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대한임상독성학회> 대한임상독성학회지

대한임상독성학회지 update

Journal of the Korean society of clinical toxicology

  • : 대한임상독성학회
  • : 의약학분야  >  기타(의약학)
  • : KCI등재
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  • : 연속간행물
  • : 반년간
  • : 1738-1320
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수록정보
수록범위 : 1권1호(2003)~18권2호(2020) |수록논문 수 : 375
대한임상독성학회지
18권2호(2020년 12월) 수록논문
최근 권호 논문
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KCI등재

1액상형 전자담배 용액에 의한 급성 니코틴 중독: 증례보고의 체계적 고찰

저자 : 양시용 ( Si Yong Yang ) , 좌민홍 ( Min Hong Choa ) , 유제성 ( Je Sung You ) , 정현수 ( Hyun Soo Chung ) , 정성필 ( Sung Phil Chung )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 51-56 (6 pages)

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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.

KCI등재

2아세트아미노펜 사용 편의성 증가 후 중독발생 위험의 지속적 관리 필요성

저자 : 조승직 ( Seung Jik Jo ) , 강현영 ( Hyun Young Gang ) , 이시진 ( Si Jin Lee ) , 배규현 ( Gyu Hyun Bae ) , 이의중 ( Eui Jung Lee ) , 한갑수 ( Kap Su Han ) , 김수진 ( Su Jin Kim ) , 이성우 ( Sung Woo Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 57-65 (9 pages)

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Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented.
Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs.
Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794).
Conclusion: Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

KCI등재

3향정신성 약물 중독에 의한 QTc 연장과 그 위험성에 대한 고찰

저자 : 박관호 ( Kwan Ho Park ) , 홍훈표 ( Hoon Pyo Hong ) , 이종석 ( Jong Seok Lee ) , 정기영 ( Ki Young Jeong ) , 고석훈 ( Seok Hun Ko ) , 김성규 ( Sung Kyu Kim ) , 최한성 ( Han Sung Choi )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 66-77 (12 pages)

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Purpose: The aims of the present study were twofold. First, the research investigated the effect of an individual's risk factors and the prevalence of psychotropic drugs on QTc prolongation, TdP (torsades de pointes), and death. Second, the study compared the risk scoring systems (the Mayo Pro-QT risk score and the Tisadale risk score) on QTc prolongation.
Methods: The medical records of intoxicated patients who visited the emergency department between March 2010 and February 2019 were reviewed retrospectively. Among 733 patients, the present study included 426 psychotropic drug-intoxicated patients. The patients were categorized according to the QTc value. The known risk factors of QTc prolongation were examined, and the Mayo Pro-QT risk score and the Tisadale risk score were calculated. The analysis was performed using multiple logistic regression, Spearman correlation, and ROC (receiver operating characteristic).
Results: The numbers in the mild to moderate group (male: 470≤QTc<500 ms, female: 480≤QTc<500 ms) and severe group (QTc≥500 ms or increase of QTc at least 60ms from baseline, both sex) were 68 and 95, respectively. TdP did not occur, and the only cause of death was aspiration pneumonia. The statically significant risk factors were multidrug intoxications of TCA (tricyclic antidepressant), atypical antipsychotics, an atypical antidepressant, panic disorder, and hypokalemia. The Tisadale risk score was larger than the Mayo Pro-QT risk score.
Conclusion: Multiple psychotropic drugs intoxication (TCA, an atypical antidepressant, and atypical antipsychotics), panic disorder, and hypokalemia have been proven to be the main risk factors of QTc prolongation, which require enhanced attention. The present study showed that the Tisadale score had a stronger correlation and predictive accuracy for QTc prolongation than the Mayo Pro-QT score. As a result, the Tisadale risk score is a crucial assessment tool for psychotropic drug-intoxicated patients in a clinical setting.

KCI등재

4급성 아세트아미노펜 중독에서 N-acetylcysteine 투여 결정 관련 인자

저자 : 이정화 ( Jeong Hwa Lee ) , 최상천 ( Sangchun Choi ) , 윤상규 ( Sang Kyu Yoon ) , 신규철 ( Kyu Cheol Shin )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 78-84 (7 pages)

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Purpose: In acute acetaminophen poisoning, the administration of N-acetylcysteine (NAC) can effectively treat the main complications, such as kidney injury and liver failure. In the current situation, measurements of the acetaminophen concentration are not checked in the usual medical facilities. Therefore, this study examined the factors of determining the administration of NAC in addition to the stated amount of intake.
Methods: The medical records of patients who visited Ajou University Hospital emergency center with acetaminophen poisoning from January 2015 to December 2019 were reviewed retrospectively. One hundred and seventy-nine patients were initially included. Among these patients, 82 patients were finally selected according to the inclusion criteria in the study. The inclusion criteria were as follows: patients who were 15 years of age or older; those whose ingested dose, ingested time, and body weight were clearly identified; and patients whose acetaminophen sampling time was within 24 hours. Patients were divided into two groups: NAC administered vs. non-NAC administered. The following variables were compared in these two groups: ingested dose, ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, psychiatric disease history, classification of toxic/non-toxic groups, duration of hospitalization, and laboratory results.
Results: Univariate analysis revealed the ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, and psychiatric disease history to be the determining factors in administering NAC. Logistic regression analysis confirmed that the ingested dose per body weight was the only significant factor leading to an NAC treatment decision. (Odds ratio=1.039, 95% Confidential interval=1.009-1.070, p=0.009)
Conclusion: The ingested dose per body weight was the only determining factor for administering NAC in patients with acute acetaminophen poisoning. On the other hand, additional criteria or indicators for the NAC administration decision will be necessary considering the inaccuracy of the ingested dose per body weight and the efficiency of NAC administration.

KCI등재

5응급실 손상환자 심층조사 자료를 이용한 2017-2018년 중독 환자의 분석

저자 : 고지윤 ( Jiyoon Koh ) , 전우찬 ( Woochan Jeon ) , 강형구 ( Hyunggoo Kang ) , 김양원 ( Yang Weon Kim ) , 김현 ( Hyun Kim ) , 오범진 ( Bum Jin Oh ) , 이미진 ( Mi Jin Lee ) , 전병조 ( Byeong Jo Chun ) , 정성필 ( Sung Phil Chung ) , 김경환 ( Kyung Hwan Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 85-93 (9 pages)

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Purpose: The annual statistics for poisoning are reported based on the data from poison control centers in many advanced countries. In 2016 a study was conducted to analyze the 2016 Korea Poisoning status. This study was conducted to make a better annual report for poisoning statistics in Korea from a 2017-2018 national representative database.
Methods: This study was a retrospective analysis of poisoning patients based on the data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2017-2018. Bite or sting injuries were not included.
Results: A total of 17714 patients presented to 23 EDs because of poisoning. Adults above 20 years old age accounted for 84.6% of the population, while the proportion of intentional poisoning was 60.8%. The poisoning substance presented in the ED were therapeutic drugs (51.2%), gas (20.3%), pesticides (16.4%), and artificial substances (11.4%). Overall, 35% of patients were admitted for further treatment. The mortality was 2.4% (422 cases), and the most common fatal substances in order were carbon monoxide, other herbicides, and paraquat.
Conclusion: This study showed the 2017-2018 status of poisoning in Korea. The prognosis is different from the cause of poisoning and the initial mental state of the patient. Therefore, appropriate methods for preventing poisoning and therapeutic plans in specific situations are needed.

KCI등재

6중증 중독환자의 임상 역학적 특징과 예후에 영향을 주는 요인분석

저자 : 정영윤 ( Young Yun Jung ) , 하철민 ( Chul Min Ha ) , 정성태 ( Sung Tae Jung ) , 이형주 ( Hyoung Ju Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 94-101 (8 pages)

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Purpose: This study examined the clinical and epidemiological characteristics of intensive care unit (ICU) patients admitted or died in the emergency medical center with acute-poisoning to investigate the variables related to the prognosis.
Methods: The data were collected from poisoning patients admitted or died in the emergency medical center of a general hospital located in Seoul, from January 2014 to February 2020. The subjects of this study were 190 patients. The medical records were screened retrospectively, and the clinical and epidemiological characteristics of the patients in the emergency room (ER) and ICU were examined to investigate the contributing factors that influence the poor prognosis.
Results: The study analyzed 182 patients who survived after being admitted to the intensive care unit (ICU). The results are as follows. The mental change (87.4%) was the most common symptom. Sedative poisoning (49.5%) was the commonest cause. For most patients, pneumonia (26.9%) was the most common complication. Hypotension (23.7%), tachycardia (42.1%), fever (15.8%), seizures (10.5%), dyspnea (2.6%), high poisoning severity score (PSS), type of toxic material, mechanical ventilator application (39.5%), inotropes application (39.5%), and pneumonia (55.3%) were correlated the LOS over 5 days in the ICU. 8 patients died. In the case of death pesticides and carbon monoxide were the main toxic materials; tachycardia, bradycardia, and hypotension were the main symptoms, and a mechanical ventilator and inotropes were applied.
Conclusion: Patients with unstable vital signs, high PSS, and non-pharmaceutical poisoning had a prolonged LOS in the ICU and a poor prognosis.

KCI등재

7의도적 음독후 응급실에 내원한 환자의 입원과 관련된 요인 분석

저자 : 노우식 ( Woo Sik Noh ) , 김혜진 ( Hye Jin Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 102-109 (8 pages)

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Purpose: This study examined factors associated with the hospitalization of patients who visited the emergency department (ED) after deliberate self-poisoning.
Methods: The medical records of the patients, who visited the ED at a tertiary teaching hospital after deliberate self-poisoning between March 2017 and December 2019, were reviewed retrospectively.
Results: Fifty-seven in the hospitalization and 236 in the discharge group patients were included. The mean age in the hospitalization and discharge group was 48.8±20.4 and 41.8±19.1, respectively (p=0.020). Univariate analysis revealed statistically significant differences in age (p=0.020), mental status (p<0.001), request for help (p=0.046), chronic disease (p=0.036), substance ingested (p<0.001), and risk rescue-rating scale (p<0.001) between the two groups (hospitalization group and discharge group). In multiple logistic regression analysis for predicting the hospitalization of patients after deliberate self-poisoning, the Risk-Rescue Rating Scale (RRRS) was identified (OR=1.493, 95% confidential interval=1.330-1.675, p<0.001). Receiver operating characteristics analysis of RRRS for the decision to hospitalize showed a cut-off value of 38.9, with a sensitivity, specificity, and area under the curve of 96.4%, 77.0%, and 0.949, respectively.
Conclusion: The RRRS can be used to determine the hospitalization for patients who visited the ED after deliberate self-poisoning. Nevertheless, multicenter prospective studies will be needed to determine the generalisability of these results.

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8글리포세이트 중독 환자에서 급성 신손상 발생의 임상 양상과 위험 인자

저자 : 박형훈 ( Hyung Hun Park ) , 최규일 ( Kyu Ill Choi ) , 이제원 ( Je Won Lee ) , 박정민 ( Jung Min Park ) , 박진욱 ( Jinwook Park ) , 노상문 ( Sang Moon Noh ) , 조재경 ( Jaekyung Cho ) , 이대로 ( Daero Lee ) , 조재철 ( Jae Chul Cho ) , 박동찬 ( Dong Chan Park ) , 김양헌 ( Yang Hun Kim ) , 이주

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 110-115 (6 pages)

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Purpose: Acute kidney injury (AKI) in patients with glyphosate poisoning has a poor prognosis. This study aimed to predict the risk factors for AKI in patients with glyphosate poisoning at the emergency department (ED).
Methods: Clinical data on glyphosate poisoning patients at ED who were older than 18 years were collected retrospectively between January 2013 and December 2019. The clinical characteristics and clinical outcomes of the AKI group in patients with glyphosate poisoning were compared with the non-AKI (NAKI) group.
Results: Of 63 glyphosate poisoning patients, AKI was observed in 15 (23.8%). The AKI patients group showed the following: old age (p=0.038), low systolic blood pressure (p=0.021), large amount of ingestion (p=0.026), delayed hospital visits (p=0.009), high white blood cells (WBC) (p<0.001), high neutrophil counts (p<0.001), high neutrophil-lymphocyte (LN) ratios (p<0.001), high serum potassium (p=0.005), low arterial blood pH (p=0.015), and low pO2 (p=0.021), low bicarbonate (p=0.009), and high Poisoning Severity Score (PSS) (p<0.001). AKI patients required hemodialysis, ventilator care (p<0.001, p=0.002), and inotropics (p<0.001). They also showed more intensive care unit admission (p<0.001), longer hospitalization (p<0.001), and high mortality (p<0.001). Logistic multivariate regression analysis showed that high WBCs (OR, 1.223) and increased LN ratios (OR, 1.414) were independently associated with the occurrence of AKI.
Conclusion: In patients with glyphosate poisoning at ED, high WBCs and increased LN ratios can help predict the occurrence of AKI.

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9급성 농약 중독환자에서 호흡 부전 발생의 위험 인자

저자 : 조남준 ( Nam-jun Cho ) , 박삼엘 ( Samel Park ) , 이은영 ( Eun Young Lee ) , 길효욱 ( Hyo-wook Gil )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 116-122 (7 pages)

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Purpose: Acute respiratory failure is an important risk factor for mortality in patients with acute pesticide poisoning. Therefore, it is necessary to investigate the risk factors to predict respiratory failure in these patients.
Methods: This study retrospectively investigated the clinical features of respiratory failure among patients with acute pesticide poi-soning requiring mechanical ventilation. This study included patients who were admitted with intentional poisoning by pesticide ingestion from January 2017 to December 2019. Paraquat intoxication was excluded.
Results: Among 469 patients with acute pesticide poisoning, 398 patients were enrolled in this study. The respiratory failure rate was 30.4%. The rate of respiratory failure according to the type of pesticide was carbamate (75.0%), organophosphate (52.6%), glufosinate (52.1%), glyphosate (23%), pyrethroid (8.9%), and others (17%). The mortality was 25.6% in the respiratory failure group. The risk factors for respiratory failure were old age, low body mass index, and ingestion of more than 300 mL.
Conclusion: Respiratory failure is a risk factor for mortality in pesticide poisoning. Old age, low body mass index, and ingestion of more than 300 mL are the risk factors for predicting respiratory failure.

KCI등재

10아트로핀으로 치료하는 유기인계와 카바메이트 중독 환자의 영양지원 평가와 방법

저자 : 박종욱 ( Jong-uk Park ) , 민영기 ( Young-gi Min ) , 최상천 ( Sangcheon Choi ) , 고동완 ( Dong-wan Ko ) , 박은정 ( Eun Jung Park )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 2호 발행 연도 : 2020 페이지 : pp. 123-129 (7 pages)

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Purpose: Atropine is an antidote used to relieve muscarinic symptoms in patients with organophosphate and carbamate poisoning. Nutritional support via the enteral nutrition (EN) route might be associated with improved clinical outcomes in critically ill patients. This study examined the administration of nutritional support in patients undergoing atropinization, including methods of supply, outcomes, and complications.
Methods: A retrospective observational study was conducted in a tertiary care teaching hospital from 2010 to 2018. Forty-five patients, who were administered with atropine and on mechanical ventilation (MV) due to organophosphate or carbamate poisoning, were enrolled.
Results: Nutritional support was initiated on the third day of hospitalization. Thirty-three patients (73.3%) were initially supported using parenteral nutrition (PN). During atropinization, 32 patients (71.1%) received nutritional support via EN (9) or PN (23). There was no obvious reason for not starting EN during atropinization (61.1%). Pneumonia was observed in both patient groups on EN and PN (p=0.049). Patients without nutritional support had a shorter MV duration (p=0.034) than patients with nutritional support. The methods of nutritional support during atropinization did not show differences in the number of hospital days (p=0.711), MV duration (p=0.933), duration of ICU stay (p=0.850), or recovery at discharge (p=0.197).
Conclusion: Most patients undergoing atropinization were administered PN without obvious reasons to preclude EN. Nutritional support was not correlated with the treatment outcomes or pneumonia. From these results, it might be possible to choose EN in patients undergoing atropinization, but further studies will be necessary.

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