MCPP 음독 후 발생한 사망 1례

소병학,이원재,심병용,김훈교,김치홍,So Byung Hak,Lee Won Jae,Shim Byoung Yong,Kim Hoon-Kyo,Kim Chi Hong 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1

MCPP (2-(2-methyl-4-chlorophenoxy)propionic acid; mecoprop), a hormonal weedkiller has been widely used. Although chronic exposure is generally considered to be mildly toxic to man, acute intoxication can be severe and should thus be taken seriously. We report the case of a patient who died after ingestion of MCPP. A 64-year-old man ingested about 400 ml of $50\%$ MCPP solution. He was stuporous and had an inadequate respiration. He had an hypotension which did not respond to vasopressors and died about twelve hours after ingestion.

2008년 국내 중독환자 실태조사; 예비연구

소병학 ( Byung Hak So ),이미진 ( Mi Jin Lee ),김현 ( Hyun Kim ),문정미 ( Jeong Mi Moon ),박경혜 ( Kyung Hye Park ),성애진 ( Ae Jin Sung ),염석란 ( Seok Ran Yeom ),오성범 ( Seong Beom Oh ),유지영 ( Ji Young You ),이경우 ( Kyung Wo 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2

Purpose: The aim of this study was to investigate toxic exposures in emergency centers with using a toxic exposure surveillance system-based report form as a preliminary study. Methods: We retrospectively reviewed the medical records of toxic exposure patients who visited emergency centers from January to December 2008. Results: 3,157 patients from 11 emergency centers were enrolled. Males were involved in 47.9% of the total cases of exposure and in 60.1% of the cases of fatal exposure. Suicidal intent was the most common (61.0%) reason and most (87.4%) fatal exposures were suicidal. Pesticides were involved in 30.7% of the cases and sedative/hypnotics/ antipsychotics were involved in 20.5%. The substances most frequently involved in fatalities were pesticides, and a 48.4% fatality rate was recorded for paraquat exposure. Conclusion: The toxic exposure data showed the preliminary poisoning events in emergency centers. It is recommended that toxicology professionals should develop a toxic surveillance system and serial reporting should be performed.

의식 저하로 내원한 중독 환자들에 대한 호기말 이산화탄소분압 관찰의 효과

권용희 ( Yong Hee Kwon ),소병학 ( Byung Hak So ),정원중 ( Won Jung Jeong ) 대한임상독성학회 2021 대한임상독성학회지 Vol.19 No.1

Purpose: This study aimed to analyse the effect of End-Tidal Carbon Dioxide (ETCO2) monitoring on patients who had been poisoned and presented in the emergency department with decreased consciousness. Methods: The data of patients over 18 years old presenting with poisoning from 2016 to 2020 was collected from the emergency department. We retrospectively analyzed their medical records, and defined patients with a Glasgow Coma Scale (GCS) score of 9 or less as having decreased consciousness. We divided the patients into two groups, one with ETCO2 monitoring and the other without, and the difference between the two groups was compared. Results: 168 patients participated in this study and 83 (49.4%) of them belonged to the ETCO2 monitoring group. In this group, the interval between arterial blood tests was statistically significantly longer and the rate of intubation was lower. In addition, in the monitoring group, the incidence of pneumonia and the rate of poor prognosis was not significantly higher. Conclusion: Although ETCO2 monitoring does not directly affect the prognosis of poisoned patients with decreased consciousness, it should be actively done as it can help to adequately treat patients while avoiding invasive techniques or unnecessary intubation.

Neonicotinoid 살충제 중독환자의 임상양상

김진철 ( Jin Chul Kim ),소병학 ( Byung Hak So ),김한준 ( Han Joon Kim ),김형민 ( Hyung Min Kim ),박정호 ( Jung Ho Park ),최세민 ( Se Min Choi ),박규남 ( Kyu Nam Park ),최경호 ( Kyoung Ho Choi ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.1

Purpose: Neonicotinoid insecticides are widely used as they have been proven by experimental studies to have low toxicity to mammals, including humans. As the use of neonicotioids increases, the number of patients with neonicotinoid poisoning has also increased. We conducted a study to investigate the clinical manifestations of neonicotinid poisoning. Methods: We retrospectively analyzed the patients who ingested neonicotinids and who visited the emergency department located in Korea from March 2002 to February 2010. We reviewed the patients’age, gender, the amount of exposure, the elapsed time to presentation, the treatment and the outcome. According to the poisoning severity score, we divided the patients with a Poisoning severity score (PSS) of 0 or 1 into the mild/moderate toxicity group and the patients with a PSS of 2 or 3 into the severe/fatal toxicity group. Results: A total of 24 patients were analyzed. The most common clinical manifestations of neonicotinoid insecticide toxicity were gastrointestinal symptoms (66.7%) such as nausea, vomiting and abdominal pain and the others are respiratory symptoms (16.7%), cardiovascular symptoms (12.5%), metabolic imbalance (12.5%), renal dysfunction (8.3%), CNS symptoms (8.3%), and asymptomatic (29.2%). Twenty patients (83.3%) showed mild/moderate toxicity and 4 patients (16.7%) showed fatal conditions such as shock and mutiorgan failure. The mortality rate was 4.2%. In these fatal cases, the patients developed respiratory failure, hypotension, altered mentality and renal failure at the acute stage and they deteriorated to a more serious condition. This severe toxicity was caused by decreased renal excretion of neonicotinid metabolite, and this was improved after hemodialysis. Conclusion: Most patients with neonicotinoid poisoning and who showed mild toxicity usually improved after symptomatic treatment. However, some patients showed significant toxicity with respiratory failure and renal function deterioration, and intensive care needed, including mechanical ventilation and hemodialysis.

4개 응급센터에 내원한 비만치료제 중독 환자들의 다양한 임상양상 경험: 16례

한승훈 ( Sung Hoon Han ),소병학 ( Byung Hak So ),정원중 ( Won Joong Jung ),김형민 ( Hyung Min Kim ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.2

Purpose: In Korea, few studies have examined the acute toxicity of anti-obesity drugs. The purpose of this study is to analyze the general characteristics and clinical aspect of acute anti-obesity drug intoxication. Methods: We retrospectively investigated patients admitted to the emergency department after anti-obesity drug intoxication between March, 2004 and February, 2012. The medical records of these patients were reviewed for demographic data, toxicologic history, time elapsed to presentation, clinical symptoms and signs, treatment, and outcome. Results: There were a total of 18 anti-obesity intoxication cases during the study period; of 16 which were included in our study. The purchasing route of the anti-obesity drug was mainly through a doctor’s prescription (68.8%), however, some were obtained through the internet and the pharmacies. The mean time to The most commonly ingested antiobesity drug was sibutramine (31.3%) and many of the cases (62.5%) were multi-drug ingestions. The most common clinical manifestations were gastrointestinal symptoms (94%), but, CNS symptoms (75%) and cardiovascular symptoms (75%) were almost equally present. 13 patients (81%) were discharged after clearance of toxic symptoms and signs with a mean observational period of 7.0 hours. 3 patients were admitted for observation and treatment; of which 1 patient died due to fatal complications. Conclusion: Most anti-obesity intoxications show mild toxicity and a nonfatal clinical course. However, the recent trend toward prescribing psychostimulant anti-obesity medication, which can be fatal after an acute overdose, calls physicians’ attention to treating of anti-obesity intoxications.

횡문근융해증을 유발하는 음독 약물별 임상경과 분석

이미진,김형민,김영민,이원재,소병학,김세경,Lee Mi Jin,Kim Hyung Min,Kim Young Min,Lee Won Jae,So Byung Hak,Kim Se Kyung 대한임상독성학회 2003 대한임상독성학회지 Vol.1 No.1

Purpose: According as the accessibility about drugs becomes various, the occurrence of drug intoxication is increasing. Since report that doxylamine causes rhabdomyolysis often, drug-induced rhabdomyolysis is one of the most important complications in patients with drug intoxication. Acute renal failure (ARF)'s availability is important to the management in rhabdomyolysis, but report about rhabdomyolysis or ARF occurrence for whole intoxicated drugs is lacking up to now. Methods: This research did to 61 patient who had rhabdomyolysis of drug intoxication. First, object patients were divided into two gruops: doxylamine-ingested (Group I) vs non-doxylamine ingested (Group II). And then we analyzed on the early patient's clinical events and laboratory data. We used ROC curve to recognize'the early clinical factors that could forecast ARF appearance among these patients in addition. Results: Almost rhabdomyolysis was happened by doxylamine in drug intoxication ($55.7\%$). However, as compared to group II, group I showed better clinical course, lesser ARF occurrence and hemodialysis requirement. In group II, time was longer in hospital reaching from intoxication, the ARF occurrence rate was higher ($52.6\%$). Analyzing the ROC curve to useful initial factors, they were creatinine, uric acid and interval time from ingestion to hospital. These cut-off values were 1.44 mg/dL, 6.8 mg/dL and 5 hrs. Sensitivity for ARF estimate was $100\%$, specificity $69-98\%$. Conclusion: Compared to group II, Doxylamine-ingested group showed good clinical course. Creatinine, uric acid, interval time from ingestion to hospital aided in ARF estimate in drug-induced rhabdomyolysis.

의도적 음독으로 응급실에 내원한 소아 청소년 환자들의 성별에 따른 특성 분석

김윤재 ( Yun Jae Kim ),소병학 ( Byung Hak So ),김형민 ( Hyung Min Kim ),정원중 ( Won Jung Jeong ),차경만 ( Kyeong Man Cha ),김성욱 ( Seong Wook Kim ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.2

Purpose: The aim of this study is to investigate the difference between male and female in some clinically meaningful aspects and to prevent intentional poisoning in children and adolescents. Methods: Retrograde medical records review of patients who visited the emergency department of two secondary hospitals for drug ingestion from March 2010 through March 2013 was performed. Unintentional ingestion or ingestion by others was excluded. Results: A total of 138 cases were reported, male 25.4% (n=35), female 74.6% (n=103). The reason for poisoning was intentional in 132 cases (95.7%) and misuse in six cases (4.3%). In female patients, non-prescription drugs was the most common cause of intentional poisoning (68.9%). Male patients tend to use life substances for intentional poisoning more frequently (20.0%) than female (3.9%). Seven male patients and 12 female patients had previous psychiatric history and 34.3% of male and 41.7% of female were consulted to the psychiatric department. Conclusion: Female adolescents are more likely to ingest drugs intentionally for suicide attempt than males of comparable ages. The drugs they ingested were, in many cases, obtained with ease from the drug store nearby and, remarkably, most of the drugs they obtained in that way were acetaminophen-containing. This suggests that some guidelines or control in the pharmacy that restrict children or adolescents from obtaining potentially or possibly life-threatening drugs might be necessary. In addition, education regarding drugs is thought to be necessary in school for teenagers as they tend to misuse them with incorrect acknowledgement.

외상 환자의 중증도 판단과 예후 예측을 위한 개별 인자들의 유용성 평가

김성윤 ( Sung Yoon Kim ),소병학 ( Byung Hak So ),김형민 ( Hyung Min Kim ),정원중 ( Won Jung Jeong ),차경만 ( Kyung Man Cha ),최승필 ( Seung Pill Choi ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: Many patients are injured by trauma. And some of them expire due to severity of trauma. Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. This study is to evaluation the usefulness of factors for determining the severity and predicting the prognosis of the trauma victims. Methods: Data on the patients who visited our Emergency departments from January 2010 to December 2011 were retrospectively reviewed using electronic medical records. The patients were activated severe trauma team calling system. The patients were categorized as survivors and non-survivors. Univariated associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. Results: Two hundred sixty two(262) patients were enrolled, and the mortality rate was 25.6%. By multivariate analysis, lower respiration rate, lower Glasgow Coma Score, higher International Normalized Ratio and emergency transfusion within 6 hours were expected as severity and prognosis predict factors (each of odds ratio were 24.907, 14.282, 2.667 and 16.144). Conclusion: As predict factors, respiration rate, Glasgow Coma Score, International Normalized Ratio and emergency transfusion, are useful determining the severity and predicting prognosis of trauma victims. [ J Trauma Inj 2015; 28: 134-143 ]

시부트라민(sibutramine) 음독 후 발생된 급성 정신병증 1례

김형민,우선희,최세민,소병학,Kim, Hyung-Min,Woo, Seon-Hee,Choi, Se-Min,So, Byung-Hak 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

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.

2009년 국내 응급실 중독환자 다기관조사: 두 번째 연차보고

성애진 ( Ae Jin Sung ),이경우 ( Kyung Woo Lee ),소병학 ( Byung Hak So ),이미진 ( Mi Jin Lee ),김현 ( Hyun Kim ),박경혜 ( Kyung Hye Park ),박정배 ( Jeong Bae Park ),염석란 ( Seok Ran Yeom ),오성범 ( Seong Beom Oh ),유지영 ( Ji You 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.1

Purpose: The purpose of this study was to examine the occurrence of toxic exposure cases in Korean emergency centers using a toxic exposure surveillance system-based report form and to provide guidelines for the prevention and treatment of toxic exposures. Methods: We retrospectively reviewed the medical records of toxic exposure patients who had visited emergency centers from January 2009 to December 2009. Epidemiology data points for the toxic exposure cases included age, gender, type of exposure, number and kind of substances involved, reason and route of poison exposure, manage-ment of the patients in the emergency departments, and the clinical outcome. Results: A total of 3,501 patients from 12 emergency departments were enrolled in the study. 50.0% of the total exposure patients were male and 63.0% of the total cases were fatal. Acute intoxication occurred in 91.3% of the total patients and suicidal intent was the most common (43.3%) reason for exposure. The most common route of exposure was ingestion (75.9%). Of the total cases, pesticides were involved in 26.3%, sedatives/hypnotics/antipsychotics were involved in 22.0%, and bites and envenomations were involved in 15.7%. Conclusion: We provided a database of patients who were admitted to emergency departments after poisoning incidents. We recommend that toxicology professionals develop a classification scheme for toxicants which is adequate for Korean domestic circumstances and initiate a toxic surveillance system for all types of exposures. With support of a psychiatric surveillance system for suicidal patients and establishment of social mediation for pesticide poisoning, major reductions in poison exposures can be achieved.