No abstract available.

No abstract available.
Drug Interactions*

Acute organophosphate (OP) poisoning produces cholinergic symptoms resulting from the inhibition of cholinesterase, and the overstimulation of muscarinic and nicotinic receptors in the synapses. The dominant clinical features of acute cholinergic toxicity include bradycardia, miosis, lacrimation, salivation, bronchorrhea, and bronchospasm. All symptomatic patients should receive therapy with oxygen, atropine, and pralidoxime. Atropine works as a physiologic antidote by competitively occupying muscarinic receptor sites, reducing the effects of excessive acetylcholine. Atropine should be immediately administered, and the dose can be titrated according to the severity of OP poisoning. A large dose may be necessary to overcome the excessive cholinergic state in case of severe poisoning. Pralidoxime is a biochemical antidote that reactivates acetylcholinesterase by removing OP from it. It is effective in treating both muscarinic and nicotinic symptoms. After some period of time, the acetylcholinesterase-OP compound undergoes a conformational change, known as aging, which renders the enzyme irreversibly resistant to reactivation by a pralidoxime. There has been a great deal of controversy over the effectiveness of pralidoxime in acute OP poisoning. However, it may be beneficial to administer pralidoxime for a sufficient period in case of severe poisoning with a large quantity of OP, which is common in Korea.
Acetylcholine ; Acetylcholinesterase ; Aging ; Atropine* ; Bradycardia ; Bronchial Spasm ; Cholinesterases ; Humans ; Korea ; Miosis ; Oxygen ; Poisoning* ; Pralidoxime Compounds ; Receptors, Muscarinic ; Receptors, Nicotinic ; Salivation ; Synapses

In mass casualty situation due to radiological accidents, it is important to start aggressive management with rapid triage decisions. External contamination needs immediate decontamination and internal contamination should be treated with special expertise and equipment to prevent the rapid uptake of radionuclides by target organs. Acute radiation syndrome shows a sequence of events that varies with the severity of the exposure. More severe exposures generally lead to more rapid onset of symptoms and severe clinical findings. After the massive exposure, various systems of the body reflect their severe damages that can lead to death within hours or up to several months. The disease progression has classically been divided into four stages: prodromal, latent, manifest illness, and recovery or death. Three characteristic clusters of symptoms including the hematopoietic syndrome, the gastrointestinal syndrome and the cerebrovascular syndrome are all associated with the acute radiation syndrome. The standard medical management of the patients with a potentially survivable radiation exposure includes good medical, surgical and supportive measures. Specific treatment with cytokines and bone marrow transplantation should be considered. The management of internal contamination is much the same as the treatment of poisoning. The standard decontamination should be applied to reduce uptake, and the chelating agents can be administered to enhance the clearance of radioisotopes. Radioactive iodine (131I) as one of the nuclear fission products can increase the incidence of thyroid cancer in children. Potential benefit of potassium iodide prophylaxis is greater especially in neonates, infants and small children.
Acute Radiation Syndrome ; Bone Marrow Transplantation ; Chelating Agents ; Child ; Cytokines ; Decontamination ; Disease Progression ; Etodolac ; Humans ; Incidence ; Infant ; Infant, Newborn ; Iodine ; Mass Casualty Incidents ; Nuclear Fission ; Potassium Iodide ; Radioisotopes ; Thyroid Neoplasms ; Triage

No abstract available.
Paraquat*

Gastric lavage is one of gastrointestinal decontamination methods which have been controversial in the clinical toxicology field for a long time. Expert groups of American and European clinical toxicologists have published the position papers regarding gastric lavage three times since 1997. They recommended that gastric lavage should not be used as a routine procedure in the management of acute intoxication, because they thought that there is no certain evidence of improving clinical outcome by its use. However, the studies they reviewed were not well-controlled randomized trials, which cannot be conducted in the clinical toxicology field due to variability of patients and ethical problems. Therefore, the results from these studies should be interpreted with caution. They also insisted that gastric lavage can be undertaken within 60 minutes of ingestion. The limitation of one hour after ingestion is too arbitrary and may cause a lot of misunderstanding. Formation of pharmacobezoar or gastric hypomotility after ingestion may significantly delay the gastric emptying time so that gastric lavage can be useful even after several hours or more in case of highly toxic substances or severe intoxication. Furthermore, as there are a number of serious intoxication by toxic pesticides with large amount in suicidal attempts in Korea, it seems that gastric lavage may be used more frequently in Korea than in Western countries. When deciding whether or not to use gastric lavage, all the indications, contraindications, and possible adverse effects should be taken into account on the basis of risk-benefit analysis. If the procedure is decided to be done, it should only be performed by well-trained experts.
Decontamination ; Eating ; Gastric Emptying ; Gastric Lavage ; Humans ; Korea ; Pesticides ; Toxicology

No abstract available.
Antidotes* ; Emergencies*

No abstract available.
Lymphangioma*

Amitraz is used as farm-animal insecticide. Its side effects in humans are related to its pharmacological activity on alpha 2-adrenergic receptors. The case describes a previously healthy 46-year-old woman who intentionally ingested approximately 250mL of liquid amitraz. She presented with vomiting, altered mental status, miosis, dry mouth, hypopnea, metabolic and respiratory acidosis, hypotension, hypothermia, polyuria, metabolic acidosis, elevated serum aminotransferase and abdominal distension. Supportive treatments including mechanical ventilation, hydration, dopamine infusion, bicarbonate infusion and gastric decompression resulted in improvement. By hospital day 3, she recovered with resolution of abdominal distension. It is paramount to recognize amitraz poisoning when apesticide-intoxicated patient presets with signs and symptoms consistent with organophosphate intoxicated patients but with greater alpha 2-adrenergic related symptoms such as decreased bowel motility and xerostomia.
Acidosis ; Acidosis, Respiratory ; Decompression ; Dopamine ; Eating ; Female ; Humans ; Hypotension ; Hypothermia ; Intention ; Middle Aged ; Miosis ; Mouth ; Polyuria ; Respiration, Artificial ; Toluidines ; Vomiting ; Xerostomia

Over the last two decades, Korean Society of Clinical Pharmacology has performed a pivotal role to have the concept of clinical pharmacology take root in Korea through various academic activities. Clinical pharmacology is not only a research discipline, but also a clinical specialty which aims to provide support for physicians and patients about rational use of drugs. Although it is difficult for any one individual to cover wide range of clinical pharmacology activities, the integrative aspects of the discipline are very important to the development and use of drugs. Recently the world has been faced with serious economic crises and pharmaceutical companies have been shrunken in their research and development, so that clinical pharmacology also has been internationally affected. However, clinical pharmacology has been rapidly grown up in Korea despite the negatively given condition. At this time it is important for physicians in this field to understand the background of our clinical pharmacology in order to complement and develop our current situation for the future. In this review the academic achievement in clinical pharmacology in Korea is valued through looking back our activities for the past twenty years.
Achievement ; Complement System Proteins ; Humans ; Korea ; Pharmacology, Clinical