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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)~17권1호(2019) |수록논문 수 : 344
대한임상독성학회지
17권1호(2019년 06월) 수록논문
최근 권호 논문
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KCI등재

1스콤브로이드 생선 중독과 히스타민 식중독

저자 : 정성필 ( Sung Phil Chung )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 1-5 (5 pages)

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Scombroid fish poisoning (SFP) is a form of histamine food poisoning caused by the ingestion of improperly stored fish. The term “scombroid” derives from the family name of the fish family first implicated, such as tuna and mackerel. On the other hand, non-scombroid fish species, such as sardine and herring, can also cause histamine poisoning. The histamine is converted from histidine by a bacterial enzyme in the causative fish. Because the symptoms of SFP can easily be confused with food allergies, it is believed to have been significantly under-reported. In 2016, an outbreak of SFP occurred among primary school students who had eaten yellowtail steak in Korea. The most common findings consisted of a rapid onset of flushing of the face and trunk, erythematous and urticarial rash, diarrhea, and headache occurring soon after consuming the spoiled fish. Usually, the course is self-limiting and antihistamines can be used successfully to relieve symptoms, but several life-threatening SFP cases have been reported. Clinical toxicologists should be familiar with SFP and have competency to make a differential diagnosis between fish allergy and histamine poisoning. SFP is a histamine-induced reaction caused by the ingestion of histamine-contaminated fish, whereas a fish allergy is an IgE-mediated reaction. This review discusses the epidemiology, pathophysiology, diagnosis, treatment, and preventive measures of SFP.

KCI등재

2단일 응급의료기관에서 경험한 글루포시네이트 암모니움 포함 제초제 중독 후 중증도 예측에 관한 연구

저자 : 이두성 ( Doo Sung Lee ) , 최경호 ( Kyoung Ho Choi )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 7-13 (7 pages)

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Purpose: Owing to the increased agricultural use of the herbicide glufosinate ammonium (GLA), the incidence of GLA poisoning has recently increased. Therefore, we investigated the possible predictive factors associated with severe complications following GLA poisoning.
Methods: A retrospective analysis of medical records was conducted based on 76 patients who had visited our regional emergency medical center with GLA poisoning from 2006 to 2017. Severe complications were defined as respiratory failure requiring intubation, systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (GCS) less than 8, and presence of seizure.
Results: Age, ingested amount and ingested amount per weight were significantly greater in the severe group (p<0.001). PSS grade 2 or higher was more common in the severe group (p<0.001), and In addition, the APACHE II score was significantly higher in the severe group (p<0.001), as were the SOFA scores (p=0.002). Serum ammonia levels were significantly higher in the severe group (p=0.007), while MDRD-GFR was smaller in the severe group (p=0.002). The spot urine protein levels were significantly higher in the severe group (p=0.005), as was the urine protein to creatinine ratio (p=0.001). Upon multivariate analysis, the amount ingested per weight and PSS grade 2 or higher were identified as significant predictors.
Conclusion: Our study showed that MDRD-GFR was significantly lower in the severe group after GLA poisoning. PSS grade 2 or higher and ingested amount per weight may be useful to evaluate the severity of complications after GLA poisoning.

KCI등재

3중환자실 급성중독환자에서 섬망의 위험인자

저자 : 김희연 ( Hee Yeon Kim ) , 차경만 ( Kyung Man Cha ) , 소병학 ( Byung Hak )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 14-20 (7 pages)

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Purpose: This study estimated the incidence of delirium and associated risk factors and outcomes in ICU patients with acute poisoning.
Methods: Data were collected from ICU patients over 18 years of age that were admitted via the emergency center after presenting with poisoning from 2010 to 2015. Delirium was assessed retrospectively using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors were evaluated by univariate and multivariate analysis.
Results: A total of 199 patients participated in this study and 68 (34.2%) were diagnosed with delirium based on the ICDSC score. The delirium group showed a significantly higher association with prolonged length of stay in the hospital and ICU in comparison with the non-delirium group. The delirium group was associated with greater use of physical restraint. A statistically greater number of patients with pharmaceutical substance poisoning developed delirium over a short period of time than those with non-pharmaceutical substance poisoning. There was no significant difference between the two groups with respect to age, sex, past history, GCS score, vital signs, application of ventilator care and renal replacement therapy.
Conclusion: The finding that the delirium group had a greater length of stay in both the hospital and the ICU is consistent with the results of previous worldwide studies of the effects of delirium on the prognosis of patients who were admitted to the ICU, suggesting the possibility for domestic application. Additionally, use of physical restraint was positively related to the incidence of delirium. Thus, interventions for minimizing the use of physical restraints and considering alternatives are needed.

KCI등재

4의료 기관 구분에 따른 중독 환자의 사망률 - 건강보험심사평가원 자료 기반

저자 : 김소영 ( Soyoung Kim ) , 최상천 ( Sangchun Choi ) , 김혁훈 ( Hyuk-hoon Kim ) , 양희원 ( Hee Won Yang ) , 윤상규 ( Sangkyu Yoon )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 21-27 (7 pages)

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Purpose: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning.
Methods: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality.
Results: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=-6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=-4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004).
Conclusion: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

KCI등재

5글리포세이트 제초제 중독 후 심전도에서 QRS파 확장을 보여 치료한 1례

저자 : 이주환 ( Joo Hwan Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 28-31 (4 pages)

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Glyphosate herbicides, which are widely used worldwide, are known to have low toxicity. However, excessive intake may cause serious life-threatening complications; therefore, caution is needed when using them. A 51-year-old man visited the hospital after ingesting glyphosate herbicide. At the time of admission, his vital signs were 80/60 mmHg-115/min-20/min-37.3°C. Electrocardiogram (ECG) showed QRS widening and corrected QT (QTc) prolongation, and blood tests showed metabolic acidosis. Treatment with gastric lavage, activated charcoal, sodium bicarbonate and intravenous lipid emulsion therapy was performed. After 2 hours, his blood pressure increased to 130/90 mg, and no QRS widening was observed on ECG.

KCI등재

6잘토프로펜 유발 Kounis 증후군 1례

저자 : 이성유 ( Seong You Lee ) , 성원영 ( Won Young Sung ) , 이장영 ( Jang Young Lee ) , 서상원 ( Sang Won Seo ) , 이원석 ( Won Suk Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 32-37 (6 pages)

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Kounis syndrome is defined as the occurrence of acute coronary syndrome associated with vasoactive mediators, such as histamines in the setting of hypersensitivity and allergic reactions or anaphylactic insults. The condition can be caused by various drugs, foods, or environmental factors that cause allergic reactions. A 35-year-old male visited the emergency room with anaphylaxis accompanied by chest pain approximately 20 minutes after taking zaltoprofen, a nonsteroidal anti-inflammatory drug. After acute treatment for the anaphylaxis, the patient was stabilized and all symptoms disappeared, but the ischemic changes in the electrocardiogram and elevation of the cardiac enzymes were observed. The emergency cardiac angiography and echocardiography were all normal. The allergic reaction of this patient to zaltoprofen was believed to cause a temporary coronary arterial vasospasm, inducing Type 1 Kounis syndrome. Thus far, there have been case reports of Kounis syndrome caused by a range of nonsteroidal antiinflammatory drugs, but there are no reports of the condition being caused by zaltoprofen. According to the pathophysiology, both cardiac and allergic symptoms must be solved simultaneously, so rapid treatment and diagnosis are needed. Doctors treating acute allergic reactions and anaphylaxis patients must check the cardiovascular symptoms thoroughly and consider the possibility of Kounis syndrome.

KCI등재

7아세트아미노펜 중독 청소년에서의 프로칼시토닌 상승

저자 : 김소은 ( So Eun Kim ) , 이재백 ( Jae Baek Lee ) , 진영호 ( Young Ho Jin ) , 윤재철 ( Jae Chol Yoon ) , 조시온 ( Si On Jo ) , 정태오 ( Tae Oh Jeong )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 38-41 (4 pages)

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Procalcitonin (PCT) is commonly employed in medical practice as a diagnostic biomarker of bacterial infection and also as a monitoring biomarker for antimicrobial therapy. There have been a few published reports concerning elevated PCT levels in people with acute liver injury caused by an overdose of acetaminophen. We report here on a case of PCT elevation in an adolescent with acute acetaminophen poisoning without any bacterial infection or liver injury. A 15-year-old girl had deliberately ingested 20 tablets of 650 mg acetaminophen (13 g) and she presented to our emergency department. The PCT level on admission was elevated to 65.64 ng/mL (reference range: 0-0.5 ng/mL). Her PCT level on the second day peaked up to 100 ng/mL and then it gradually decreased. There was no evidence of liver injury or infection on the computed tomography examination and other lab tests. The patient regained her good health and was discharged on the sixth day of hospitalization.

KCI등재

8도코로(Tokoro)마 중독과 관련한 저 칼슘혈증

저자 : 윤재철 ( Jae Chol Yoon ) , 이재백 ( Jae Baek Lee ) , 정태오 ( Tae Oh Jeong ) , 조시온 ( Si On Jo ) , 진영호 ( Young Ho Jin )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 17권 1호 발행 연도 : 2019 페이지 : pp. 42-45 (4 pages)

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Dioscorea tokoro has long been used in Korean traditional medicine as a pain killer and anti-inflammatory agent. A 53-year-old male who consumed water that had been boiled with raw tubers of D. tokoro as tea presented with numbness and spasm of both hands and feet. Laboratory results showed hypocalcemia, hypoparathyroidism, and vitamin D insufficiency. During his hospital stay, colitis, acute kidney injury, and toxic encephalopathy developed. The patient received calcium gluconate intravenous infusion and oral calcium carbonate with alfacalcidol. His symptoms improved gradually, but hypocalcemia persisted despite the calcium supplementation. We suggest that ingestion of inappropriately prepared D. tokoro can cause symptomatic hypocalcemia in patients with unbalanced calcium homeostasis.

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(2006)홍길동 외 1명심리학41회 피인용

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