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대한임상독성학회지 update

Journal of the Korean society of clinical toxicology

  • : 대한임상독성학회
  • : 의약학분야  >  기타(의약학)
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수록정보
수록범위 : 1권1호(2003)~18권1호(2020) |수록논문 수 : 362
대한임상독성학회지
18권1호(2020년 06월) 수록논문
최근 권호 논문
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KCI등재

1칼슘통로차단제 중독의 치료

저자 : 이성우 ( Sung Woo Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 1호 발행 연도 : 2020 페이지 : pp. 1-10 (10 pages)

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Pharmaceutical agents are the most common causes of poisoning in Korea. Calcium channel blockers (CCBs) are commonly used in Korea for the management of hypertension and other cardiovascular diseases, but are associated with a risk of mortality due to overdose. Due to the frequent fatalities associated with CCB overdose, it is essential that the emergency physician is capable of identifying CCB intoxication, and has the knowledge to manage CCB overdose. This article reviews the existing clinical guidelines, retrospective studies, and systematic reviews on the emergency management of CCB overdose.
The following are the varied treatments of CCB overdose currently administered. 1) For asymptomatic patients: observation with enough time and decontamination, if indicated. 2) For symptomatic patients: infusion of calcium salt, high dose insulin therapy, and vasopressor (norepinephrine) or atropine for bradycardia. 3) For patients refractory to the first line therapy or with refractory shock or impending arrest: lipid emulsion therapy and extracorporeal membrane oxygenation. 4) As adjunct therapy: phosphodiesterase inhibitors, glucagon, methylene blue, pacemaker for AV block. Small CCB ingestion is known to be fatal for pediatric patients. Hence, close observation for sufficient time is required.

KCI등재

2중독 관련 사망에서의 사망진단서 오류

저자 : 박찬혁 ( Chan Hyeok Park ) , 김선휴 ( Sun Hyu Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 1호 발행 연도 : 2020 페이지 : pp. 11-17 (7 pages)

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Purpose: This study examines errors in death certificates (DCs) issued to cases of poisoning.
Methods: DCs issued in poisoning cases were retrospectively reviewed. Errors in the DC were classified as major and minor errors, and were evaluated in accordance with their impact on the process of selecting the cause of death (COD).
Results: A total of 79 DCs were evaluated; 43 (54.4%) DCs were issued in the emergency department (ED), and 36 (45.6%) DCs were issued outside the ED. The average major and minor errors per DC were determined to be 0.4 and 3.3, respectively. Moreover, an average of 3.0 errors were discovered in DCs issued at the ED, and 4.4 errors in DCs issued outside the ED. The most common major errors were incorrect manner of death (11.4%, 9/79), followed by unacceptable COD (7.6%, 6/79), and the mode of dying as an underlying COD (5.1%, 4/79). The common minor errors most frequently encountered were incorrect time interval (86.1%, 68/79), followed by incorrect other significant conditions (73.4%, 58/79), and no record for date of onset (62.0%, 49/79).
Conclusion: Our results indicate that the total numbers of major errors, minor errors and cases of misjudged cause of death were greater in DCs issued outside the ED than in DCs issued at the ED. The most frequently quoted major error of DCs related to poisoning was determined to be the incorrect manner of death.

KCI등재

3급성 일산화탄소 중독환자에서 병원 전 고산소혈증이 장기 신경학적 예후에 미치는 영향

저자 : 김주찬 ( Ju Chan Kim ) , 전병조 ( Byeong Jo Chun ) , 문정미 ( Jeong Mi Moon ) , 조용수 ( Young Soo Cho )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 1호 발행 연도 : 2020 페이지 : pp. 18-25 (8 pages)

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Purpose: We studied the impact of arterial oxygen tension (PaO2) on the long term neurologic outcome in patients with acute carbon monoxide poisoning.
Methods: The study population included 311 patients who presented to emergency department with acute CO poisoning from January 2015 to January 2018. These patients underwent arterial blood gas testing at the time of presentation. The baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was the long term neurologic status.
Results: The normoxia group was significantly older and it had a higher incidence of diffusion weighted MRI abnormality, and this group needed multiple HBO sessions compared to the group with moderate or severe hyperoxia. Also, the incidence of altered mentality at discharge was higher in the normoxia group than that of the moderate hyperoxia group.
The incidence of a poor long term neurologic outcome was 11.3%. The incidence of a poor long term neurologic outcome decreased as the PaO2 increased. The PaO2 was significantly lower in patients with a poor long term neurologic outcome than that of the patients with a good outcome 198 (165.2 to 231.1) mmHg in the good outcome group vs. 154 (119-162) mmHg in poor outcome, p<0.001).
In multivariate logistic regression analysis, PaO2 was selected as an independent factor of the poor long-term neurologic outcome (OR 0.981 (95% CI: 0.968 to 0.995))
Conclusion: Higher PaO2 was independently associated with a lower incidence of a poor long-term neurologic outcome.

KCI등재

4고엽제 노출이 폐렴의 치료 결과에 미치는 영향

저자 : 김동성 ( Dong Sung Kim ) , 이정엽 ( Jungyoup Lee ) , 계유찬 ( Yu Chan Kye ) , 정의기 ( Euigi Jung ) , 정기영 ( Ki Young Jeong )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 1호 발행 연도 : 2020 페이지 : pp. 26-33 (8 pages)

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Purpose: Agent Orange (AO) is a herbicide and defoliant used by the United States and its military allies during the Vietnam War. Pneumonia is a common cause of death among Vietnam veterans in our hospital. There have been no previous studies researching any association between AO exposure and the prognosis for pneumonia. The primary objective of this study was to investigate associations between AO exposure and 30-day mortality due to pneumonia. The secondary objective was to examine the clinical factors associated with therapeutic outcomes in veterans with pneumonia, and to assess the prevalence of combined diseases in AO-exposed veterans. 
Methods: This study retrospectively included veteran patients diagnosed with pneumonia in the emergency department and hospitalized between February 2014 and March 2018. The enrolled patients were grouped according to their defoliant exposure history, and the clinical information of defoliant-exposed and non-defoliant-exposed groups were compared. Patients were divided according to 30-day mortality, and significant factors influencing mortality were evaluated by using univariate analysis and multivariate analysis. The final multivariate model revealed the effect of AO exposure on therapeutic outcomes of pneumonia. 
Results: A total of 1006 patients were analyzed. Of these, 276 patients had a history of AO exposure, whereas 730 patients had not been exposed. Factors positively associated with 30-day mortality were malignancy, respiratory rate, blood urea nitrogen, and albumin which was negatively associated with mortality. 
Conclusion: Exposure to defoliant is not associated with 30-day mortality in patients with pneumonia. However, veterans with defoliant exposure are associated with a high prevalence of diabetes mellitus, hypertension, cerebrovascular accident, malignancy, and chronic kidney disease.

KCI등재

5급성 일산화탄소 중독 환자에서 급성 심혈관계, 신경학적 독성의 위험요인과 노출 경로의 역학적 특성

저자 : 박진수 ( Jinsoo Park ) , 신승열 ( Seunglyul Shin ) , 서영호 ( Youngho Seo ) , 정현민 ( Hyunmin Jung )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 1호 발행 연도 : 2020 페이지 : pp. 34-41 (8 pages)

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Purpose: This study evaluated aggressive hyperbaric oxygen therapy (HBOT) by understanding various exposure routes of acute carbon monoxide (CO) poisoning, the risk factors causing acute cardiovascular, and neurological toxicity caused by poisoning.
Methods: A retrospective study was conducted based on the medical records of 417 acute CO poisoning patients who visited the emergency care unit from March 2017 to August 2019. The exposure routes, HBOT performance, age, sex, medical history (hypertension, diabetes mellitus, ischemic heart disease, heart failure), intentionality, loss of consciousness (LOC), intake with alcohol or sedatives, and initial test results (carboxyhemoglobin (COHb), troponin- I, electrocardiography, echocardiography, brain MRI) were examined. Comparative analysis of the clinical information was conducted between the groups that showed acute cardiovascular toxicity and neurological toxicity, and groups that did not.
Results: Among 417 patients diagnosed with acute CO poisoning, 201 cases (48.2%) were intentional, and charcoal briquette was the most common route (169 patients (40.5%)). Two hundred sixteen cases (51.8%) were accidental, and fire was the most common route (135 patients (32.4%)). The exposure route was more diverse with accidental poisoning. Three hundred ninety-nine patients were studied for acute cardiovascular toxicity, and 62 patients (15.5%) were confirmed to be positive. The result was statistically significant in intentionality, LOC, combined sedatives, initial COHb, HTN, and IHD. One hundred two patients were studied for acute neurological toxicity, which was observed in 26 patients (25.5%). The result was statistically significant in age and LOC.
Conclusion: Active HBOT should be performed to minimize damage to the major organs by identifying the various exposure routes of CO poisoning, risk factors for acute cardiovascular toxicity (intentionality, LOC, combined sedatives, initial COHb, HTN, IHD), and the risk factors for acute neurological toxicity (age, LOC).

KCI등재

6소라 섭취 후 테트라민 중독에 의한 호흡부전 1례

저자 : 이주환 ( Joo Hwan Lee ) , 박진욱 ( Jin Wook Park ) , 홍성준 ( Seong Jun Hong ) , 전재천 ( Jae-cheon Jeon ) , 진상찬 ( Sang-chan Jin )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 1호 발행 연도 : 2020 페이지 : pp. 42-46 (5 pages)

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Tetramine toxicity due to sea snail ingestion is generally mild and has a good prognosis. Tetramine toxicity acts on the acetylcholine receptor, affecting the neuromuscular junction and autonomic nervous system. A 78-year-old female patient visited the emergency room with vomiting and dyspnea after eating sea snails. At the time of admission, the vital signs recorded were 140/80 mmHg-105/min-24/min-36.5。C, and 90% oxygen saturation. Arterial blood test revealed hypercapnia (pCO2 58.2 mmHg) and respiratory acidosis (pH 7.213, HCO3 - 22.5 mmol/L), whereas other blood tests showed no specific findings. Due to decreased consciousness and hypoxia, endotracheal intubation and mechanical ventilation were administered to the patient. Successful weaning was accomplished after 12 hrs, and the patient was discharged without any further complications. Although tetramine toxicity rarely results in acute respiratory failure due to paralysis of the respiratory muscle, caution is required whilst treating the patient.

KCI등재

7마리화나 흡연으로 인해 발생한 젊은 연령 뇌경색 1례

저자 : 하수영 ( Sue Young Ha ) , 강동완 ( Dong-wan Kang ) , 이승훈 ( Seung-hoon Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 18권 1호 발행 연도 : 2020 페이지 : pp. 47-50 (4 pages)

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A 21-year-old female patient complaining of hemiparesis was diagnosed with right middle cerebral artery infarction. No risk factor was found, despite an extensive young-age stroke work-up, except her history of marijuana use. The patient had smoked marijuana for treating depression for more than five years. Magnetic resonance angiography showed multifocal intra- and extracranial stenoses, suggesting cannabinoid-induced vasculopathy. Since the use of illicit drugs has increased nationwide, physicians should consider it as a possible cause of a stroke due to an unknown etiology.

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(2006)홍길동 외 1명심리학41회 피인용

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