Ethylene glycol is a widely used and readily available substance. Ethylene glycol ingestion does not cause direct toxicity; however, its metabolites are highly toxic and can be fatal even in trace amounts. Poisoning is best diagnosed through inquiry, but as an impaired state of consciousness is observed in most cases, poisoning must be suspected when a significantly elevated osmolar gap or high anion gap metabolic acidosis is found in blood tests. Hemodialysis and alcohol dehydrogenase inhibitors such as ethanol and fomepizole are a part of the basic treatment, and timely diagnosis and treatment are crucial because any delays can lead to death. However, there are few reported cases in Korea, and no report on the use of fomepizole. Herein, we report a case of acute renal failure caused by ethylene glycol poisoning that was treated with fomepizole and hemodialysis and present a literature review.
Acid-Base Equilibrium ; Acidosis ; Acute Kidney Injury* ; Alcohol Dehydrogenase ; Consciousness ; Diagnosis ; Eating ; Ethanol ; Ethylene Glycol* ; Hematologic Tests ; Korea ; Poisoning ; Renal Dialysis ; Renal Replacement Therapy*

PURPOSE: Extracorporeal treatment has been used increasingly to treat patients with acute ethylene glycol poisoning. We analyzed all patients with acute poisoning of ethylene glycol during a recent 10-year period to provide clinical recommendations for adequate application of continuous renal replacement therapy for these patients. METHODS: A retrospective chart review study was conducted for patients whose final diagnosis were “toxic effects of glycols or other alcohols,” between October 2006 and September 2016. The basal characteristics of patients, suspected amount of ingestion, intention of poisoning, concomitant alcohol ingestion, mental state at admission, time from exposure to admission, chief complaint, length of hospital stay, method of treatments, laboratory results including acute kidney injury and urine oxalate crystal, as well as treatment results were examined. RESULTS: A total number of 14 patients were included in this study. Nine patients (64.3%) underwent continuous renal replacement therapy; 5 patients (35.7%) underwent ethanol mono-therapy. Between the antidote therapy group and the extracorporeal treatment group, there was a significant difference in the levels of plasma bicarbonate, chloride, anion gap, pH, and base excess in arterial blood gas analysis, as well as the calculated osmolar gap. One patient expired due to multi-organ failure, while the others recovered completely. CONCLUSION: Continuous renal replacement therapy was most frequently chosen as a treatment method in patients with acute ethylene glycol poisoning. Further research regarding indication of continuous renal replacement therapy and combing therapy with other treatment will be necessary to determine the best treatment method.
Acid-Base Equilibrium ; Acute Kidney Injury ; Animals ; Blood Gas Analysis ; Comb and Wattles ; Diagnosis ; Eating ; Ethanol ; Ethylene Glycol* ; Glycols ; Humans ; Hydrogen-Ion Concentration ; Intention ; Length of Stay ; Methods* ; Plasma ; Poisoning* ; Renal Replacement Therapy ; Retrospective Studies

Acute Disease ; Humans ; Nervous System Diseases ; diagnosis ; therapy ; Organophosphate Poisoning ; diagnosis ; therapy

No abstract available.
Coronary Angiography ; Electrocardiography ; Flowers ; Honey/*poisoning ; Humans ; Inferior Wall Myocardial Infarction/*chemically induced/diagnosis/therapy ; Male ; Middle Aged ; Plant Nectar ; Predictive Value of Tests ; *Rhododendron ; Risk Factors ; Toxins, Biological/*poisoning

PURPOSE: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. METHODS: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. RESULTS: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). CONCLUSIONS: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.
Acute Disease ; Adolescent ; Adult ; Animals ; Antivenins/therapeutic use ; *Elapidae ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/diagnosis/*etiology/therapy ; Humans ; Male ; Middle Aged ; Ophthalmoplegia/diagnosis/*etiology/therapy ; Prospective Studies ; Snake Bites/*complications/diagnosis/therapy ; Snake Venoms/*poisoning ; Tertiary Healthcare ; Time Factors ; Uveitis, Anterior/diagnosis/*etiology/therapy ; *Viperidae ; Young Adult

OBJECTIVETo investigate the expression of sonic hedgehog (Shh) signaling pathway in liver fluorosis and to explore related mechanism.

METHODSTo establish animal model, 48 normal SD rats (aged 4-5 weeks) were randomly divided into 4 groups (12 each): control group, fluoriosis group, blocking group and blocking control group. After 6 months, the blocking group and blocking control group were injected intraperitoneally once every 2 days for 3 times with 10 mg/kg cyclopamine or dimethysulfoxide, respectively. Rats were sacrificed at the end of the experiment and the fluoride content in urine and liver function was determined. The expression of Shh and Gli1 protein and mRNA in hepatocytes was detected by immunohistochemistry and real-time fluorescence quantitative PCR, respectively.

RESULTSThe fluoride contents in the urine and the incidence of dental fluorosis increased in the fluoride and blocking control groups as compared with those in the control group, but decreased in the blocking group compared with those of the fluoride and blocking control group. Compared with the control group, the titers of aspartate transaminase (AST) and alanine transaminase (ALT) significantly increased, while the activity of total protein and albumin decreased in the fluoride and blocking control groups. Compared with the fluoride and blocking control groups, the activity of the ALT slightly declined and the AST, total protein and albumin slightly increased in the blocking group. Histologically, the cells were disorganized and swollen with cytoplasmic clearing (balloon cells), compared with the control group. The expression of Shh and Gli1 significantly increased in all but the control group. Compared with the fluoride and blocking control groups, the expression of Shh and Gli1 declined in the blocking group.

CONCLUSIONSThe overexpression and cyclopamine inhibition of the Shh signaling pathway are closely related to the content of fluoride in the liver. The Shh signaling pathway plays an important role in the pathogenesis of liver injury caused by fluorosis, suggesting a preventive and therapeutic target of the disease.

Alanine Transaminase ; analysis ; Animals ; Aspartate Aminotransferases ; analysis ; Dimethyl Sulfoxide ; pharmacology ; Disease Models, Animal ; Fluoride Poisoning ; drug therapy ; metabolism ; Fluorosis, Dental ; diagnosis ; Hedgehog Proteins ; antagonists & inhibitors ; metabolism ; Hepatocytes ; metabolism ; Kruppel-Like Transcription Factors ; metabolism ; Liver ; metabolism ; Liver Diseases ; drug therapy ; metabolism ; RNA, Messenger ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; drug effects ; Veratrum Alkaloids ; pharmacology ; Zinc Finger Protein GLI1

Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by transient headache, altered mental functioning, seizures, and loss of vision associated with findings of predominantly posterior cerebral lesions on imaging studies. Magnetic resonance imaging typically shows bilateral hyperintensity on T2 weighted imaging and fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. The common etiologies of PRES include eclampsia, renal impairment, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension. The prognosis is usually benign when adequate treatment is initiated immediately. Otherwise, delay in diagnosis and treatment may lead to permanent neurological sequelae. We report on the case of a 24-year-old man who presented with the characteristics of PRES with acute carbon monoxide poisoning.
Autoimmune Diseases ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Drug Therapy ; Eclampsia ; Female ; Headache ; Hypertension ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Poisoning ; Posterior Leukoencephalopathy Syndrome ; Pregnancy ; Prognosis ; Seizures ; Young Adult

Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by transient headache, altered mental functioning, seizures, and loss of vision associated with findings of predominantly posterior cerebral lesions on imaging studies. Magnetic resonance imaging typically shows bilateral hyperintensity on T2 weighted imaging and fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. The common etiologies of PRES include eclampsia, renal impairment, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension. The prognosis is usually benign when adequate treatment is initiated immediately. Otherwise, delay in diagnosis and treatment may lead to permanent neurological sequelae. We report on the case of a 24-year-old man who presented with the characteristics of PRES with acute carbon monoxide poisoning.
Autoimmune Diseases ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Drug Therapy ; Eclampsia ; Female ; Headache ; Hypertension ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Poisoning ; Posterior Leukoencephalopathy Syndrome ; Pregnancy ; Prognosis ; Seizures ; Young Adult

Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.
Acute Kidney Injury/*diagnosis/pathology/therapy ; Antioxidants/therapeutic use ; Creatinine/blood ; Hemoperfusion ; Herbicides/*poisoning ; Humans ; Iron Chelating Agents/therapeutic use ; Lung Diseases/*diagnosis/pathology/therapy ; Paraquat/blood/*poisoning/urine ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. METHODS: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. RESULTS: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). CONCLUSIONS: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.
4-Hydroxycoumarins/*poisoning ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects/blood ; Anticoagulants/*poisoning ; Blood Coagulation/*drug effects ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Partial Thromboplastin Time ; Prothrombin Time ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Rodenticides/*poisoning ; Serum Albumin/metabolism ; Vitamin K/*blood ; Vitamin K Deficiency Bleeding/blood/*chemically induced/diagnosis/therapy ; Young Adult