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논문검색은 역시 페이퍼서치

대한임상독성학회지검색

Journal of the Korean society of clinical toxicology


  • - 주제 : 의약학분야 > 기타(의약학)
  • - 성격 : 학술지
  • - 간기: 반년간
  • - 국내 등재 : -
  • - 해외 등재 : -
  • - ISSN : 1738-1320
  • - 간행물명 변경 사항 :
논문제목
수록 범위 : 14권 2호 (2016)

Aryloxyphenoxy propionate 계열 제초제 중독환자의 임상 양상

임준영 ( Junyeong Lim ) , 문정미 ( Jeongmi Moon ) , 전병조 ( Byeongjo Chun )
4,000
초록보기
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.

글라이포세이트 노출로 인한 DNA손상에 대한 녹차의 예방적 효과

박정민 ( Jung-min Park ) , 최우익 ( Woo-ik Choi ) , 진상찬 ( Sang-chan Jin ) , 이재호 ( Jae-ho Lee ) , 최인장 ( In-jang Choi )
4,000
초록보기
Purpose: Green tea is known as a potent anti-oxidant, anti-carcinogen, and genetic protector. Glyphosate (N-phosphonomethyl glycine) is a widely used non-selective herbicide that causes DNA damage. The present study was conducted to investigate the protective effects of green tea in human blood lymphocytes exposed to glyphosate using the Sister Chromatid Exchange (SCE) frequency method. Methods: Peripheral blood was obtained from 10 volunteers and cultured through four different conditions. Four groups were divided into control, glyphosate only (300 ng/mL), glyphosate and low (20 μm) concentrations of epigallocatechin gallate (EGCG) and glyphosate and high (100 μm) concentrations of EGCG. Results: The glyphosate exposed groups had a higher mean SCE frequency (10.33±2.50) than the control group (6.38±2.28, p<0.001). The low concentrations of EGCG groups had a lower mean SCE frequency (9.91±1.93) than the glyphosate-only group, although this difference was not significant (p=0.219). However, the high concentration group (9.49±1.85) had a significantly lower SCE frequency than the glyphosate-only group (p=0.001). Conclusion: EGCG has a gene protective effect in human lymphocytes exposed to the genotoxicity of glyphosate in the case of high concentrations.

중독 환자에서 고아밀라아제혈증의 발생률, 관련 요인 및 임상적 영향

서민구 ( Min Gu Seo ) , 오상훈 ( Sang Hoon Oh ) , 임지용 ( Jee Yong Lim ) , 김한준 ( Han Joon Kim ) , 최세민 ( Se Min Choi )
4,000
키워드보기
초록보기
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.

급성 진정제 중독 추정 환자에서 플루마제닐의 투여: 위험도/이익 재평가

허재홍 ( Jae Hong Huh ) , 최상천 ( Sang Chun Choi ) , 임용균 ( Yong Gyun Lim ) , 샘슨램포탕 ( Samsun Lampotang ) , 박은정 ( Eung Jung Park )
4,000
초록보기
Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were “poisoning” and “benzodiazepine” or “sedatives-hypnotics” from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non- TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.

베타차단제를 포함한 정신과적 약물 중독: 심혈관계 영향을 중심으로

주성우 ( Sung Woo Joo ) , 민영기 ( Young-gi Min ) , 최상천 ( Sang-cheon Choi ) , 박은정 ( Eun Jung Park )
4,000
초록보기
Purpose: Beta blocker (BB) has been prescribed for anxiety and panic disorder. Patients intoxicated by psychiatric drugs have often been exposed to BB. Moreover, BB overdose has adverse effects including cardiovascular effects, which can be life-threatening. This study was conducted to identify the characteristics of BB intoxication with psychiatric drugs and the adverse effects on the cardiovascular system. Methods: A single center, retrospective study was performed from January 2010 to December 2015. A total of 4,192 patients visited the emergency department (ED) with intoxication, and 69 with BB intoxication were enrolled. Results: Overall, 64 patients (92.8%) of enrolled patients were intoxicated with drugs prescribed for the purpose of psychiatric disorders. Propranolol was the most common BB (62 cases, 96.2%), and the median dose was 140.0 mg (25%-75% 80.0-260.0). Twenty-four patients (37.5%) had experienced cardiovascular events, and these patients tended to have decreased mentality, hypotension and coingestion with quetiapine. An initial mean arterial pressure (MAP) below 65 mmHg (odds ratio 10.069, 95% confidence interval 1.572-64.481, p=0.015) was identified as a factor of cardiovascular event upon multiple logistic regression analysis. Conclusion: Initial MAP below 65 mmHg was a factor of cardiovascular adverse effect in patients of BB intoxication with psychiatric drugs.

Glufosinate 중독 환자의 신경학적 예후 인자로서 APACHE II Score의 유용성

유대한 ( Dae Han Yoo ) , 이정원 ( Jung Won Lee ) , 최재형 ( Jae Hyung Choi ) , 정동길 ( Dong Kil Jeong ) , 이동욱 ( Dong Wook Lee ) , 이영주 ( Young Joo Lee ) , 조영신 ( Young Shin Cho ) , 박준범 ( Joon Bum Park ) , 정혜진 ( Hae Jin Chung ) , 문형준 ( Hyung Jun Moon )
4,000
초록보기
Purpose: The incidence of glufosinate poisoning is gradually increasing, and it can be fatal if severe poisoning occurs. However, factors useful for predicting the post-discharge neurological prognosis of patients who have ingested glufosinate have yet to be identified. Our objective was to evaluate the utility of the acute physiology and chronic health evaluation (APACHE) II score measured in the emergency department for predicting the neurological prognosis. Methods: From April 2012 to August 2014, we conducted a retrospective study of patients who had ingested glufosinate. The outcome of the patients at discharge was defined by the Cerebral Performance Category Score (CPC). The patients were divided into a good prognosis group (CPC 1, 2) and a poor prognosis group (CPC 3, 4, 5), after which the APACHE II scores were compared. The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve from patients determined calibration and discrimination. Results: A total of 76 patients were enrolled (good prognosis group: 67 vs poor prognosis group: 9). The cut-off value for the APACHE II score was 12 and the area under the curve value was 0.891. The Hosmer and Lemeshow C statistic χ2 was 7.414 (p=0.387), indicating good calibration for APACHE II. Conclusion: The APACHE II score is useful at predicting the neurological prognosis of patients who have ingested glufosinate.

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 Hwang )
4,000
초록보기
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.

일산화탄소 중독의 역학적 특징: 전국 20개 병원 응급실 손상환자 표본 심층조사

배소현 ( Sohyun Bae ) , 이지숙 ( Jisook Lee ) , 김경환 ( Kyunghwan Kim ) , 박준석 ( Junseok Park ) , 신동운 ( Dongwun Shin ) , 김현종 ( Hyunjong Kim ) , 박준민 ( Joonmin Park ) , 김훈 ( Hoon Kim ) , 전우찬 ( Woochan Jeon )
4,000
초록보기
Purpose: This study was conducted to describe the characteristics of patients with carbon monoxide (CO) poisoning. Methods: We retrospectively surveyed data from the Emergency Department based Injury In-depth Surveillance of 20 hospitals (2011-2014). We included patients whose mechanism of injury was acute CO poisoning caused by inhalation of gases from charcoal or briquettes. We surveyed the annual frequency, gender, age, result of emergency treatment, rate of intensive care unit (ICU) admission, result of admission, association with alcohol, and place of accident. We also surveyed the cause and experience of past suicide attempts by intentional poisoning. Results: A total of 3,405 patients were included (2,015 (59.2%) and 1,390 (40.8%) males and females, respectively) with a mean age of 39.83±18.51 year old. The results revealed that the annual frequency of CO poisoning had increased and the frequency of unintentional CO poisoning was higher than that of intentional CO poisoning in January, February and December. The mean age of intentional CO poisoning was younger than that of unintentional CO poisoning (38.41±13.03 vs 40.95±21.83) (p<0.001). The rates of discharge against medical advice (DAMA), ICU care and alcohol association for intentional CO poisoning were higher than for unintentional CO poisoning (36.4% vs 14.0%, 17.8% vs 4.7%, 45.2% vs 5.6%) (p<0.001). The most common place of CO poisoning was in one`s residence. Conclusion: The annual frequency of total CO poisoning has increased, and unintentional CO poisoning showed seasonal variation. DAMA, ICU care, and alcohol association of intentional CO poisoning were higher than those of unintentional CO poisoning.

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 )
4,000
키워드보기
초록보기
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 ) , 이동언 ( Dong Eun Lee ) , 박정배 ( Jung B
4,000
초록보기
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.
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