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An Outbreak of Food Borne Illness Due to Methomyl Pesticide Intoxication in Korea
길효욱,정미혜,박정수,최환원,김소영,홍세용 대한의학회 2013 Journal of Korean medical science Vol.28 No.11
On February 21, 2013, 6 elderly people collapsed abruptly after eating bean sprout bibimbab (boiled rice mixed with bean sprouts and seasoned with soybean sauce) at a countryside restaurant in the Chungbuk Province, Korea. Minutes after eating the meal, all of the patients lapsed into a state of stupor. Respiratory arrest developed in 2 patients; and one of two patients died of cardiac arrest. The autopsy identified methomyl and methanol in the deceased patient’s gastric contents and in the remaining soybeanbean sauce seasoning. Five of the 6 patients ingested one spoonful of the soybeanbean sauce seasoning and survived, while one patient who died of cardiac arrest, ingested approximately two spoons. Symptoms of toxicity presented quickly in the subjects and progressed rapidly, including chest tightness, an unusual sensation in the pit of the stomach, dizziness, ataxia, and finally, collapse. Three patients who drank ethanol with the meal experienced only mild toxic symptoms. Our analysis of the clinical observations in these cases suggests that ingestion of methomyl pesticide and the additive toxicity of methanol may have been responsible for the intoxication.
The Effect of Dialysis Membrane Flux on Amino Acid Loss in Hemodialysis Patients
길효욱,양종오,이은영,이은미,최종순,홍세용 대한의학회 2007 Journal of Korean medical science Vol.22 No.4
We examined whether high flux membranes (HF) may induce a greater loss of amino acids compared to low flux membranes (LF). Ten hemodialysis patients participated in this study. Pre- and post-hemodialysis plasma amino acid profiles were measured by reverse-phase high pressure liquid chromatography for both HF and LF. We measured the dialysate amino acid losses during hemodialysis. The reduction difference for plasma total amino acid (TAA), essential amino acid (EAA), and branch chained amino acid (BCAA) was not significantly different in comparisons between the two membranes. (HF vs. LF; TAA 66.85±30.56 vs. 53.78±41.28, p=0.12; EAA 14.79±17.16 vs. 17.97±28.69, p=0.12; BCAA 2.21±6.08 vs. 4.16±10.98 mg/L, p=0.13). For the HF, the reduction in plasma amino acid levels for TAA and EAA were statistically significant. Although it was not statistically significant, the dialysate losses of BCAA were greater than the reduction in plasma (plasma reduction vs. dialysate loss; HF 2.21±6.08 vs. 6.58±4.32, LF 4.16±10.98 vs. 7.96± 3.25 mg/L). HF with large pores and a sieving coefficient do not influence dialysate amino acid losses. Hemodialysis itself may influence the dialysate amino acid losses and may have an effect on protein metabolism.
살충제 중독환자에서 혈액관류가 혈중 살충제 농도에 미치는 영향
길효욱,양종오,이은영,홍세용,Gil Hyo-Wook,Yang Jong-Oh,Lee Eun-Yong,Hong Sae-Yong 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1
Purpose: Hemoperfusion is an effective modality of extracorporeal elimination of toxins in acutely poisoned patients. We evaluated the effect of hemoperfusion on plasma concentration of toxins in patients exposed to certain pesticides. Methods: Eleven patients who were acutely exposed to pesticides participated in our study. We measured plasma pesticide concentration from the whole blood obtained by arterial and venous sources by gas chromatography. Results: The plasma concentrations of only 3 patients was measured. Methidation clearance by hemoperfusion was 82.2%, fenitrothion was 23%, and endosulfan was 0% Conclusion: Measurement of plasma organophosphate concentration is not a practical application. Our results suggest that hemoperfusion is applicable in patients with pesticide intoxication according to clinical status.
Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication
길효욱,Jung-Rak Hong,장시형,홍새용 대한의학회 2014 Journal of Korean medical science Vol.29 No.11
Paraquat (PQ) has known negative human health effects, but continues to be commonlyused worldwide as a herbicide. Our clinical data shows that the main prognostic factor isthe 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 onhigh-resolution computed tomography imaging 7 days post-PQ ingestion. The incidenceof acute kidney injury is approximately 50%. The average serum creatinine level reaches itspeak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain twoconnecting lines from the highest PQ level for the survivors and the lowest PQ level amongthe non-survivors at a given time. Patients with a PQ level between these two lines areconsidered treatable. The following treatment modalities are recommended to preservekidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration,3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a generaloverview on the diagnostic procedure and treatment modality of acute PQ intoxication,while focusing on our clinical experience
원인 불명의 급성 신부전으로 발현된 급성 파라콰트중독 1례
길효욱,양종오,이은영,홍세용,Gil Hyo Wook,Yang Jong Oh,Lee Eun Young,Hong Sae Yong 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1
Paraquat, a widely used herbicide, is extremely toxic, causing multiple organ failure in human. Many treatment modality has been used, but now paraquat is very fatal drug. Elimination rate of plasma paraquat seems to be a factor for the survival rate. So early diagnosis and early treatment are very important. Plasma paraquat concentration could be measured by radioimmunoassay. But it is impossible that the test was done at Emergency room and the result was checked immediately. There was relation between plasma paraquat concentrations and urine paraquat concentration. Because of its simplicity and low cost, urine paraquat concentration test is complementary to the plasma concentration measurement. If the patient has psychotic problem or unconscious mental state, and is observed unexplained dyspnea and oral ulcer, urine paraquat test is very important to rule out acute paraquat intoxication. We experienced a patient who was presented as unexplained acute renal failure initially and was diagnosed as paraquat intoxication later.