의식이 명료한 일산화탄소 중독환자를 대상으로 응급실에서 시행한 간이정신상태검사의 임상적 의의

육현 ( Hyun Youk ),차용성 ( Yong Sung Cha ),김현 ( Hyun Kim ),김성훈 ( Sung Hoon Kim ),김지현 ( Ji Hyun Kim ),김오현 ( Oh Hyun Kim ),김형일 ( Hyung Il Kim ),차경철 ( Kyoung Chul Cha ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hw 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Purpose: Because carbon monoxide (CO)-intoxicated patients with an alert mental status and only mild cognitive dysfunction may be inadequately assessed by traditional bedside neurologic examination in the emergency department (ED), they may not receive appropriate treatment. Methods: We retrospectively investigated the incidence and features of cognitive dysfunction using the Korean version of the Mini-Mental State Examination (MMSE-K) in ED patients with CO poisoning with alert mental status. We conducted a retrospective review of 43 consecutive mild CO poisoned patients with a Glasgow Coma Scale score of 15 based on documentation by the treating emergency physician in the ED between July 2014 and August 2015. Results: Cognitive dysfunction, defined as a score of less than 24 in the MMSE-K, was diagnosed in six patients (14%) in the ED. In the MMSE-K, orientation to time, memory recall, and concentration/calculation showed greater impairments. The mean age was significantly older in the cognitive dysfunction group than the non-cognitive dysfunction group (45.3 yrs vs. 66.5 yrs, p<0.001). Among the initial symptoms, experience of a transient change in mental status before ED arrival was significantly more common in the cognitive dysfunction group (32.4% vs. 100%, p=0.003). Conclusion: Patients with CO poisoning and an alert mental status may experience cognitive dysfunction as assessed using the MMSE-K during the early stages of evaluation in the ED. In the MMSE-K, orientation to time, memory recall, and concentration/calculation showed the greatest impairment.

Glyphosate 음독의 임상양상

김용원 ( Yong Won Kim ),김현 ( Hyun Kim ),차경철 ( Kyoung Chul Cha ),신형진 ( Hyung Jin Shin ),차용성 ( Yong Sung Cha ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.1

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.

만성 리튬 중독환자의 지연성 정정맥 혈액 투석여과 사례

김태수 ( Tae Su Kim ),차용성 ( Yong Sung Cha ),김김현 ( Hyun Kim ),김오현 ( Oh Hyun Kim ),차경철 ( Kyoung Chul Cha ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.1

A 66-year-old male with chronic alcoholism presented with tremor, gait disturbance, memory impairment, insomnia, decreased appetite, and confusion. The patient had been taking lithium daily for treatment of bipolar disorder. Brain CT showed no specific abnormality, and serum lithium and ammonia levels were 3.63 mEq/L (therapeutic range, 0.6~1.2 mEq/L) and 85μg/dL (reference range: 19~54μg/dL), respectively. Therefore, the initial differential diagnosis included chronic lithium intoxication, hepatic encephalopathy, Wernicke encephalopathy, or alcohol withdrawal syndrome. Even with the provision of adequate hydration, the patient’s neurologic status did not show improvement, so that lactulose enema, thiamine replacement, and continuous venovenous hemodiafiltration (CVVHDF) were started on the third admission day. By the fifth admission day he had made a rapid neurologic recovery, and was discharged on the 20th admission day. Therefore, CVVHDF might be a treatment for patients with chronic lithium intoxication, because, even if serum lithium concentration is normal, lithium concentration in the brain may be different from that of the serum.

초본 섭취 후 발생한 심장독성

정우진 ( Woo Jin Jung ),김현 ( Hyun Kim ),차용성 ( Yong Sung Cha ),김오현 ( Oh Hyun Kim ),차경철 ( Kyoung Chul Cha ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.1

Purpose: Herbal preparations have long been used for medical purposes by traditional cultures, and their use is increasing in modern societies. However, many herbal agents produce specific cardiovascular toxicities in humans. We performed this study in order to investigate the clinical characteristics of the cardiac toxicities associated with herbal remedies. Methods: We conducted a retrospective study of 45 patients (mean age 57±10 years) who presented with cardiotoxicity between January 2007 and May 2011 due to ingestion of herbal remedy substances. Patients were identified as suffering cardiotoxicity if they presented with chest pain, EKG abnormality, and elevation of cardiac enzyme. Results: Of the 45 total cases, 17 included hemodynamic instability (37.8%), 7 with increasing cardiac enzyme (15.6%), 2 with cardiac arrest (4.4%) and one case of mortality (2.2%). The cardiotoxic herb group that demonstrated the worst clinical course was Ranunculaceae. Conclusions: In our study results, 57.6% of the herbal intoxication patients demonstrated the effects of cardiotoxicity. Thus, we recommend careful monitoring of herbal intoxication patients.

스노보드 손상 환자에 있어서 손목 손상의 특성

김영준 ( Yeong Jun Kim ),이강현 ( Kang Hyun Lee ),차경철 ( Kyoung Chul Cha ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ),오진록 ( Jin Rok Oh ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: The purpose of this study was to analyze the characteristics and severity of wrist injuries in snowboarding. Methods: December 2005 to February 2008, Snowboarders who experienced wrist injures were included in this study. On the basis of the medical records and radiographic evaluation, the severity of distal radius fracture was classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification. Results: Most of the injured snowboarders were a either of the beginner (35 cases, 46.1%) or the intermediate (27 cases, 35.5%) level. The most common cause of injury in snowboarding was a slip down (60 cases, 78.9%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical reduction, made up 42.3% of the distal radial fractures in snowboarders. When we analyzed the differences in severity between the educated and the non-educated groups, an A2 type injury in the AO classification was the most common type of injury in the educated group (20 cases, 38.5%), it means less severe fractures ocurred in the educated group (p=0.045). The most frequent injury mechanism of fractures was slip down (48 cases, 63.2%), and a slip down backwards was the dominant type of slip down (36 cases, 75.0%) (p=0.031). Conclusion: Among the snowboarders in this study who suffered self-down injury to the wrist, more fractures were associated with a backwards slip down than with a forward slip down due to over extension. For educated snowboarders the severity of fracture was lower than it was for uneducated snowboarders. (J Korean Soc Traumatol 2009;22:29-36)

유기인계 중독에 의한 심근손상 환자에서의 경흉부 심장 초음파검사를 사용한 심장기능평가

이윤석 ( Yoonsuk Lee ),김오현 ( Oh Hyun Kim ),김형일 ( Hyung Il Kim ),차경철 ( Kyoung Chul Cha ),김현 ( Hyun Kim ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ),차용성 ( Yong Sung Cha ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: Cardiac complications may occur in cases of organophosphate (OP) poisoning. However, a few studies regarding patterns of cardiac toxicity as determined by transthoracic echocardiography (TTE) after exposure to OP have been reported. In the current study, the authors examined cardiac functions using TTE in patients with myocardial injury caused by exposure to OP. Methods: A retrospective review was conducted on 16 consecutive cases of OP poisoning with myocardial injury(defined as elevated troponin I within 48 hours of arrival at the regional emergency center in South Korea and diagnosed and treated at the center from January 2012 to November 2014. Results: TTE was performed in 11 (69%) of the 16 patients with an elevated troponin I (TnI) level within 48 hours. Of these 11 patients, 5 patients (45.5%) exhibited reduced ejection fraction (EF), and 3 exhibited regional wall motion abnormality (RWMA). Two patients (18.2%) had both reduced systolic function and RWMA. Two of the 5 patients with reduced EF returned to normal systolic function, however two patients did not regain normal systolic function after admission. One patient expired due to multiple organ failure, and 4 patients were transferred with a moribund status. Twelve of 15 patients who survived to discharge (at 4 to 35 months) were followed. Five of these patients died during follow-up and 7 survived without further complications. Conclusion: OP can cause reversible cardiac dysfunction including reduced systolic function and RWMA. Serum TnI may be useful for initial assessment of cardiac function during the workup of patients suffering from OP poisoning. After the initial assessment of cardiac enzyme, further evaluation with TTE in patients with abnormal cardiac enzyme will be necessary to understand the cardiac toxicity.

단순 외상팀 활성화 조건이 중증 외상 환자의 치료 결과에 미치는 영향

이동건 ( Dong Keon Lee ),이강현 ( Kang Hyun Lee ),차경철 ( Kyoung Chul Cha ),박경혜 ( Kyoung Hye Park ),최한주 ( Han Joo Choi ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: The goal of this study was to compare the outcome of the after trauma team (AfterTT) group to the before trauma team (BeforeTT) group. Methods: All trauma patients who visited to emergency room (ER) between July 1, 2006 and February 29, 2008 based on trauma registry, with systolic blood pressure (SBP) <90 mmHg or GCS <9 were included in this study. We compared the amount of packed RBC transfusion, the ER stay time, the ER visit to CT evaluation time, the ER visit to operation time, the length of ICU stay, the length of hospital admission and the survival discharge rate between the AfterTT group and the BeforeTT group. Patients with brain injuries had little chance of survival. Burn patients, who visited the ER 24 hours after injury and patients who were dead on arrival (DOA) were excluded from this study. Results: Total of 93 patients were included in this study: 42 in the AfterTT group and 51 in the BeforeTT group. The AfterTT group and the Before TT group showed no differences in Revised Trauma Score (RTS) and mean age. The amount of packed RBC transfusion was lower in the AfterTT group, but no statistically significant difference was noted (AfterTT 11±11units, BeforeTT 16±15units, p=0.136). The ER visit to operation time was shorter in the AfterTT group, but there were no statistically significant difference between the groups (AfterTT 251±223 minutes, BeforeTT 486±460 minutes, p=0.082). The length of ICU stay was shorter in the AfterTT group, but the difference was not statistically significant (AfterTT 11±12 days, Before TT 15±30 days, p=0.438). The length of Hospital admission was shorter in the AfterTT group (AfterTT 43±37 days, BeforeTT 68±70 days, p=0.032), but this difference was not statistically significant. Conclusion: Simple Trauma team activation criteria decreased the amount of packed RBC transfusion and the hospital admission duration. Hemodynamic instability (SBP<90 mmHg) and decreased mental state (GCS<9) are good indices for activating the trauma team. (J Korean Soc Traumatol 2009;22:71-76)

카바메이트 중독 후 발생한 급성췌장염

박요섭 ( Joseph Park ),김용원 ( Yong Won Kim ),오세현 ( Se Hyun Oh ),차용성 ( Yong Sung Cha ),차경철 ( Kyoung Chul Cha ),김오현 ( Oh Hyun Kim ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ),김현 ( Hyun Kim ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.2

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.

앉은 부채 섭취 후 발생한 심장독성 3예

김태훈 ( Tae Hoon Kim ),김현 ( Hyun Kim ),김오현 ( Oh Hyun Kim ),차용성 ( Yong Sung Cha ),차경철 ( Kyoung Chul Cha ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.1

Recently, some patients have visited the emergency department for treatment of different symptoms of acute poisoning after intake of unidentified herbs, which can be mistaken for wild edible greens, because wild edible greens are good for health and contain vitamins, enzymes, minerals, fibers, and anticancer materials. Winter or early spring, is extremely high, with rapid onset of severe symptoms of poisoning. There have been no reports of poisoning by SymplocarpusRenifolius in Korea, however, we report on three severe cases involving patients who experienced cardiogenic shock with nausea, vomiting, abdominal pain, chest discomfort, dizziness, numbness, and general weakness.

부식제 중독 환자에서 시간에 따른 내시경 합병증 비교

최진걸 ( Jin Geul Choi ),김오현 ( Oh Hyun Kim ),김현 ( Hyun Kim ),이동건 ( Dong Keon Lee ),고진 ( Jin Go ),김태훈 ( Tae Hoon Kim ),차경철 ( Kyoung Chul Cha ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ),차용성 ( Yong Sung C 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.2

Purpose: Endoscopy has been recommended as a primary procedure for determining the extent of damage and prognosis in patients with caustic ingestions. Endoscopy within the first 24 hours has been suggested, however, such immediate endoscopy is not always possible. Therefore, we wanted to determine complications and possible delayed sequelae after the endoscopy performed dependent on time, including less than 24 hours and more than 24 hours, after ingestion of relatively high toxic caustic agents. Methods: From January 2005 to May 2013, 105 consecutive patients were diagnosed with caustic poisoning in the emergency department of the Wonju Severance Christian Hospital. Out of 95 patients who underwent endoscopy, while excluding 49 patients who ingested sodium hypochlorite and 15 patients due to insufficient data, 41 patients were ultimately included. We compared general characteristics, complications related to endoscopy, late sequelae, total admission length, and mortality between two groups. Results: Twenty eight patients (68.3%) were diagnosed with acid ingestion. Median endoscopy time was 17.8 (IQR 9.7-36.9) hours and performed in 16 patients (39%) after 24 hours. There were no complications, such as perforation and bleeding in either endoscopy within 24 hours group or endoscopy after 24 hours group. In addition, no difference in ingested materials, endoscopy grade, or late sequelae was observed between endoscopy within 24 hours group and endoscopy after 24 hours group. Conclusion: No difference in complications and late sequelae was observed between endoscopy within 24 hours group and endoscopy after 24 hours group when endoscopy was performed based on a clinician’s assessment.