아스피린 중독에 의한 심전도 변화 2례

유제성,박종우,최영환,조영순,조광현,박준석,정성필,이한식,You Je-Sung,Park Jong-Woo,Choi Young-Hwan,Cho Young-Soon,Cho Kwang-Hyun,Park Jun-Seok,Chung Sung-Pil,Lee Hahn-Shick 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Symptoms of aspirin overdose may vary from acid-base disturbance, electrolyte abnormality, non-cardiogenic pulmonary edema, chemical hepatitis, seizure to cardiac toxicity. Cardiac adverse effects from aspirin are uncommon but there are reports of arrhythmia, cardiopulmonary arrest, and myocardial infarction. We report 2 cases of young women with aspirin overdose who exhibited ischemic changes on their ECGs a few hours after the ingestion with spontaneous recovery in a few days. First case, a 29 year old woman, presented to the emergency department 6 hours after ingesting 250 tablets of aspirin (325 mg/T). On examination, the temperature was $36.3^{\circ}C$: blood pressure, 105/72mmHg; Pulse, 111/min and respiratory rate, 24/min. Second case, a 27 year old woman, an hour after ingesting 60 tablets (325mg/T). On examination, the temperature was $36.0^{\circ}C$: blood pressure, 102/72 mmHg; pulse, 89/min and respiratory rate, 25/min. In both cases, ECG after 6 hours of ingestion had sinus tachycardia and developed T wave inversion on the anterior leads in the following ECGs. Their initial serum salicylate levels after 6 hours of ingestion were 71.2 mg/dL and 28.4 mg/dL respectively. These salicylate levels were resolving when these ECGs were observed. The ECG changes resolved in the following days and they were discharged without any further symptoms. Further studies are needed, but for the time being, when dealing with salicylate overdose, transient cardiac depression should be kept in mind to avoid adverse ischemic cardiac events.

국내 응급의료센터의 해독제 보유 현황

유제성,김의중,이한식,김승호,정성필,You, Je-Sung,Kim, Eui-Chung,Lee, Hahn-Shick,Kim, Seung-Ho,Chung, Sung-Pil 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.2

Purpose: Inadequate hospital stocking and unavailability of essential antidotes is a worldwide problem. The purpose of this study was to determine the adequacy of antidote stocks in Korean hospitals based on a modified version of US antidote stocking guidelines. Methods: Both written and telephone surveys to collect information on hospital demographics and antidote stocking were given to the emergency departments or hospital pharmacies of 117 hospitals with emergency medical centers. The twenty antidotes included in the survey were taken from year 2000 US antidote stocking guidelines, except for activated charcoal and black widow spider antivenin. Antidote stocks were compared by hospital size, geographic location, and type of emergency medical center. Results: Complete responses were received from all hospitals. A mean of $12.4{\pm}2.9$ antidotes were adequately stocked per hospital. All hospitals stocked atropine, $CaCl_2$ naloxone, and sodium bicarbonate. However, digoxin Fab fragment (16%), cyanide kits (15%), EDTA (10%), BAL (9%), and fomepizole (1%) were not uniformly stocked. Large and teaching hospitals were significantly more likely to stock greater numbers of antidotes. Conclusions: Korean hospitals as a group do not have adequate antidote stocks. Korean stocking guidelines and an antidote management system are recommended in order to correct these deficiencies.

흰꽃독말풀 열매 달인 물 복용 후 발생한 의식 변화 환자 1례

유제성,남연우,이진희,정성필,김승호,박인철,You Je-Sung,Nam Yeoun-Woo,Lee Jin-Hee,Chung Sung-Pil,Kim Seung-Ho,Park In-Cheol 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Datura stramonium is a wild growing plant, consumption of which can result in severe toxicity. It contains a variety alkaloids include atropine, hyoscamine, and scopolamine that can all cause anticholonergic poisoning. It has been use of herb medicine in Korea. Side effects from ingesting Datura stramonium include dry mouth, blurred vision, photophobia, and may be followed by hyperthermia, confusion, agitation, hallucination, and aggressive behavior. In severe toxicity, it can cause seizure, coma, life-threatening arrhythmia, and death. We experienced one patient who developed stupor mentality caused by Datura stramonium. Severe presentation, especially mental change of Datura stramonium should draw attention. Poisoning associated with Datura stramonium can be prevented through educational public health program.

Amatoxin 중독 환자에서 Silymarin, Penicillin, N-acetylcysteine의 효과 비교: 체계적 고찰

최민우,고동률,공태영,좌민홍,유제성,정성필,Choi, Min Woo,Ko, Dong Ryul,Kong, Taeyoung,Choa, Min Hong,You, Je Sung,Chung, Sung Phil 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.1

Purpose: This study was conducted to evaluate the clinical efficacy of pharmacologic treatment of amatoxin poisoning patients. Methods: Literature was accessed through PubMed, EMBASE, Cochrane library, KoreaMed, KISS and KMBASE. Studies relevant to human use of pharmacologic therapy including silymarin, penicillin and N-acetylcysteine (NAC) for amanita poisoning were included. Case reports, letters, editorials and papers with insufficient information were excluded. Comparison of clinical outcomes (especially mortality and liver transplantation rate) in each study was analyzed. Results: The final analysis included 13 retrospective studies. None of these studies showed direct comparisons of individual agents. Among 12 studies comparing silymarin vs penicillin, eight showed clinical superiority of silymarin. Among eight studies comparing silymarin with NAC, six showed clinical superiority of silymarin. Among seven studies of NAC vs penicillin, five showed clinical superiority of NAC. Conclusion: This systematic review suggested that clinical superiority of various pharmacological agents used to treat amatoxin poisoning is debatable. Nevertheless, the available evidence suggests it is reasonable to consider combinations of multiple agents for patients with amanita poisoning. Further studies are required to establish a treatment regimen for amanita poisoning.

Acetaminophen 중독에 의한 급성 간 부전 환자에서 Molecular Adsorbents Recirculating System을 이용한 치험 1례

양병근 ( Byung Keun Yang ),유제성 ( Je Sung You ),주영선 ( Young Seon Joo ),정성필 ( Sung Phil Chung ),이한식 ( Hahn Schick Lee ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.1

We report on a patient who developed acute hepatic failure despite intravenous N-acetyl cysteine therapy who was treated with the Molecular Adsorbents Recirculating System (MARS). She presented 20 hours after the ingestion of 13 g of acetaminophen. The MARS is based on albumin dialysis principle which can be applied for patients with acute poisoning from drugs that have high protein-binding capacity because of its ability to selectively remove from circulation protein-bound toxins. The clinical toxicologist should be consider this technology when treating patients with hepatic failure following acetaminophen poisoning.

액상형 전자담배 용액에 의한 급성 니코틴 중독: 증례보고의 체계적 고찰

양시용 ( Si Yong Yang ),좌민홍 ( Min Hong Choa ),유제성 ( Je Sung You ),정현수 ( Hyun Soo Chung ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2020 대한임상독성학회지 Vol.18 No.2

Purpose: Acute nicotine poisoning by liquid nicotine in electronic cigarettes is becoming an increasing problem worldwide. The current systematic review aimed to determine the harm of acute nicotine poisoning by reviewing published case reports. Methods: An online literature search with PubMed, Embase, Cochrane Library, and KoreaMed database was performed to identify relevant studies addressing acute nicotine poisoning with electronic cigarettes. Two investigators searched the case reports written in English or Korean. Results: Twenty-six cases were included in this study. The routes of intoxication included ingestion in 18 cases, intravenous injection in three cases, subcutaneous injection in two cases, and ocular exposure in two cases. Ten cases had a cardiac arrest, and seven of them died. Seven out of 12 cases with intentional poisoning had a cardiac arrest. Nine children under 18 years were reported, and three of them had a cardiac arrest. Sixteen cases without a cardiac arrest recovered well, except for one case with sudden sensorineural hearing loss. Conclusion: The authors reviewed the risks of electronic cigarette liquid in terms of acute poisoning through a systematic review. The nicotine solution of an e-cigarette can be life-threatening in cases of acute poisoning. Therefore, active emergency treatment with early recognition is necessary. In addition, various management methods and regulations for preventing acute nicotine poisoning, such as restriction of distribution and nicotine concentration, should be considered.

급성 Valproic acid 중독에서 L-carnitine과 체외 제거방법: 체계적 고찰

양병근 ( Byung Keun Yang ),구재은 ( Jae Eun Ku ),주영선 ( Young Seon Joo ),유제성 ( Je Sung You ),정성필 ( Sung Phil Chung ),이한식 ( Hahn Shick Lee ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.2

Purpose: The purpose of this study is to review the evidence comparing the efficacy and safety between L-carnitine and extracorporeal elimination therapy in the management of acute valproic acid L-carnitine vs Extracorporeal Elimination for Acute Valproic acid Intoxication Methods: PubMed, Embase, Cochrane library, Web of Science, KoreaMed, KMbase, and KISS were searched, using the terms carnitine and valproic acid. All studies, regardless of design, reporting efficacy or safety endpoints were included. Reference citations from identified publications were reviewed. Both English and Korean languages were included. Two authors extracted primary data elements including poisoning severity, presenting features, clinical management, and outcomes. Results: Thirty two articles including 33 cases were identified. Poisoning severity was classified as 3 mild, 11 moderate, and 19 severe cases. Nine cases were treated with L-carnitine while 24 cases received extracorporeal therapy without L-carnitine. All patients except one expired patient treated with hemodialysis recovered clinically and no adverse effects were noted. A case report comparing two patients who ingested the same amount of valproic acid showed increased ICU stay (3 vs 11 days) in case of delayed extracorporeal therapy. Conclusion: Published evidence comparing L-carnitine with extracorporeal therapy is limited. Based on the available evidence, it is reasonable to consider L-carnitine for patients with acute valproic acid overdose. In case of severe poisoning, extracorporeal therapy would also be considered in the early phase of treatment.

급성 약물중독 환자의 응급 기관내 삽관에서 임상적 특성

한얼 ( Eol Han ),정현수 ( Hyun Soo Chung ),박유석 ( Yoo Seok Park ),유제성 ( Je Sung You ),주영선 ( Youngseon Joo ),공태영 ( Taeyoung Kong ),박인철 ( Incheol Park ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.1

Purpose: The aim of this study was to compare the clinical characteristics in emergency endotracheal intubation between patients with acute drug intoxication and medical disease. Methods: Data for airway registry collected in two emergency departments (ED) between April 2006 and March 2010 were reviewed retrospectively. The airway registry data included patient’s demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. Results: A total of 1480 patients were enrolled; 62 patients were classified as belonging to the intubation group after the drug intoxication group. No significant differences in Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, and complications after intubation were observed between patients with acute drug intoxication and medical disease. However, significant difference was observed for indication of emergency endotracheal intubation. While emergency endotracheal intubations were usually performed in medical patients because of failure of airway patency, they were performed in intoxicated patients with the goal of preventing serious complications. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcome of intoxicated patients are not significantly different from those for medical patients.

Phentermine 과량복용 2례

구재은 ( Jae Eun Ku ),주영선 ( Young Seon Joo ),유제성 ( Je Sung You ),정성필 ( Sung Phil Chung ),이한식 ( Hahn Shick Lee ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.1

Phentermine has been widely used as an appetite suppressant since 2004 in Korea. The authors experienced two cases of acute phentermine overdose and report with the literature review. A 36-year-old man and a 24-year-old woman presented together to the emergency department with taking 13 tablets (390 mg) of phentermine 16 hours ago. They had tachycardia, hypertension and complained visual symptoms, nausea, insomnia and anxiety. These symptoms were resolved by conservative management.

중증외상환자의 전산화단층촬영 및 중 재술에 의한방사선 유효선량 및 생애 귀속위험도

이원효 ( Won Hyo Lee ),공태영 ( Tae Young Kong ),김승환 ( Seung Hwan Kim ),유제성 ( Je Sung You ),박유석 ( Yoo Seok Park ),이재길 ( Jae Gil Lee ),정성필 ( Sung Phil Chung ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Purpose: This study was performed to calculate and analyze the effective radiation doses from computed tomography (CT) and radiologic intervention in patients in the emergency department (ED) with trauma critical pathway (CP) activation and further to estimate the lifetime attributable risks (LARs) for the incidence of and mortality from cancers induced by the radiation dose. Methods: Through a retrospective electrical chart review of 104 injured patients who trauma critical pathway were activated from November 2012 to March 2013, we calculated effective radiologic doses by taking the product of the dose-linear product of the scan and the conversion coefficient. After a determination of the image results, we divided the patients into two groups, negative or positive, and calculated the effective dose for each group. With these results, we estimated the LARs for the incidence of and the mortality from cancers by using the table in the Biologic Effects of Ionizing Radiation (BEIR)-VII report. Results: A total of 76 patients were enrolled. The mean age was 49.0±8.5 years. The mean injury severity score (ISS) was 12.7±8.4. The cumulative effective dose (CED) for individual patients varied from 2.8 mSv to 238.8 mSv, and the mean was 47.6±39.9 mSv. The CED in patients with an ISS≥16(63.2±26.6 mSv) was higher than that of patients whose ISS<16(33.5±23.1 mSv) (p<0.001). The CED in patients who were treated with surgery or intervention(69.0±45.2 mSv) was higher than that of patients who were treated conservatively(33.6 ±22.4 mSv) (p<0.001). The LARs for cancer incidence and mortality were 328.5±308.6 and 189.0±159.3 per 100, 000 people, respectively. Conclusion: The CED and the LAR for trauma CP-activated patients in the ED were significant, so efforts should be made to decrease the effective dose received by severely injured patients.