Glyphosate herbicides, which are widely used worldwide, are known to have low toxicity. However, excessive intake may cause serious life-threatening complications; therefore, caution is needed when using them. A 51-year-old man visited the hospital after ingesting glyphosate herbicide. At the time of admission, his vital signs were 80/60 mmHg-115/min-20/min-37.3℃. Electrocardiogram (ECG) showed QRS widening and corrected QT (QTc) prolongation, and blood tests showed metabolic acidosis. Treatment with gastric lavage, activated charcoal, sodium bicarbonate and intravenous lipid emulsion therapy was performed. After 2 hours, his blood pressure increased to 130/90 mg, and no QRS widening was observed on ECG.
Acidosis ; Blood Pressure ; Charcoal ; Electrocardiography ; Gastric Lavage ; Hematologic Tests ; Herbicides ; Humans ; Middle Aged ; Poisoning ; Sodium Bicarbonate ; Vital Signs

PURPOSE: To report a case of toxic optic neuropathy caused by chlorfenapyr ingestion accompanied by central nervous system involvement. CASE SUMMARY: A 44-year-old female visited our clinic complaining of reduced visual acuity in both eyes for 7 days. She had ingested a mouthful of chlorfenapyr for a suicide attempt 2 weeks prior to the visit. Gastric lavage was performed immediately after ingestion at the other hospital. Her best-corrected visual acuity was finger count 30 cm in the right eye and hand motion in the left eye. Both pupils were dilated by 5.0 mm and the response to light was sluggish in both eyes. A relative afferent pupillary defect was detected in her left eye. Funduscopy revealed optic disc swelling in both eyes. Magnetic resonance imaging of the brain showed a symmetric hyper-intense signal in the white matter tract including the internal capsule, corpus callosum, middle cerebellar peduncle, and brainstem. The patient was diagnosed with toxic optic neuropathy induced by chlorfenapyr ingestion, and underwent high-dose intravenous corticosteroid pulse therapy. Three days later, the best-corrected visual acuity was no light perception in both eyes. Three months later, optic atrophy was observed in both eyes. Optical coherence tomography revealed a reduction in the thicknesses of the retinal nerve fiber layer and ganglion cell and inner plexiform layer in the macular area. CONCLUSIONS: Ingestion of even a small amount of chlorfenapyr can cause severe optic nerve damage through the latent period, despite prompt lavage and high-dose steroid treatment.
Adult ; Brain ; Brain Stem ; Central Nervous System ; Corpus Callosum ; Eating ; Female ; Fingers ; Ganglion Cysts ; Gastric Lavage ; Hand ; Humans ; Internal Capsule ; Magnetic Resonance Imaging ; Middle Cerebellar Peduncle ; Mouth ; Nerve Fibers ; Optic Atrophy ; Optic Nerve ; Optic Nerve Diseases ; Poisoning ; Pupil ; Pupil Disorders ; Retinaldehyde ; Suicide ; Therapeutic Irrigation ; Tomography, Optical Coherence ; Visual Acuity ; White Matter

Chronic silica nephropathy has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease, and end-stage renal disease. On the other hand, acute intentional exposure is extremely rare. The authors' experienced a 44-year-old man who took rapid cement hardener (sodium silicate) in a suicide attempt whilst in a drunken state. He visited the emergency department approximately 1 hour after ingestion. Information on the material was obtained after 3 L gastric lavage. The patient complained of a sore throat, epigastric pain, and swollen to blood tinged vomitus. Proton pump inhibitors, hemostats, steroid, and fluids were administered. Nine hours after ingestion, he was administered 200 mL hematochezia. Immediately after, a gastroenterologist performed an endoscopic procedure that revealed diffuse hyperemic mucosa with a color change and variable sized ulceration in the esophagus, whole stomach, and duodenal 2(nd) portion. Approximately 35 hours later, persistent oligouria and progressive worsening of the renal function parameters (BUN/Cr from 12.2/1.2 to 67.5/6.6 mg/dL) occurred requiring hemodialysis. The patient underwent 8 sessions of hemodialysis for 1 month and the BUN/Cr level increased to 143.2/11.2 mg/dL and decreased to 7.6/1.5 mg/dL. He was discharged safely from the hospital. Follow up endoscopy revealed a severe esophageal stricture and he underwent endoscopic bougie dilatation. Acute cement hardener (sodium silicate) intoxication can cause renal failure and strong caustic mucosal injury. Therefore, it is important to consider early hemodialysis and treatment to prevent gastrointestinal injury and remote esophageal stricture.
Acute Kidney Injury* ; Adult ; Caustics ; Dilatation ; Drug Overdose ; Eating ; Emergency Service, Hospital ; Endoscopy ; Esophageal Stenosis ; Esophagus ; Follow-Up Studies ; Gastric Lavage ; Gastrointestinal Hemorrhage ; Hand ; Humans ; Kidney ; Kidney Failure, Chronic ; Mucous Membrane ; Pharyngitis ; Proton Pump Inhibitors ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Silicates ; Silicon Dioxide ; Stomach ; Suicide ; Tolnaftate ; Ulcer

PURPOSE: The number of glyphosate and glufosinate intoxication cases are increasing in Korea. This study was undertaken is to compare the clinical manifestations of poisoning by these two herbicides and to document severities and clinical outcomes. METHODS: We retrospectively evaluated cases of glyphosate or glufosinate intoxication among patients that visited our emergency department between January 1, 2013, and December 31, 2017. Incidences of intoxications were analyzed over this five year period, and underlying diseases, transportation, mental state, shock occurrence, inotropics, gastric lavage, charcoal administration, intubation and ventilator therapy, and hemodialysis were investigated. In addition, we included transfer to the intensive care unit, incidences of pneumonia and of other complications, death, and hopeless discharge. RESULTS: There were 119 cases of glyphosate intoxication and 42 of glufosinate intoxication. Levels of consciousness were lower for glufosinate and vasopressor usage was higher due to a high shock rate (p=0.019). In addition, many patients were referred to the ICU for intubation and ventilation. The incidences of pneumonia and of other complications were significantly higher for glufosinate. CONCLUSION: Overall glufosinate intoxication was found to be more severe than glyphosate intoxication as determined by complication and ICU admission rates.
Charcoal ; Consciousness ; Emergency Service, Hospital ; Gastric Lavage ; Herbicides ; Humans ; Incidence ; Intensive Care Units ; Intubation ; Korea ; Pneumonia ; Poisoning* ; Renal Dialysis ; Retrospective Studies ; Shock ; Transportation ; Ventilation ; Ventilators, Mechanical

BACKGROUND/AIMS: The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy. METHODS: We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage). The primary outcome was satisfactory visualization. Secondary outcomes included identification of a bleeding source, the success rate of hemostasis, duration of endoscopy, complications related to erythromycin infusion or gastric lavage, number of transfused blood units, rebleeding rate, and bleeding-related mortality. RESULTS: A total of 43 patients were randomly assigned: 14 patients in the erythromycin group; 15 patients in the gastric lavage group; and 14 patients in the erythromycin + gastric lavage group. Overall satisfactory visualization was achieved in 81% of patients: 92.8% in the erythromycin group; 60.0% in the gastric lavage group; and 92.9% in the erythromycin + gastric lavage group, respectively (p = 0.055). The identification of a bleeding source was possible in all cases. The success rate of hemostasis, duration of endoscopy, and number of transfused blood units did not significantly differ between groups. There were no complications. Rebleeding occurred in three patients (7.0%). Bleeding-related mortality was not reported. CONCLUSIONS: Intravenous erythromycin infusion prior to emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding seems to provide satisfactory endoscopic visualization.
Emergencies ; Endoscopy* ; Erythromycin* ; Gastric Lavage ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Hemostasis ; Humans ; Melena ; Mortality ; Pilot Projects ; Prospective Studies

Cases of the cement ingestion are rare. This paper reports the successful management of cement ingestion with gastric lavage and endoscopic washing. A 69-year-old man who had a stuporous mentality and seizures visited the local emergency room. He was found in his room with cement powder and several liquor bottles. He underwent a gastric lavage in the prior emergency room, which showed evidence of cement ingestion. He was transferred to the emergency center after primary care. Cement mixed with water is a strong alkali and acts as a caustic agent in the gastrointestinal tract. In addition, it can become hard in a few hours and sometimes produce gastric bezoars. Generally, gastric lavage is not recommended for caustic agents. On the other hand, gastric lavage and endoscopic washing was performed repeatedly for successful removal despite the physical and chemical characteristics of cement. Therefore, the active removal of ingested cement by both gastric lavage and endoscopic washing is recommended.
Aged ; Alkalies ; Bezoars ; Eating* ; Emergencies ; Emergency Service, Hospital ; Endoscopy ; Gastric Lavage ; Gastrointestinal Tract ; Hand ; Humans ; Primary Health Care ; Seizures ; Stupor ; Water

Pneumatosis cystoides intestinalis and portomesenteric venous gas are uncommon radiological findings, but are found commonly in cases of bowel ischemia, or as a result of various non-ischemic conditions. A 72-year-old man visited an emergency center with altered mental status 2 hours after ingestion of an unknown pesticide. On physical examination, he showed the characteristic hydrocarbon or garlic-like odor, miotic pupils with no response to light, rhinorrhea, shallow respiration, bronchorrhea, and sweating over his face, chest and abdomen. Laboratory results revealed decreased serum cholinesterase, as well as elevated amylase and lipase level. We made the clinical diagnosis of organophosphate poisoning in this patient based on the clinical features, duration of symptoms and signs, and level of serum cholinesterase. Activated charcoal, fluid, and antidotes were administered after gastric lavage. A computerized tomography scan of the abdomen with intravenous contrast showed acute pancreatitis, poor enhancement of the small bowel, pneumatosis cystoides intestinalis, portomesenteric venous gas and ascites. Emergent laparotomy could not be performed because of his poor physical condition and refusal of treatment by his family. The possible mechanisms were believed to be direct intestinal mucosal damage by pancreatic enzymes and secondary mucosal disruption due to bowel ischemia caused by shock and the use of inotropics. Physicians should be warned about the possibility of pneumatosis cystoides intestinalis and portomesenteric venous gas as a complication of pancreatitis following anticholinesterase poisoning.
Abdomen ; Aged ; Amylases ; Antidotes ; Ascites ; Charcoal ; Cholinesterases ; Diagnosis ; Eating ; Emergencies ; Gastric Lavage ; Humans ; Ischemia ; Laparotomy ; Lipase ; Odors ; Organophosphate Poisoning ; Pancreatitis ; Physical Examination ; Pneumatosis Cystoides Intestinalis ; Poisoning* ; Pupil ; Respiration ; Shock ; Sweat ; Sweating ; Thorax ; Treatment Refusal

PURPOSE: Activated charcoal (AC) has been widely used as a universal antidote. Currently, emergency medical centers in Korea cannot administer AC due to discontinuation of the supply of commercial ready-mixed AC suspension. This study was conducted to investigate the proportion of emergency medical centers that administer AC to poisoning patients and provide basic information for emergency physicians and toxicologists. METHODS: A prospective telephone survey of all of the included emergency medical institutions was conducted. The type of emergency medical institution, average annual number of patients admitted to the emergency department, annual average number of patients who were poisoned and whether the hospital currently utilizes gastric lavage and administration of AC were determined. RESULTS: AC was administered to poisoning patients in 40% of regional emergency medical centers, 59.3% of local emergency medical centers, and 45.9% of local emergency medical rooms. Overall, 37% of total emergency medical institutions did not administer AC due to discontinuation of the commercial ready-mixed AC suspension. Additionally, 77% of emergency physicians in institutions without AC knew AC is necessary for poisoning patients. The rate of vomiting experienced by the medical staff according to types of charcoal showed that the average rate of vomiting was 33% for commercial ready-mixed activated charcoal suspension and 51% for self-prepared charcoal powder (p=0.02). CONCLUSION: AC should be secured promptly in emergency medical institutions. Before the supply of commercial ready-mixed AC suspension becomes again it is essential to develop a standardized regimen for self-preparation of charcoal powder and to educate emergency physicians and toxicologists to its use.
Charcoal* ; Emergencies* ; Emergency Service, Hospital ; Gastric Lavage ; Humans ; Korea* ; Medical Staff ; Poisoning* ; Prospective Studies ; Telephone ; Vomiting

Bentazone is classified as a moderately hazardous (class II) herbicide by the World Health Organization. A 53-year-old Korean woman was transferred to the emergency department after a suicide attempt using approximately 500 mL of bentazone one hour prior to admission. Upon admission, she was alert and tachycardia of 125/min was observed. She was treated with gastric lavage and activated charcoal, during which she experienced diarrhea. Two hours after bentazone ingestion, cardiac arrest and muscle rigidity throughout the body occurred. Cardiopulmonary resuscitation was immediately started. Endotracheal intubation after administration of a muscle relaxant (succinylcholine) was unsuccessful because of temporomandibular joint muscle rigidity. Surgical cricothyroidotomy was performed by the emergency physician, but the patient was not resuscitated. For cardiac arrest patients with muscle rigidity caused by bentazone overdose, endotracheal intubation may be challenging because of muscle rigidity, despite appropriate use of muscle relaxants. Early surgical cricothyroidotomy may be the preferred method of airway management in these patients.
Airway Management ; Cardiopulmonary Resuscitation* ; Charcoal ; Diarrhea ; Drug Overdose ; Eating ; Emergencies ; Emergency Service, Hospital ; Fatal Outcome ; Female ; Gastric Lavage ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Methods ; Middle Aged ; Muscle Rigidity ; Suicide ; Tachycardia ; Temporomandibular Joint ; World Health Organization

Dehumidifying agents are commonly used to remove moisture and odors and are not meant for oral ingestion. The hazards of accidental oral ingestion of dehumidifying agents are not well known. A 31-year-old man with autism drank the liquid desiccant contained in the barrel of a dehumidifier while sleepwalking. The desiccant mainly consisted of calcium chloride. He was taken to the emergency center with persistent vomiting and underwent gastric lavage. The patient was treated for hypercalcemia due to calcium chloride poisoning. He eventually died of multiple organ failure. Autopsy findings were as follows: acute suppurative pneumonia, intra-abdominal inflammation, liver necrosis, acute pancreatitis, and gastrointestinal hemorrhage. Calcium chloride has relatively low toxicity; however, when ingested orally, it can cause severe internal damage, and even death. We suggest active preventive measures to ensure the safe use of dehumidifying agents.
Adult ; Autistic Disorder ; Autopsy ; Calcium Chloride ; Eating ; Emergencies ; Gastric Lavage ; Gastrointestinal Hemorrhage ; Humans ; Hypercalcemia ; Inflammation ; Liver ; Multiple Organ Failure ; Necrosis ; Odors ; Pancreatitis ; Pneumonia ; Poisoning ; Silica Gel ; Somnambulism ; Vomiting