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Methamphetamine (MA) is a major drug of abuse in Korea. Currently preliminary evidence suggests that MA dependence may cause long-term neural damage in human. Repeated exposure to psychostimulants such as methamphetamine results in behavioral sensitization, a paradigm thought to be relevant to drug craving and addiction in human. Sensitization alters neural circuitry involved in normal processes of incentrive, motivation, and reward. However the precise mechanism of this behavioral sensitization has not yet been fully elucidated. Repeated use of high dose MA causes neurotoxicity which is characterized by a long-lasting depletion of striatal dopamine (DA) and tyrosin hydroxylase activity of DA, DA-transporter binding sites in the striatum. The loss of DA transporters correlates with memory problems and lack of motor coordination. DA fuels motivation and pleasure, but it' s also crucial for learning and movement. This selective review provides a summary of studies that assess the neurobiological mechanisms of MA.
정동길 ( Dong Kil Jeong ), 문형준 ( Hyung Jun Moon ), 이정원 ( Jung Won Lee ), 박세훈 ( Sae Hoon Park ), 이현정 ( Hyung Jung Lee ), 설승환 ( Seung Whan Seo ), 김아름 ( Ah Reum Kim ), 최재형 ( Jae Hyung Choi ), 김재우 ( Jae Woo Kim ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.2
Purpose: Although Pokeweed intoxication is relatively less severe, thereis little data onthe clinical presentation ofPokeweed intoxication in Korea. This study examined the clinical aspectsto providebasic data for evaluating Pokeweed intoxication. Methods: A retrospective study by a chart review was performedon 19 patients who ingested Pokeweed and presented to anacademic emergency department with an annual census of 40,000 between March 2012 and May 2012. Results: Nineteen patients were identified. All patients wereintoxicated unintentionally. The most common symptoms were vomiting with diarrhea and abdominal pain. The onset time varied, but occurs 30 minutes to 5 hours post ingestion of Pokeweed. All patients were discharged without fatal complications. Conclusion: Compared to previous reports, mostpokeweed poisoning patients complain of gastrointestinalsymptoms. Supportive care is the mainstay of the management of pokeweed intoxication. All symptoms were resolved over a 24 to 48 hour period.
Purpose: Paraquat is the most commonly used herbicide in Korea. Exposure to paraquat through the skin has resulted in local irritation or inflammation of varying degree, sometimes severe. The purpose of this study was to review the patients with paraquat poisoning by skin absorption. Methods: We analysed retrospectively the clinical and laboratory findings of 45 patients with paraquat poisoning after dermal exposure, who were admitted to Soonchunhyang University Cheonan Hospital from January 1999 to December 2003. Results: Among 870 cases of paraquat poisoning, 45 cases were exposed to paraquat through the skin. The peak incidence was the fifth decade($40\%$). The clinical symptoms were pain, pruritus, nausea, and vomiting. The major skin lesions were generalized vesicobullae and necrotic erosion in face, scrotum, trunk, upper and lower extremities and etc. All patients were survived after skin contact or inhalation of paraquat. Conclusion: This study illustrates the extreme toxicity of paraquat and demonstrates that lethal quantities of paraquat may be absorbed if repeated exposure to it. Stricter precautions, including the mandatory use of protective clothing, should be recommended whenever this material is used.
Purpose: In recent review of physician suicides] the relative risk of physicians is higher than the general population. The majority of physician suicide were by poisoning. The purpose of this study was to analyse the medical personnels with suicide by poisoning compared with the general population. Methods: We reviewed medical records of 15 medical related personnels with suicide by poisoning who visited the emergency medical centers of St. Mary's and Kangnam St. Mary's hospitals from March 1998 to Aug 2004. For the comparison with general population in analysis] the collected data was acquired from medical records of 677 intoxicated patients in St. Mary's Hospital during the same period. Results: Fifteen suicides of physicians (n=7), nurses (n=4), medical students (n=2), pharmacist (n=1) and medical assistant technician (n=1) was evaluated with regard to the method of poisoning. Preferred methods were ingestion of medications orally ($54\%$) and by infusion/injection ($46\%$). The results were compared with the general population group (n=677: oral ingestion of medications $98\%$, inhalation $1.6\%$). Intoxications by infusion/injection predominated more clearly in physicians than in the total collective. Conclusion: Comparing with the general population, the tendency to a method of suicidal poisoning being typical of the profession rises among physicians and related occupations with the degree of specialization, caused by increasing knowledge, easier access to appropriate drugs and methods.
Purpose: No studies have been conducted to investigate the acute toxicity of aryloxyphenoxypropionate herbicides in humans following ingestion. Therefore, this study was conducted to investigate the clinical characteristics of aryloxyphenoxypropionate herbicide poisoning and provide guidance for physicians treating patients who have ingested these types of herbicides. Methods: A retrospective observational case series was conducted using ten patients with history of aryloxyphenoxy propionate herbicide. Data were collected for clinical manifestation, management and final outcome. Results: The most common symptoms were gastrointestinal irritation and an altered mental state (Glasgow Coma Scale<15). An elevated lactate level was a common laboratory abnormality, and prolonged QTc interval was commonly observed. These clinical features normalized within one day of supportive treatment. Conclusion: The acute toxicity of aryloxyphenoxypropionate herbicides in humans is manageable with supportive treatment. However, physicians should take into account depressed consciousness, the possibility of arrhythmia, and an elevated lactate level when planning their treatment strategy.
Purpose: This study was conducted to investigate the incidence, associated factors and clinical impact of hyperamylasemia in self-poisoning patients. Methods: This study was based on a toxicology case registry of patients treated from 2009 to 2013 at a tertiary care university hospital. We retrospectively investigated the demographics, clinical variables, laboratory variables and intoxicants. Hyperamylasemia was defined as an elevation in serum amylase level to above the upper normal limit within 24 hours after admission. We analyzed the predisposing factors and clinical outcomes of patients in the hyperamylasemia group. Results: Hyperamylasemia was identified in 49 (13.3%) of the 369 patients. Using multivariate logistic regression, the odds ratios for HA were 3.384 (95% confidence interval, 1.142-8.013, p=0.014), 3.261 (95% confidence interval, 1.163-9.143, p=0.025) and 0.351 (95% confidence interval, 0.154-0.802, p=0.013) for pesticides, multi-drug use and sedatives, respectively. In the hyperamylasemia group, the peak amylase levels during 72 hours were correlated with the peak lipase levels (r=0.469, p=0.002) and peak aspartate aminotransferase levels (r=0.352, p=0.013). Finally, none of these patients had confirmed acute pancreatitis. Conclusion: Hyperamylasemia occurred rarely in these self-poisoning patients, and pesticide and multi-drug use were independent predictors of hyperamylasemia. Peak amylase levels were correlated with the peak lipase and aspartate aminotransferase levels.
Purpose: Acute toxic hepatitis is a common cause of acute liver failure (ALF). We investigated the causes, clinical manifestation, and outcomes of ALF patients who underwent liver transplantation due to acute toxic hepatitis caused by herbal medicines and preparations. Methods: Between January 1992 and May 2008, we retrospectively reviewed the medical records of 24 patients who were transplanted due to acute toxic hepatitis caused by herbal medicines and preparations. We applied the RUCAM score to patients with acute toxic hepatitis and assessed the relationship between herbal preparations and liver injury. We studied the patients' medication history, liver function tests, and clinical outcomes. Results: The type of liver injury was divided into three groups: hepatocellular type, 14 patients (58.3%); cholestatic type, 4 patients (16.7%); and mixed type, 6 patients (25%). Polygonum multiflorum Thunberg (3 cases) was the most common cause of acute toxic hepatitis, followed by Acanthopanax senticosus (2 cases), pumpkin juice (2 cases), Dictamnus dasycarpus Turcz (2 cases), Hovenia dulcis (1 case), Phellinus linteus (1 case), and Artemisia capillaries (1 case). One year survival after liver transplantation was 76%. Conclusion: We identified the herbal preparations leading to acute liver failure. Many patients consider herbal remedies to be completely free of unwanted side effects. However, we found that many herbal products have biological activities that can lead to severe hepatotoxicity.
Purpose: This study was conducted to compare demographic and characteristic differences in self-poisoned patients by age groups using a comprehensive trauma database. Methods: This study included 1,823 patients who were admitted to the emergency room following self-poisoning. Three age groups were defined: young patients (less than 19 years), adult patients (19 to 64 years) and elderly patients (65 years and old). From January 2011 to December 2015, data were obtained from in a single emergency medical center. We investigated the materials of poisoning, ingestion time, GCS, systolic blood pressure, heart rate, and outcomes of patients. Results: A total of 1,823 self-poisoned patients visited the hospital during 5 years. Among these, 130 (7.1%) were categorized as young, 1,460 (80.1%) were adults and 233 (12.8%) were elderly. The most common drug of self-poisoning substances was antipyretics (50.0%) for those in the young group, sedative drugs (45.0%) for adults, and pesticides (41.2%) for the elderly. Mortality was 2.7% in the adult group and 14.6% in the elderly group. After adjusting for all factors related to mortality, the odds ratio (OR) of mortality was 2.63 in the elderly group (95% confidence interval [CI]: 1.44-4.81). Conclusion: There were definite differences in the characteristics of three groups. The younger patients used drugs that could be easily obtained while older patients used more lethal drugs.
Purpose: This study was conducted to identify the characteristics associated with sulfuric acid injury in the emergency department. Methods: Data were collected retrospectively from January 2007 to December 2015 on all sulfuric acid injuries presenting to the emergency department in Gu-mi Soonchunhyung University Hospital. Patients injured by sulfuric acid were recorded over a nine year study period and collected data included demographics, injury mechanism, injured body part, hospital care and final diagnosis. Results: A total of 26 cases were identified. Most patients were male (88.5%) and the face was the most commonly injured body part. The most common mechanism of injury was splashing injury. A total of 16 (61.5%) patients were identified as having lesions worse than second degree burns. Conclusion: Sulfuric acid can cause severe and fatal skin burn. When working with sulfuric acid, acid proof protect clothing, goggles and glove should be worn. Furthermore, safety education and workplace environment improvement are necessary to reduce sulfuric acid injury.