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Toxicologic Features and Management in Aconitine Intoxication Following Ingestion of Herbal Tablets Containing Aconitum Species.

Wool Lim CHO ; Youngho JIN ; Tae Oh JEONG ; Jae Baek LEE ; Ji Hun KANG

Journal of The Korean Society of Clinical Toxicology.2008;6(2):104-109.

PURPOSE: Unrefined tablets prepared from Aconitum tubers are occasionally used in Korean folk medicine. This study defines the potential sources, clinical toxicology, and treatment of aconitine poisoning. METHODS: A retrospective survey was conducted in 63 patients in the ED of a tertiary University Hospital with suspected toxicity from an unrefined tablet prepared from Aconitum tubers from 1999 to 2007. RESULTS: A total of 63 cases enrolled included 26 men and 37 women, aged 30 to 86 years. Forty-eight patients ingested aconitine tablets as digestives, 26 tablets on average. After a latent period of 30 to 450 minutes, patients developed a combination of neurologic (87.3%), gastrointestinal (82.5%), cardiopulmonary (41.3%), and other (28.6%) features typical of aconitine poisoning. Initial ECG abnormalities revealed dysrhythmia (61.9%), conduction disturbance (42.9%), and abnormal waveforms (39.7%), with 28.6% of patients having normal ECGs. All patients received supportive treatment or close observation regardless of ingestion amounts. Patients with hypotension or ventricular arrhythmia were treated with inotropic agents or amiodarone. CONCLUSION: Toxicologic signs and symptoms can occur after the consumption of aconitine tablets, regardless of ingestion amount. The risk occurs because of inadequately processed aconitine roots. This study will provide important data for public education and distribution regulations for Aconitum sp. in Korea.
Aconitine ; Aconitum ; Aged ; Arrhythmias, Cardiac ; Eating ; Electrocardiography ; Female ; Humans ; Hypotension ; Korea ; Male ; Medicine, Traditional ; Retrospective Studies ; Social Control, Formal ; Tablets ; Toxicology

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A one-year Follow-up Study of Patients Exposed to Chlorine Gas.

Hyuk Sool KWON ; You Dong SOHN ; Hee Cheol AHN ; Ji Yun AHN

Journal of The Korean Society of Clinical Toxicology.2008;6(2):99-103.

PURPOSE: Chlorine gas is a common irritant that usually causes mild respiratory symptoms. One severe symptom, RADS (Reactive Airway Dysfunction Syndrome), is not well known to physicians. We analyzed the clinical features of chlorine gas exposure. METHODS: We prospectively collected 25 cases of chlorine gas exposure near our emergency center on January 10th, 2007, and analyzed demographic data, event-to-ER interval, symptoms, and laboratory results based on medical records. RESULTS: Only 2 patients out of 25 were admitted because of severe symptoms, the rest were discharged without complications. Sixty percent of them visited the ER within 12 h of exposure. The most common symptoms were chest discomfort (60%), headache (40%), nausea (40%), throat irritation (26%), and cough (32%). Two out of eight dyspnea cases showed abnormal pulmonary function, but only one case was diagnosed as RADS. CONCLUSION: Most symptoms after chlorine gas exposure can be treated conservatively. However, patients with chlorine exposure should be followed up long term for delayed complications.
Chlorine ; Cough ; Dyspnea ; Emergencies ; Environmental Exposure ; Follow-Up Studies ; Headache ; Humans ; Hypersensitivity ; Nausea ; Pharynx ; Prospective Studies ; Thorax

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Clinical Characteristics of Acute Zolpidem Intoxication.

Joo Hyun SUH ; Hyung Keun ROH ; Eun Kyung EO ; Young Jin CHEON ; Koo Young JUNG

Journal of The Korean Society of Clinical Toxicology.2008;6(2):91-98.

PURPOSE: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. METHODS: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. RESULTS: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: 0.2~7.4 mg/L). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. CONCLUSION: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.
Benzodiazepines ; Emergencies ; Humans ; Hypnotics and Sedatives ; Polymethacrylic Acids ; Pyridines ; Retrospective Studies

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Acute Organophosphorus Pesticide Poisoning.

Mi Jin LEE ; Joon Seok PARK ; Tai Yong HONG ; Sung Soo PARK ; Yeon Ho YOU

Journal of The Korean Society of Clinical Toxicology.2008;6(2):83-90.

Organophosphate (OP) pesticides are the most common source of human toxicity globally, causing high mortality and morbidity despite the availability of atropine as a specific antidote and oximes to reactivate acetylcholinesterase. The primary toxicity mechanism is inhibition of acetylcholinesterase (AchE), resulting in accumulation of the neurotransmitter, acetylcholine, and abnormal stimulation of acetylcholine receptors. Thus, the symptoms (muscarinic, nicotinic, and central nervous system) result from cholinergic overactivity because of AchE inhibition. OP can also cause rhabdomyolysis, pancreatitis, parotitis, and hepatitis. OP therapy includes decontamination, supportive therapy, and the use of specific antidotes such as atropine and oximes. However, there has been a paucity of controlled trials in humans. Here we evaluated the literature for advances in therapeutic strategies for acute OP poisoning over the last 10 years.
Acetylcholine ; Acetylcholinesterase ; Antidotes ; Atropine ; Decontamination ; Hepatitis ; Humans ; Neurotransmitter Agents ; Oximes ; Pancreatitis ; Parotitis ; Pesticides ; Receptors, Cholinergic ; Rhabdomyolysis

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Corrosive Injury Due to Edible Vinegar.

Do Hyoun KIM ; Sung Woo LEE ; In NAMGUNG ; Jong Hak PARK ; Su Jin KIM ; Yun Sik HONG

Journal of The Korean Society of Clinical Toxicology.2011;9(1):34-38.

Vinegar is a very popular ingredient used in many cuisines. It is also known for its beneficial health, beauty and possible weight-loss properties. The authors report on a patient who presented to the emergency department with unstable vital signs complaining of generalized abdominal pain after ingestion of 450 ml of apple cider vinegar. We documented a case of corrosive gastrointestinal injury with persistent metabolic acidosis occurring after ingesting apple cider vinegar with an acetic acid concentration of 12~14%. Toxic damage to the liver and kidney were also observed, peaking on post-ingestion day 3. The patient received supportive care and hemoperfusion for three days without much clinical improvement and died in the seventh day of intensive care due to disseminated intravascular coagulation and multi organ failure. Edible vinegar, when taken in large amounts, is capable of inducing corrosive injuries of the GI tract as well as severe systemic toxicities, such as metabolic acidosis. Safety precautions regarding vinegar deserve more public attention and clinicians also should be astute enough to recognize the potential damage accompanying vinegar ingestion.
Abdominal Pain ; Acetic Acid ; Acidosis ; Beauty ; Disseminated Intravascular Coagulation ; Eating ; Emergencies ; Gastrointestinal Tract ; Hemoperfusion ; Humans ; Critical Care ; Kidney ; Liver ; Vital Signs

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A Case of Acute Respiratory Failure After Trichloroethylene Inhalation.

Jae Seok PARK ; Young Woo JEON ; Young Il KIM ; Hyo Wook GIL ; Jong Oh YANG ; Eun Young LEE ; Sae Yong HONG

Journal of The Korean Society of Clinical Toxicology.2011;9(1):30-33.

Trichloroethylene (TCE, C2HCl3), which was introduced as a gas for general anesthesia and analgesia in early 1900's has been widely used in industry as an organic solvent. Occupational exposure to TCE is an important medical problem. Manifestations of acute exposure to TCE include mucocutaneous irritation, hepatotoxicity, cognitive impairment, sleep, headache, respiratory insufficiency and death. We report a 38-year-old man who was admitted to a department of emergency medicine after occupational inhalation exposure to TCE. He rapidly developed semicoma and respiratory depression. After mechanical ventilation, hypercapnea and hypoxemia disappeared and his mental state again became alert. Careful evaluation and proper respiratory support are important for respiratory failure after occupational TCE inhalation.
Adult ; Analgesia ; Anesthesia, General ; Anoxia ; Emergency Medicine ; Headache ; Humans ; Inhalation ; Inhalation Exposure ; Occupational Exposure ; Respiration, Artificial ; Respiratory Insufficiency ; Trichloroethylene

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Availability of Toxicologic Screening Tests in the Emergency Department.

In Kyung UM ; Jong Su PARK ; Kap Su HAN ; Hanjin CHO ; Sung Hyuck CHOI ; Sung Woo LEE ; Yun Sik HONG

Journal of The Korean Society of Clinical Toxicology.2011;9(1):26-29.

PURPOSE: The role of a point of care test (POCT) is currently becoming important when treating patients and making decisions in the emergency department. It also plays a role for managing patients presenting with drug intoxication. But the availability of the test has not yet been studied in Korea. Therefore, we investigated the utility and the availability of POCT for drug screening used in the emergency department. METHODS: This was a retrospective study for those patients with drug intoxication between January 2007 and December 2010 in an urban emergency department. RESULTS: Between the study period, 543 patients were examined with a Triage(R)-TOX Drug Screen. Among those, 248 (45.7%) patients showed negative results and 295 (54.3%) patients showed positive results. The sensitivity of the test for benzodiazepine, acetaminophen and tricyclic antidepressants were 85.9%, 100%, 79.2%, respectively. CONCLUSION: POCT of drug screening in emergency department showed good accuracy especially in patient with benzodiazepine, acetaminophen and tricyclic antidepressant intoxication. Therefore, it can be useful diagnostic tool for the management of intoxicated patients.
Acetaminophen ; Antidepressive Agents, Tricyclic ; Benzodiazepines ; Drug Evaluation, Preclinical ; Emergencies ; Humans ; Korea ; Mass Screening ; Retrospective Studies

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Cardiac Toxicity Following a Diphenhydramine Overdose.

Sung Jun PARK ; Jong Hak PARK ; In Kyung UM ; Kyung Ae PARK ; Do Hyoun KIM ; Su Jin KIM ; Sung Woo LEE ; Yun Sik HONG

Journal of The Korean Society of Clinical Toxicology.2011;9(1):20-25.

PURPOSE: This study was designed to analyze the contributing factors, as well as the incidence and nature of the cardiac toxicity, in patients presenting with diphenhydramine overdose. METHODS: We retrospectively reviewed the medical records of the intoxicated patients who presented to the ED of Korea University Anam Hospital from January 2008 to December 2010. Those patients who visited due to a diphenhydramine overdose were selected and the following features were recorded for analysis: the general characteristics, vital signs, the amount of ingested diphenhydramine, the time interval from ingestion to presentation, the coingested drugs (if any), the toxicities and the ECG findings. Cardiac toxicity, while defined mainly in terms of the temporary ECG changes such as QTc prolongation, right axis deviation, QRS widening, high degree AV block and ischemic changes, also encompassed cardiogenic shock, which is a clinical finding. RESULTS: A total of eighteen patients were enrolled. Of the eighteen patients, eight had ingested diphenhydramine only, while ten had ingested other drugs in addition to diphenhydramine. The most commonly observed toxicity following diphenhydramine overdose included cardiac toxicity (78%). Cardiac toxicity was observed in all the patients who presented to the emergency department 2 hours after ingestion. The patients with QTc prolongation turned out to have ingested significantly larger amounts of diphenhydramine. CONCLUSION: QTc prolongation and right axis deviation were common findings for the patients with a diphenhydramine overdose. QTc prolongation was more likely to occur with ingesting larger amounts of diphenhydramine. Close monitoring is mandatory for patients who have ingested large amounts of diphenhydramine to prevent such potentially lethal cardiac toxicity.
Atrioventricular Block ; Axis, Cervical Vertebra ; Diphenhydramine ; Eating ; Electrocardiography ; Emergencies ; Humans ; Incidence ; Korea ; Medical Records ; Retrospective Studies ; Shock, Cardiogenic ; Vital Signs

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Veiled Paraquat Poisoning: A Focus on Clinical Characteristics.

Ye Wan SONG ; Sang Cheon CHOI ; Young Yeol YOU ; Yeoun Ho SHIN ; Eun Jung PARK ; Jung Hwan AHN ; Young Gi MIN ; Yoon Seok JUNG

Journal of The Korean Society of Clinical Toxicology.2011;9(1):14-19.

PURPOSE: Most paraquat poisonings are easily diagnosed by history taking on physical examination, however, some are failed to be diagnosed initially if the poisoning was veiled. The purpose of this study was to explore the clinical characteristics of veiled paraquat poisoning. METHODS: We retrospectively reviewed the medical records of patients whose discharge diagnosis was paraquat poisoning in one university teaching hospital between 1 Jan, 2001 and 31 Dec, 2010. Veiled paraquat poisoning was determined when there was a positive urine paraquat kit in patients who did not mention paraquat poisoning in an initial physical examination or had unknown cause of pulmonary fibrosis, acute renal failure, or multi-organ failure. RESULTS: Of the 117 patients with paraquat poisoning during the study period, 6 patients (5.1%) had veiled paraquat poisoning. The clinical characteristics were 1) proteinuria - 6 (100%), 2) increased creatinine - 4 (66.7%), 3) green skin stains - 2 (33.3%), 4) mucosal ulcer - 3 (50%). Blood chemistry results were variable. CONCLUSION: We should suspect veiled paraquat poisoning for patients who have proteinuria, increased creatinine, green skin stain, mucosal ulcer and vomiting, or if they have rapidly progressing acute renal failure or multi-organ failure with unknown cause, even if patients didn't mention about paraquat poisoning upon the initial physical examination. In cases with the above clinical conditions, a thorough repeated physical examination including history taking and use of urine paraquat kits should be performed.
Acute Kidney Injury ; Coloring Agents ; Creatinine ; Hospitals, Teaching ; Humans ; Medical Records ; Paraquat ; Physical Examination ; Proteinuria ; Pulmonary Fibrosis ; Retrospective Studies ; Skin ; Ulcer ; Vomiting

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Atypical Clinical Course of after Glyphosate Herbicide Intoxication.

Yong Won KIM ; Hyun KIM ; Kyoung Chul CHA ; Hyung Jin SHIN ; Yong Sung CHA ; Kang Hyun LEE ; Sung Oh HWANG

Journal of The Korean Society of Clinical Toxicology.2011;9(1):8-13.

PURPOSE: Although glyphosate-surfactant herbicide intoxication is relatively mild toxic in humans, we encountered an atypical clinical presentation. We performed this study to understand the atypical clinical course and factors associated with severe intoxication after glyphosate ingestion. METHODS: We conducted a retrospective study of 61 patients (male 43, mean age 54+/-18.8 years) who were presented with glyphosate ingestion between March 1997 and March 2011. The severe intoxication group was defined as patients with systolic blood pressure less than 90 mmHg, respiratory distress needing intubation, or altered mental state. RESULTS: Of the 61 patients, 22 patients (36.1%) had a severe clinical course, 1 patient (1.6%) had died and 1 patient (1.6%) had moribund discharge. The most common symptoms were nausea with or without vomiting which occurred in 30 patients (49.2%). Twenty-seven patients had metabolic acidosis that was the second most common medical complication. Advanced age, pH, base excess, HCO3, Sat, creatinine, X-ray abnormalities and ECG abnormalities were significant factors. Hemoglobin, platelet, pO2, pCO2, BUN, sodium, potassium and AST levels were not different comparing the laboratory characteristics between the severe and mild intoxication groups. CONCLUSION: The results of this study showed that severe intoxication occurred in 22 patients (36.1%) after glyphosate intoxication. Advanced age, pH, base excess, HCO3, Sat, creatinine, X-ray abnormality and ECG abnormalities were significant predictive factors for severe intoxication in patients with glyphosate surfactant herbicide poisoning.
Acidosis ; Blood Platelets ; Blood Pressure ; Creatinine ; Eating ; Electrocardiography ; Glycine ; Hemoglobins ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Nausea ; Potassium ; Retrospective Studies ; Sodium ; Vomiting

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