대한임상독성학회 춘계 학술대회 초록집

대한임상독성학회 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.1

심포지움 : 중독관리체계

대한임상독성학회 대한임상독성학회 2003 대한임상독성학회지 Vol.1 No.1

의도적 중독으로 응급센터에 내원한 환자에 대한 연령별 비교 분석

김진현 ( Jin Hyun Kim ),조진성 ( Jin Seong Cho ),김진주 ( Jin Joo Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Geun Lee ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

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.

급성 약물중독에 합병된 일과성 혹은 지속성 고암모니아혈증의 특성

이수형 ( Soo Hyung Lee ),박홍인 ( Hong In Park ),최마이클승필 ( Michael Sung Pil Choe ),제동욱 ( Dong Wook Je ),노우영 ( Woo Young Nho ),김성훈 ( Seong Hun Kim ),이미진 ( Mi Jin Lee ),안재윤 ( Jae Yun Ahn ),문성배 ( Sung Bae Moon 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Purpose: In patients with altered mentality caused by drugs or unknown causes, ammonia is checked to facilitate differential diagnosis or diagnose hepatic coma. This helps early prevention and treatment of brain damage due to hyperammonemia. This study was conducted to evaluate clinical characteristics of intoxicated adult patients with hyperammonemia. Methods: We evaluated 95 patients with hyperammonemia among intoxicated patients above the age of 15 who visited our ED from January 2013 to December 2015. We analyzed the demographic characteristics and type of poisoning substance, reason for ingestion, toxicological characteristics such as elapsed time from ingestion to hospital visit, lab, clinical progression and complications. Data were evaluated using the student`s t test or Mann-Whitney U test for continuous variables, and Chi-square test and Fisher`s exact test for frequency analysis of categorical variables. Results: When compared to healthy individuals, patients with hyperammonemia showed statistical significance on their SOFA score (p=0.016) and poison severity score (p<0.001). Additionally, patients with hyperammonemia showed significantly different initial serum AST level (p=0.012) and maximum serum AST level during the hospital stay (p=0.026) when compared to healthy individuals. Moreover, individuals with sustained hyperammonemia compared to transient hyperammonemia showed clinically significant SOFA scores (p<0.001), poison severity scores (p=0.007), mortality rates in the ICU (p=0.021), as well as different duration of hospital stay (p=0.037), serum creatinine level (p=0.002), erythrocyte sedimentation rate (p=0.025), and serum myoglobin (p=0.015). Conclusion: Most poisoning-induced hyperammonemia cases were transient and recovered without special treatment. Therefore, hyperammonemia is almost non-specific among poisoning patients.

글라이포세이트의 유전자 독성에 대한 멜라토닌의 유전자 보호 효과

김정규 ( Jung-gyu Kim ),최우익 ( Woo-ik Choi ),이재호 ( Jae-ho Lee ),최인장 ( In-jang Choi ),진상찬 ( Sang-chan Jin ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Purpose: Glyphosate is a widely used non-selective herbicide. Previous studies have shown that glyphosate has genotoxicity, and that even low-doses of glyphosate can cause DNA damage. Melatonin is a hormone produced and secreted by the pineal gland that is known to be a potent anti-carcinogen, anti-oxidant, and genetic protector. This study was conducted to investigate the genoprotective effect of melatonin against glyphosate in human blood lymphocytes. Methods: Human peripheral blood was obtained from 15 young, healthy volunteers and cultured under four different toxicologic conditions. The four groups consisted of a control group, glyphosate only group (300 ng/mL), glyphosate with low level of melatonin group (50 μM), and glyphosate with high level of melatonin group (200 μM). The mean Sister Chromatid Exchange (SCE) frequency of each group was then analyzed. Results: Glyphosate exposed groups had a higher mean SCE frequency (10.33±2.50) than the control group (6.78 ±2.31, p<0.001). Interestingly, the group that received a low-level of melatonin had a lower mean SCE frequency (8.67±2.58) than the glyphosate-only group, while the group that received a high level of melatonin had a much lower mean SCE frequency (8.06±2.50) than the glyphosate-only group. There was statistical significance. Conclusion: Melatonin exerted a potent gene protective effect against the genotoxicity of glyphosate on human blood lymphocytes in a dose-dependent fashion.

고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인 지속적 저혈당성 혼수 환자 1례

강정호 ( Jeong Ho Kang ),박현수 ( Hyun Soo Park ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.

유기인계 중독환자에서 내원시 혈당과 예후와의 연관성

이성도 ( Sung Do Lee ),문정미 ( Jeong Mi Moon ),전병조 ( Byeong Jo Chun ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: Many studies have examined the mechanisms of impaired glucose homeostasis after organophosphate (OP) exposure, however no study has evaluated the clinical utility of blood glucose measurements in patients with OP poisoning. The current study was conducted to evaluate the initial glucose level at presentation and the glycemic variables during the first 3 days after admission as a predictor of mortality. Methods: This retrospective observational case series included 228 patients with a history of OP poisoning. Among other clinical data, information on the initial glucose level at presentation and mean glucose level, delta glucose level, and the presence of a hypoglycemic event during the first 3 days of admission, was collected. Results: Survivors had lower initial glucose levels at presentation and glucose variability during the first 3 days of admission compared to non-survivors. The frequency of hypoglycemic events was higher in non-survivors. In multivariate analysis, the initial glucose level (> 233 mg/dl) was an independent predictor of mortality, along with age. Conclusion: The initial glucose level at presentation can be helpful in prediction of mortality in cases of OP intoxication at bedside. The physician should pay attention to patients with a glucose level>233 mg/dl at presentation after ingestion of OP.

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.

급성 엔도설판 중독의 임상적 고찰

김소은 ( So Eun Kim ),김수익 ( Su Ik Kim ),이재백 ( Jae Baek Lee ),진영호 ( Young Ho Jin ),정태오 ( Tae Oh Jeong ),조시온 ( Si On Jo ),윤재철 ( Jae Chol Yoon ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: Acute endosulfan poisoning is rare but causes significant morbidity and mortality. The aim of our study is to describe complications and features of seizure and determine factors associated with mortality in acute endosulfan poisoning. Methods: Twenty-eight adult patients with acute endosulfan poisoning admitted to our emergency department during a 15-year period were studied retrospectively. The clinical features of seizure, use of antiepileptic drugs during seizure, and hospital courses were evaluated. Clinical factors between survived group and non-survived group were compared for identification of factors associated with mortality. Results: Of the 28 patients with endosulfan poisoning, 4 patients (14.3%) died and 15 (53.6%) patients developed generalized tonic-clonic seizure. Thirteen patients (46.4%) and 5 patients (17.9%) progressed to status epilepticus (SE) and refractory status epilepticus (RSE), respectively. SE and RSE were associated with mortality. Almost all significant complications including shock, acute renal failure, hepatic toxicity, rhabdomyolysis, and cardiac injury developed in SE and RSE patients. Conclusion: SE and RSE were important contributors to death in endosulfan poisoning. Emergency physicians treating endosulfan poisoning should make an effort not to progress seizure following endosulfan poisoning to SE and RSE using a rapid and aggressive antiepileptic drug.

산업장 화학 사고로 응급실에 내원한 환자의 임상적 고찰: 일개병원의 후향적 연구

신희준 ( Hee Jun Shin ),오세광 ( Se Kwang Oh ),유병대 ( Byeong Dai Yoo ),전덕호 ( Duck Ho Jun ),이동하 ( Dong Ha Lee ),우극현 ( Kuck Hyeun Woo ),윤성용 ( Seong Yong Yoon ),최성용 ( Sung Yong Choi ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: The purpose of this study is to understand what kinds of chemical substances have been used annually and to investigate incidents that occurred due to chemical hazard release and to analyze statistically clinically chemical injury patients who visited one regional emergency medical center in Gumi city with documented references review. Methods: Annual chemical waste emission quantity (Kg/Year) (Cwep) was reproduced using national web site data governed by the Ministry of Environment and 5 years (from 1 .Jan. 2010 to 31. Dec. 2014) of medical records of chemical injury patients who visited our emergency department were reviewed retrospectively. By applying exclusion criteria, 446 patients of 460 patients were selected. Results: Dichloromethane, Toluene, Trichloroethylene, and Xylene were always included within Top 5 of Cweq. Six cases of chemical incidents were reported and in 3 of 6 cases involving Hydrogen fluoride were included during the study period. Male gender and twenties were the most prevalent group. Injury evoking chemicals were Hydrogen fluoride, unknown, complex chemicals (over 2 substances) in sequence. The most frequent site of wounds and injuries was the respiratory tract. Gas among status, intoxication among diagnosis, and discharge among disposition was most numerous in each group. Conclusion: There have been no uniform clinical protocols for chemical wounds and injuries due to various kinds of chemicophysical properties and ignorance of antidotes. Therefore conduct of a multicenter cohort study and experiments for ruling out chemicals according to chemicophysical priority as well as development of antidotes and clinical protocols for chemical injury patients is needed.