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Epidemiologic Characteristics of Intentional Poisoning: Emergency Department Based Injury in-depth Surveillance During 2011–2015.

Hak Soo LEE ; Juhee HAN ; Ji Hoon KIM ; Sunpyo KIM ; Sun Hyu KIM ; Ji Sook LEE ; Gyu Chong CHO ; Chul HAN ; Joon Min PARK ; Sung Phil CHUNG ; Min Joung KIM

Journal of The Korean Society of Clinical Toxicology.2017;15(2):131-139. doi:10.22537/jksct.15.2.131

PURPOSE: The purpose of this study was to investigate the epidemiologic characteristics of patients who visited emergency departments (EDs) after intentional poisoning in Korea. METHODS: This study retrospectively analyzed the data of of 23 hospitals during a five-year period, between 2011 and 2015. We included patients who inflicted injury to themselves - attempt of suicide - by means of poisoning. RESULTS: A total of 18,121 patients visited an ED after intentional poisoning. Among them, 58.3% were females; however, there were more males among those aged 60 years or older. The mortality rate for males was 8.6%, which was 3.1 times higher than that for females with 2.8%. The most common poison was pesticides (35.4%) in males and sedative-hypnotics (44.0%) in females. The most common causative agent of death was pesticide in both sexes (75.2% and 65.3%, respectively). Since the production of paraquat was discontinued in 2011, the number of deaths from pesticide poisoning has decreased. The mortality rate declined in both males and females, from 12.6% and 4.5% in 2011 to 7.1% and 2.1% in 2015, respectively. CONCLUSION: In this study, we analyzed the epidemiologic characteristics of intentional poisoning, especially the frequency of suicide attempts by gender and age group, the cause of suicide, and the causative agent. This can be used as basic data for establishing policies to reduce and prevent suicide attempts by poisoning.
Emergencies* ; Emergency Service, Hospital* ; Epidemiology ; Female ; Humans ; Korea ; Male ; Mortality ; Paraquat ; Pesticides ; Poisoning* ; Retrospective Studies ; Suicide

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Analysis of Death Due to Poisoning in the National Capital Region (2014–2016).

Meejung PARK ; Jongsin PARK ; Sangki LEE ; Sangwhan IN

Journal of The Korean Society of Clinical Toxicology.2017;15(2):101-106. doi:10.22537/jksct.15.2.101

PURPOSE: This study examined the patterns of drugs, poisons, and chemicals detected in autopsy samples performed in the Seoul Institute and other regional forensic offices of the National Forensic Service (NFS) between 2014 and 2016. METHODS: The investigation carried out using the laboratory information management system. Forensic toxicological identification and quantitation were performed in autopsy samples, including heart blood, peripheral blood, liver, kidney, vitreous humor and etc. Gas chromatography/mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) were used to analyze the drugs and poisons. RESULTS: Forensic autopsies were performed on 9,674 cases in this period. Based on the autopsy reports, 699 cases (7.2%) were considered as unnatural deaths caused by fatal intoxication. The number of male deaths was higher than that of female deaths, with the age of 50-59 being the most common age group. CONCLUSION: Drugs comprised the largest number of deaths due to poison, followed by alcohol, agrochemicals, drug with alcohol, carbon monoxide, and cyanide, in that order. Zolpidem was the most frequently used drug in all drug-related intoxication cases.
Agrochemicals ; Autopsy ; Carbon Monoxide ; Female ; Heart ; Humans ; Information Management ; Kidney ; Liver ; Male ; Mass Spectrometry ; Poisoning* ; Poisons ; Seoul ; Spectrum Analysis ; Vitreous Body

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Analysis of Poisoning Patients Using 2016 ED Based Injury in-depth Surveillance Data.

Sung Phil CHUNG ; Mi Jin LEE ; Hyunggoo KANG ; Bum Jin OH ; Hyun KIM ; Yang Weon KIM ; Byeong Jo CHUN ; Kyung Hwan KIM

Journal of The Korean Society of Clinical Toxicology.2017;15(2):86-93. doi:10.22537/jksct.15.2.86

PURPOSE: Some advanced countries have reported annual statistics for poisoning based on data from poison control centers. This study was conducted to propose a baseline format and statistics of poisoning in Korea from a national representative database. METHODS: This study was a retrospective analysis of poisoning patients based on data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2016. Bite or sting injuries were not included. Variables related to poisoning were summarized using a similar format as the National Poison Data System in the United States. RESULTS: A total of 7,820 poisoning patients presented to 23 EDs. Adults ≥20 years accounted for 84% of the population, while the proportion of intentional poisoning was 59.4%. The most common poisoning substances were therapeutic drugs (45%), gas (21%), pesticides (15%), and artificial toxic substances (13%). Overall, 34.5% of patients were admitted for further treatment. The mortality was 3.2% (248 cases), and the most common causative substances were carbon monoxide, glyphosate, and paraquat, in order. CONCLUSION: This study showed the recent status of poisoning in Korea. However, a comprehensive poisoning registry based on poison control centers may be required to provide more accurate national statistics in the future.
Adult ; Bites and Stings ; Carbon Monoxide ; Centers for Disease Control and Prevention (U.S.) ; Drug Overdose ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Mortality ; Paraquat ; Pesticides ; Poison Control Centers ; Poisoning* ; Retrospective Studies ; United States

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Fomepizole for Ethylene Glycol or Methanol Poisoning in Children.

Ha Na MIN ; Yoon Jung HWANG ; Dong Ryul KO ; Young Seon JOO ; Tae Young KONG ; Min Hong CHOA ; In Cheol PARK ; Sung Phil CHUNG

Journal of The Korean Society of Clinical Toxicology.2017;15(2):79-85. doi:10.22537/jksct.15.2.79

PURPOSE: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. METHODS: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. RESULTS: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. CONCLUSION: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.
Anaphylaxis ; Child* ; Ethylene Glycol* ; Humans ; Methanol* ; Pediatrics ; Poisoning* ; Prospective Studies ; Retrospective Studies ; Thrombophlebitis

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Trends in Korean Pediatric Poisoning Patients: Retrospective Analysis of National Emergency Department Information System.

Kyeongjae LEE ; Kyung Hwan KIM ; Dong Wun SHIN ; Junseok PARK ; Hoon KIM ; Woochan JEON ; Joon Min PARK ; Hyunjong KIM

Journal of The Korean Society of Clinical Toxicology.2017;15(2):69-78. doi:10.22537/jksct.15.2.69

PURPOSE: This study reports the clinical features of infant, child, school aged and adolescent patients treated for acute poisoning in nationwide emergency departments (EDs). METHODS: We retrospectively analyzed clinical data pertaining to patients under 19 years of age who were treated for acute poisoning in nationwide EDs from 2013 to 2015. The data were collected by the National Emergency Department Information System (NEDIS). All patients were divided into three groups: ‘Infant and child group’ (0 to 5 years), ‘school age group’ (6 to 12 years) and ‘adolescent group’ (13 to 18 years). General characteristics, Korea Standard Classification of Disease 7(th) (KCD-7) codes and results of care were collected. RESULTS: There were 14,500 pediatric poisoning cases during the study period. The distribution of patient age was bimodal with two peaks among infant, child and adolescent group. The proportion of alert mentality at the ED visit of the infant and child group was 99.3%, while that of the adolescent group was 86.4%. The proportion of intentional intoxication was higher in the adolescent group (40.7%) than other age groups. Among children less than 13 years of age, various poisonous substances and therapeutic drugs were common. CONCLUSION: There were some clinical differences in acute poisoning patients between age groups. It is necessary to establish a preventive plan considering characteristics by age. Since the KCD-7 code has limitations in analyzing the characteristics of poisoning patients, it is necessary to consider the registration system of poisoning patients.
Adolescent ; Child ; Classification ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Infant ; Information Systems* ; Korea ; Pediatrics ; Poisoning* ; Retrospective Studies*

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A Case of Successful Resuscitation of 10,150 J Shocks and Therapeutic Hypothermia on Aconitine-induced Cardiovascular Collapse.

Hyung Jun MOON ; Jung Won LEE ; Ki Hwan KIM ; Dong Kil JEONG ; Jong Ho KIM ; Young Ki KIM ; Hyun Jung LEE

Journal of The Korean Society of Clinical Toxicology.2014;12(2):97-101.

Aconitine, found in the Aconitum species, is highly extremely toxic, and has been known to cause fatal cardiac arrhythmias and cardiovascular collapse. Although several reports have described treatment of aconitine intoxication, management strategy for the patient in a hemodynamically compromised state who experienced cardiopulmonary collapse is unknown. We report here on a case of a successful cardiopulmonary resuscitation and therapeutic hypothermia in an aconitine-induced cardiovascular collapsed patient. A 73-year-old male who presented with nausea, vomiting, chest discomfort, and drowsy mental state after eating an herbal decoction made from aconite roots was admitted to the emergency department. He showed hemodynamic compromise with monomorphic ventricular tachycardia resistant to amiodarone and lidocaine. After 3 minutes on admission, he collapsed, and cardiopulmonary resuscitation was initiated. We treated him with repeated cardioversion/defibrillation of 51 times, 10,150 joules and cardiopulmonary resuscitation of 12 times, 69 minutes for 14 hours and therapeutic hypothermia for 36 hours. He recovered fully in 7 days.
Aconitine ; Aconitum ; Aged ; Amiodarone ; Arrhythmias, Cardiac ; Cardiopulmonary Resuscitation ; Eating ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Hypothermia* ; Hypothermia, Induced ; Lidocaine ; Male ; Nausea ; Resuscitation* ; Shock* ; Tachycardia, Ventricular ; Thorax ; Vomiting

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Dabigatran Toxicity Secondary to Acute Kidney Injury.

Hyoung Ho MOON ; Seung Eun LEE ; Dong Jun OH ; Hee Bum JO ; Ki Hwan KWON ; Yoon Jin KIM ; Kyung Soo KIM ; Sung Joon SHIN

Journal of The Korean Society of Clinical Toxicology.2014;12(2):92-96.

Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of 138,000/mm3, activated partial thromboplastin time (aPTT) of 10?s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.
Acute Kidney Injury* ; Aged ; Atrial Fibrillation ; Cerebral Infarction ; Colonoscopy ; Creatinine ; Dabigatran ; Dialysis ; Disseminated Intravascular Coagulation ; Embolism ; Erythrocytes ; Fissure in Ano ; Gastrointestinal Hemorrhage ; Hematuria ; Hemorrhage ; Hemostasis ; Humans ; International Normalized Ratio ; Kidney ; Partial Thromboplastin Time ; Plasma ; Prothrombin Time ; Recurrence ; Renal Dialysis ; Renal Insufficiency ; Stroke ; Thrombin ; United States Food and Drug Administration

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Fatal Brain Injury in Pyrethroid Poisoned Patient: Case Report.

Woo Jin JUNG ; Yong Sung CHA ; Dong Keon LEE ; Hyun KIM

Journal of The Korean Society of Clinical Toxicology.2014;12(2):88-91.

Pyrethroids have been widely using insecticides. Although generally regarded as less toxic to mammals including humans, we report one fatal case of pyrethroid poisoning with severe brain injury.
Brain Injuries* ; Humans ; Insecticides ; Mammals ; Poisoning ; Pyrethrins

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A Case Report of Spider Bite by Tarantula.

Do Young KIM ; Seung Baek HAN ; Ji Hye KIM ; Jin Hue BAEK ; Hyun Min JUNG ; Hyung Min LEE ; Ah Jin KIM

Journal of The Korean Society of Clinical Toxicology.2014;12(2):85-87.

A total of 631 species of spiders have been reported in Korea. However, there are no spiders with noxious venom such as Latrodectus sp. Because of this, to date, no serious medical problems due to spider bites have been reported in Korea, and only two cases of spider bite were officially reported. However, as the number of earning spiders from other countries is increased, the number of cases of spider bite has also shown a recent increase. A 17-year-old man presented with numbness of both extremities after being bitten by a spider which he had as a pet. The spider is called an Indian ornamental tree spider (Poecilotheria regalis sp.), one kind of tarantula species. Herein, we report on a case of a spider bite by a tarantula.
Adolescent ; Extremities ; Humans ; Hypesthesia ; Korea ; Spider Bites* ; Spider Venoms ; Spiders ; Venoms

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Acute Pancreatitis after Carbamate Poisoning.

Joseph PARK ; Yong Won KIM ; Se Hyun OH ; Yong Sung CHA ; Kyoung Chul CHA ; Oh Hyun KIM ; Kang Hyun LEE ; Sung Oh HWANG ; Hyun KIM

Journal of The Korean Society of Clinical Toxicology.2014;12(2):77-84.

PURPOSE: Carbamate insecticides are potent cholinesterase inhibitors capable of causing severe cholinergic toxicity. Use of carbamate rather than organophosphate insecticides has been increasing. Compared with organophosphate poisoning, relatively few studies have investigated carbamate-associated acute pancreatitis. We investigated general characteristics and pancreatitis of carbamate poisoning and the predictors, among those readily assessed in the emergency department. METHODS: We performed a retrospective review of consecutive patients, aged over 18 years, who were admitted between January 2008 and April 2012 to an emergency department (ED) of an academic tertiary care center for treatment of carbamate poisoning. Patients who exhibited poisoning by any other material, except alcohol, were excluded. After application of exclusion criteria, patients were divided according to carbamate-induced pancreatitis and non-pancreatitis groups. RESULTS: A total of 41 patients were included in this study. Among these 41 patients, the prevalence of acute pancreatitis was 36.6% (15 patients). Initial blood chemistry tests showed a statistically higher glucose level in the pancreatitis group, compared with the non-pancreatitis group (222, IQR 189-284 vs. 137, IQR 122-175 mg/dL, P<0.05). Regarding clinical courses and outcomes, a significantly higher proportion of patients developed pneumonia [10 (66.7%) vs. 6 (23.1%), P<0.05] and had a longer hospital stay (7 days, IQR 6-12 vs. 5 days, IQR 2-11, P<0.05), but no difference in mortality, in the pancreatitis group vs. the non-pancreatitis group. In multivariate analysis, the initial glucose was showing significant association with the presentation of carbamate-induced acute pancreatitis (odds ratio 1.018, 95% confidence interval 1.001-1.035, P<0.05). CONCLUSION: Carbamate-induced acute pancreatitis is common, but not fatal. Initial serum glucose level is associated with acute pancreatitis.
Blood Glucose ; Carbamates ; Chemistry ; Cholinesterase Inhibitors ; Emergency Service, Hospital ; Glucose ; Humans ; Insecticides ; Length of Stay ; Lipase ; Mortality ; Multivariate Analysis ; Organophosphate Poisoning ; Pancreatitis* ; Pneumonia ; Poisoning* ; Prevalence ; Retrospective Studies ; Tertiary Care Centers

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