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A case of Systemic Toxicity that Occurred in an Adult Who Intentionally Ingested Rhododendron Sclippenbashii.

Sang Min JEONG ; Seung Han LEE ; Jeong Soo LIM ; Sang Yeol YOON ; Seung RYU ; Jin Woong LEE ; Seung Whan KIM ; In Sool YOO ; Yeon Ho YOU

Journal of The Korean Society of Clinical Toxicology.2009;7(2):180-182.

It is well known that Rhododendron sclippenbashii contains the toxic material grayanotoxin. So, Koreans do not eat it, but they do eat azalea although it contains grayanotoxin. That is why there have been no reports about Rhododendron sclippenbashii intoxication after ingesting it intentionally, not accidentally. In this case, the patient was admitted to the emergency room with several toxic symptoms after intentionally consuming 50 blossoms of Rhododendron sclippenbashii to get rid of thirst. Treatment with saline infusion and atropine was successful and the outcome was favorable enough in this case to produce a complete cure without any sequelae at discharge. But toxic symptoms were seen for 24 hours, although the symptoms usually fade in 9 hours. Therefore, we should carefully treat and observe, for over 24 hours, the patient who intentionally ingests about 50 blossoms of Rhododendron sclippenbashii.
Adult ; Atropine ; Bradycardia ; Drug Combinations ; Emergencies ; Flowers ; Humans ; Intention ; Piperonyl Butoxide ; Pyrethrins ; Rhododendron ; Thirst

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A Case of Acute Psychosis after Sibutramine Ingestion.

Hyung Min KIM ; Seon Hee WOO ; Se Min CHOI ; Byung Hak SO

Journal of The Korean Society of Clinical Toxicology.2009;7(2):176-179.

A 38-year-old woman was admitted to our hospital due to agitation, nausea, chest discomfort, tachycardia and hypertension 6h after ingesting approximately 60 capsules of sibutramine. The woman developed the clinical features of acute psychosis, including auditory hallucination, agitation and paranoid ideation, on day 2. No relevant changes were detected on the laboratory examinations or on the electrocardiogram throughout the period of hospitalization. She was treated with risperidone and benzodiazepine. The symptoms subsequently resolved completely with cessation of the provoking agent. The patient was discharged on day 7 and the follow-up revealed no sequelae for 5 months.
Adult ; Benzodiazepines ; Capsules ; Cyclobutanes ; Dihydroergotamine ; Eating ; Electrocardiography ; Female ; Follow-Up Studies ; Hallucinations ; Hospitalization ; Humans ; Hypertension ; Nausea ; Psychotic Disorders ; Risperidone ; Tachycardia ; Thorax

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A Lethal Case of Aute Zipeprol Poisoning Occurring in a Drug Addicted Old Woman.

Doo Hwan LEE ; Sang Cheon CHOI ; Jung Hwan AHN ; Young Shin CHO ; Gi Woon KIM ; Young Gi MIN ; Yoon Seok JUNG

Journal of The Korean Society of Clinical Toxicology.2009;7(2):172-175.

Zipeprol dihydrochloride is a non-opioid mucolytic, antitussive agent and it is frequently prescribed for respiratory symptoms such as cough and sputum. The main pharmacologic mechanisms of zipeprol are inhibition of superior laryngeal nerve stimulation and direct antagonism for stimulation of the bronchial receptors, which might have an effect for the drug's mucolytic action. Many cases of drug abuse with zipeprol have occurred world-wide due to the hallucinogenic effect of the drug. In Korea, zipeprol was reported to be the most commonly abused drug among young people for the 1990s. Zipeprol associated death was first reported since 1991 and 69 cases of death related to zipeprol abuse were further reported during 8 years (between 1991 and 1998). In addition to the hallucinogenic effect, dyspnea, extrapyramidal symptoms, seizure, cerebral edema have been reported as the signs and symptoms of toxic zipeprol overdose. However, zipeprol abuse is not common for old age people and non drug abusers. We report here on a fatal case of acute zipeprol poisoning in an eighty five year old drug addicted woman.
Brain Edema ; Cough ; Drug Users ; Dyspnea ; Female ; Humans ; Korea ; Laryngeal Nerves ; Piperazines ; Seizures ; Sputum ; Substance-Related Disorders

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The Clinical Characteristics and Mortality Factors of Patients with Hemorrhagic Complications after Anticoagulation Therapy with Warfarin.

Se Ho LEE ; Nam Kyu KIM ; Chang Hwan SOHN ; Jung Hun KIM ; Won KIM ; Kyung Soo LIM ; Bum Jin OH

Journal of The Korean Society of Clinical Toxicology.2009;7(2):164-171.

PURPOSE: The number of patients who take warfarin is growing and so is the number of complications. Hemorrhage is the major complication, but the clinical characteristics and outcomes have not been determined for Korean patients. Therefore, we tried to evaluate the characteristics of the patients with hemorrhagic complications after taking warfarin as anticoagulation therapy. METHODS: We retrospectively reviewed the medical records of the patients who visited the emergency room with bleeding complications after taking warfarin anticoagulation at the out-patient clinic for 1 year from 1st January 2008. We compared between two groups (the major hemorrhage group vs. the minor hemorrhage group) according to the clinical criteria, the unstable vital signs that required blood transfusion, transfusion more than 2 units of blood, the need for further laboratory follow-up, the need for interventional treatment and the development of critical complications or death due to bleeding. RESULTS: There were 150 patients who met the criteria and had acute hemorrhagic complications (the major group: 90 patients and the minor group: 60 patients). In the major hemorrhage group, the frequent sites of bleeding were the gastro-intestinal system (40 patients), lung (14 patients) and intracranium (7 patients). At the emergency room, the major group showed a higher initial INR of the activated prothrombin time than did the minor group (p=0.02). The bleeding sites of the fatal cases were the gastro-intestinal system (3 patients), lung (3 patients) and intracranium (3 patients), but the percentage of fatality was the highest for intracranium bleeding. CONCLUSION: In the major hemorrhage group, gastrointestinal bleeding was the most frequent complication and fatality was the highest for intracranium bleeding. An initially higher INR showed a greater risk of major bleeding, but not more fatalities.
Blood Transfusion ; Emergencies ; Follow-Up Studies ; Hemorrhage ; Humans ; International Normalized Ratio ; Lung ; Medical Records ; Outpatients ; Prothrombin Time ; Retrospective Studies ; Vital Signs ; Warfarin

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The Predictive Factors of the Serum Creatine Kinase Level Normalization Time in Patients with Rhabdomyolysis due to Doxylamine Ingestion.

Min Chul SHIN ; Oh Young KWON ; Jong Suk LEE ; Han Sung CHOI ; Hoon Pyo HONG ; Young Gwan KO

Journal of The Korean Society of Clinical Toxicology.2009;7(2):156-163.

PURPOSE: Doxylamine succinate (DS) is frequently used to treat insomnia and it may induce rhabdomyolysis in the overdose cases. The purpose of this study is to evaluate the factors that can predict the serum creatine kinase (CK) level normalization time for patients with rhabdomyolysis due to DS ingestion. METHODS: This study was conducted on 71 patients who were admitted with rhabdomyolysis after DS ingestion during the period from January 2000 to July 2009. Rhabdomyolysis was defined as a serum CK level over 1,000 U/L. The collected data included the general characteristics, the anticholinergic symptoms, the ingested dose, the peak serum CK level, the time interval (TI) from the event to the peak CK level and the TI from the event to a CK level below 1,000 U/L. We evaluated the correlation between the patients'variables and the TI from the event to the peak CK level time and the time for a CK level below 1,000 U/L. RESULTS: The mean ingested dose per body weight (BW) was 30.86+/-18.63 mg/kg and the mean TI from the event to treatment was 4.04+/-3.67 hours. The TI from the event to the peak CK level was longer for the patients with a larger ingestion dose per BW (r=0.587, p<0.05). The CK normalization time was longer for the patients with a larger ingested dose per BW (r=0.446, p<0.05) and a higher peak CK level (r=0.634, p<0.05). CONCLUSION: The ingested dose per BW was correlated with the TI from the event to the peak CK level, and the ingested dose per BW and the peak CK level have significant correlations with the CK normalization time. These factors may be used to determine the discharge period of patients who had rhabdomyolysis following a DS overdose.
Body Weight ; Creatine ; Creatine Kinase ; Doxylamine ; Eating ; Humans ; Rhabdomyolysis ; Sleep Initiation and Maintenance Disorders ; Succinic Acid

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Clinical Experience with Continuous Renal Replacement Therapy as a Method of Extracorporeal Elimination and as performed by Emergency Room Physicians for Patients with Poisoning.

Jung Hwan AHN ; Sang Cheon CHOI ; Yoon Seok JUNG ; Young Gi MIN

Journal of The Korean Society of Clinical Toxicology.2009;7(2):150-155.

PURPOSE: Extracorporeal elimination of drugs is a critical part of managing poisonings, although the indications and optimal method remain a matter of debate. The aim of this study is to report our clinical experiences with continuous renal replacement therapy (CRRT), as performed by emergency room physicians, as method of extracorporeal drug elimination in patients with poisoning. METHODS: This study was a retrospective study of the consecutive patients who underwent CRRT, as performed by an emergency room physician, for acute poisoning. The patient characteristics, the kinds of drugs and the method of extracorporeal elimination were analyzed by reviewing the patients'charts. RESULTS: During eleven months, 26 patients with acute poisoning underwent extracorporeal elimination (2 patients; intermittent hemodialysis, 24 patients; CRRT). The mean time from the decision to performing extracorporeal elimination was 206.0+/-36.8 minutes for intermittent hemodialysis, 62.9+/-8.5 minutes for continuous venoveno-hemodiafiltration (CVVHDF) and 56.6+/-6.8 minutes for charcoal hemoperfusion. For the patients with CRRT, CVVHDF was conducted in 10 patients (3 patients; valproic acid, 2 patients; Lithium, 1 patient; salicylates, 1 patient; methanol) and charcoal hemoperfusion by using CRRT was done in 14 patients (13 patients; paraquat, 1 patient; dapsone). For the 12 patients who required hemodialysis due to severe poisoning, 7 patients underwent CRRT because of their unstable vital signs. CONCLUSION: CRRT was an effective method of extracorporeal drug elimination in patients with acute poisoning, and especially for the cases with unstable vital sign and for those patients who required an early start of extracorporeal elimination according to the characteristics of the drug. (ED note: the writing of the abstract was not clear. Check it carefully.)
Charcoal ; Emergencies ; Hemoperfusion ; Humans ; Lithium ; Paraquat ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies ; Salicylates ; Valproic Acid ; Vital Signs ; Writing

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Influence of the Werther Effect: An Increase of Intentional Carbon Monoxide Poisoning.

In Young HEO ; Sang Cheon CHOI ; Chung Ah LEE ; Jung Hwan AHN ; Young Gi MIN ; Yoon Seok JUNG ; Joon Pil CHO ; Jin Sook KIM

Journal of The Korean Society of Clinical Toxicology.2009;7(2):143-149.

PURPOSE: Suicide attempts are known to be influenced by mass media reports. The purpose of this study was to evaluate the effects of mass media reporting celebrity suicides on an increase of intentional carbon monoxide (CO) poisoning and suicide attempts. METHODS: We retrospectively reviewed the medical records of the consecutive patients who presented with suicide attempts to the Emergency Department of Ajou University Hospital during a 24 month period. We obtained the demographic data, any past history of suicide attempt and the methods of suicide attempts from the medical records of the suicide attempters. Time series analysis was conducted for evaluating the influence of mass media reporting of celebrity suicide on the suicide rates. RESULTS: We finally enrolled 770 patients during the study period. The total number of suicide attempts by CO poisoning was 18 and the average number of suicide attempts by CO was 0.33+/-0.73 per week. All of the suicide attempts by CO poisoning occurred after a celebrity committed suicide using CO from burning charcoal. CONCLUSION: This study showed that celebrity suicide by CO poisoning resulted in the Werther effect, which made the rate of intended CO poisoning increase, and the study provided further evidence for the need to actively restrain mass media reporting of suicide to decrease the Werther effect.
Burns ; Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Emergencies ; Humans ; Mass Media ; Medical Records ; Retrospective Studies ; Suicide

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Drug-Induced Anaphylactic Shock at the Emergency Department.

Sang Guen HAN ; Ryeok AHN ; Sun Hyu KIM ; Seung Won CHOE ; Eun Seog HONG

Journal of The Korean Society of Clinical Toxicology.2009;7(2):137-142.

PURPOSE: This study was conducted to investigate the characteristics of drug induced anaphylaxis and anaphylactic shock in patients who were admitted to the emergency department. METHODS: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90 mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. RESULTS: The mean age of the study subjects was 47.9+/-14.2 years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group (51.5+/-15.1 vs 42.5+/-10.6, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. CONCLUSION: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.
Anaphylaxis ; Anti-Bacterial Agents ; Blood Pressure ; Chronic Disease ; Cyanosis ; Dizziness ; Drug Hypersensitivity ; Emergencies ; Epinephrine ; Female ; Humans ; Male ; Prognosis ; Retrospective Studies ; Shock ; Sweat ; Sweating ; Syncope

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Evaluation of the Risk Factors for Aspiration Pneumonitis Following Drug Intoxication.

Dong Hee KIM ; Joo Suk OH ; Yeon Young KYOUNG ; Se Min CHOI ; Young Min OH ; Kyoung Ho CHOI ; Kyu Nam PARK

Journal of The Korean Society of Clinical Toxicology.2009;7(2):127-136.

PURPOSE: It is known that aspiration pneumonitis is associated with high mortality and morbidity following overdose. However, until now, few domestic studies on this subject have been conducted. The main aim of this study is to investigate the risk factors associated with aspiration pneumonitis in intubated patients following overdose. METHODS: Among 654 adult overdosed patients who visited our institution from Jan. 2006 to June 2008, we enrolled 70 intubated patients within 24 hours after their overdose, and we reviewed the medical records to collect the data. This data was processed by univariate analysis, followed by multiple logistic regression analysis. P values <0.05 were deemed statistically significant. RESULTS: In our study, a high incidence of pneumonitis was seen in the patients with an older age, a lower GCS and a high poisoning severity score or a high comorbidity score (p<0.05). Compared with the non-pneumonitis group, the pneumonitis group had a higher incidence of intubation (6% vs 61.8%, respectively, p<0.05). The main cause of intubation was a decreased mentality (68.6%). Older age, a high comorbidity score, irrigation without airway protection, relative hypoxemia and hyperkalemia were the risk factors of aspiration pneumonitis in the intubated overdosed patients (p<0.05). Among these factors, age, a high potassium level and airway protection might be significant predictors of aspiration penumonitis (p<0.05). CONCLUSION: Older age, a high potassium level and irrigation without proper airway protection may be the significant factors that can predict aspiration pneumonitis in patients who are intubated within 24 hours after overdose, although the further investigations on this are needed.
Adult ; Age Factors ; Anoxia ; Comorbidity ; Humans ; Hyperkalemia ; Incidence ; Intubation ; Logistic Models ; Medical Records ; Pneumonia ; Pneumonia, Aspiration ; Potassium ; Risk Factors

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Acute Hydrofluoric Acid Exposure: Our Clinical Experience at Emergency Centers in Two University Teaching Hospitals.

Kyu Hong HAN ; Jung Il YANG ; Seung Yook JO ; Yong Chul CHO ; Seung RYU ; Jin Woong LEE ; Seung Whan KIM ; In Sool YOO ; Yeon Ho YOU ; Jung Soo PARK

Journal of The Korean Society of Clinical Toxicology.2009;7(2):121-126.

PURPOSE: We investigated the clinical characteristics and demographics of patients who suffered from hydrofluoric acid chemical injury and the mechanism of damage. METHODS: We retrospectively reviewed the medical records of patients who were exposed to hydrofluoric acid from March 2004 to March 2009 and who were seen at the emergency centers in two university teaching hospitals. RESULTS: Forty four patients out of 47 patients suffered from chemical burn, while the injuries of the remaining 3 could not be identified by the medical records. A total of 17 hydrofluoric acid chemical injury patients were enrolled during the study period, and their mean age was 29.6+/-7.0. All the patients were accidentally injured by contact with the material and none of them inhaled or ingested the material. Only 6 patients wore appropriate protective equipments and 5 underwent the water irrigation for more than 10 minutes. The most common exposure area was the hand and forearm (70.5%). Less than 1% of all of the patients had their total body surface (TBS) exposed to hydrofluoric acid (mean=0.35%). The mean time interval from calcium gluconate administration to pain relief was 33.6+/-8.8 hours. CONCLUSION: When exposed to hydrofluoric acid, it is important to wear protective equipment and undergo water irrigation for more than 10 minutes. Pain and skin damage were observed in all the patients. After treatment, we concluded that administration of calcium gluconate and pain killers was successful in relieving pain, and the prognosis was also positive for the admitted and followed up patients when less than 1% of the TBS was exposed.
Burns, Chemical ; Calcium Gluconate ; Demography ; Emergencies ; Forearm ; Gluconates ; Hand ; Hospitals, Teaching ; Humans ; Hydrofluoric Acid ; Medical Records ; Prognosis ; Retrospective Studies ; Skin ; Water

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