. Child deaths under the age of 10 were 129 cases. Homicide was 40 cases (62.5%) out of 64 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 41 cases(31.8%)
Asphyxia ; Autopsy* ; Cause of Death ; Child ; Ethanol ; Female ; Gyeonggi-do ; Heart Diseases ; Homicide ; Humans ; Incheon ; Infant, Newborn ; Korea ; Law Enforcement ; Male ; Parturition ; Poisoning ; Seoul ; Suicide ; Vascular Diseases

OBJECTIVETo study the influence and mechanism of acute ethanol intoxication (AEI) on rat neuronal apoptosis after severe traumatic brain injury (TBI).

METHODSNinety-six Sprague-Dawley rats were randomly divided into four groups: normal control, AEI-only, TBI-only and TBI+AEI (n equal to 24 for each). Severe TBI model was developed according to Feeney's method. Rats in TBI+AEI group were firstly subjected to AEI, and then suffered head trauma. In each group, animals were sacrificed at 6 h, 24 h, 72 h, and 168 h after TBI. The level of neuronal apoptosis and the expression of Bcl-2 protein were determined by TUNEL assay and immunohistochemical method, respectively.

RESULTSApoptotic cells mainly distributed in the cortex and white matter around the damaged area. Neuronal apoptosis significantly increased at 6 h after trauma and peaked at 72 h. Both the level of neuronal apoptosis and expression of Bcl-2 protein in TBI-only group and TBI+AEI group were higher than those in control group (P less than 0.05). Compared with TBI-only group, the two indexes were much higher in TBI+AEI group at all time points (P less than 0.05).

CONCLUSIONOur findings suggest that AEI can increase neuronal apoptosis after severe TBI.

Animals ; Apoptosis ; drug effects ; Brain Injuries ; Cerebral Cortex ; cytology ; Disease Models, Animal ; Ethanol ; poisoning ; Immunohistochemistry ; In Situ Nick-End Labeling ; Male ; Neurons ; physiology ; Prosencephalon ; cytology ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Rats ; Rats, Sprague-Dawley