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대한임상독성학회> 대한임상독성학회지> 증례 : 아지드화 나트륨(sodium azide) 음독 후 사망한 1례

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증례 : 아지드화 나트륨(sodium azide) 음독 후 사망한 1례

A Lethal Case of Sodium Azide Ingestion

남연우 ( Yeoun Woo Nam ) , 김정언 ( Jung Eon Kim ) , 조준호 ( Junho Cho ) , 정성필 ( Sung Pil Chung ) , 이한식 ( Hahn Shick Lee ) , 김의중 ( Eui Chung Kim )
  • : 대한임상독성학회
  • : 대한임상독성학회지 6권1호
  • : 연속간행물
  • : 2008년 06월
  • : 49-51(3pages)

DOI


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초록 보기

 
Sodium azide (NaN3) is a white to colorless, crystalline powder that is highly water soluble, tasteless, and odorless. It is used mainly as a preservative in aqueous laboratory reagents and biologic fluids and also as an automobile airbag gas generant. Although it has caused deaths for decades, the toxic properties and effects of sodium azide in humans remains unknown. A 31-year-old comatose female was transported to the emergency department with an empty bottle labeled sodium azide. She developed cardiac arrest 15 minutes after arrival and expired in spite of 30 minutes of resuscitative effort. Subsequently, resuscitation team members incidentally suffered from sodium azide’s exposure and developed eye discomfort, skin rashes parasthesias, pruritus, sore throat, and headache.

UCI(KEPA)

I410-ECN-0102-2016-510-000272022

간행물정보

  • : 의약학분야  > 기타(의약학)
  • : KCI등재
  • :
  • : 반년간
  • : 1738-1320
  • :
  • : 학술지
  • : 연속간행물
  • : 2003-2020
  • : 362


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1종설 :아세트아미노펜 중독

저자 : 정성필 ( Sung Pil Chung ) , 김승호 ( Seung Ho Kim ) , 이한식 ( Hahn Shick Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 1-8 (8 pages)

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Acetaminophen (AAP) overdose can result in potentially serious hepatotoxicity. The ingested dose and time from ingestion to presentation are important prognostic factors. Toxic dose in adult is thought to be at least 10 g or 200 mg/kg. However, early management of acute overdose should be guided by the plasma AAP concentration. The antidote for AAP poisoning is N-acetylcysteine (NAC). It provides complete protection against hepatotoxicity if given within 8 h of acute overdose. If the concentration is above the possible toxicity line as predicted by the Rumack- Matthew nomogram, either the 72-hr oral or the 20-hr intravenous NAC regimen should be administered. NAC is also effective if started late in patients with established hepatic failure. This article summarizes the current consensus of clinical assessment and management for acute AAP overdose.

2원저 : 국내 급성 dichlorvos 중독 현황과 임상상 분석

저자 : 이미진 ( Mi Jin Lee ) , 박준석 ( Joon Seok Park ) , 권운용 ( Woon Yong Kwon ) , 어은경 ( Eun Kyung Eo ) , 오범진 ( Bum Jin Oh ) , 이성우 ( Sung Woo Lee ) , 서주현 ( Joo Hyun Suh ) , 노형근 ( Hyung Keun Roh )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 9-15 (7 pages)

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Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.

3원저 : 중독손상으로 퇴원한 환자에서 중독 양상 비교 - 전국 입원손상환자 조사사업 자료를 이용 -

저자 : 정시영 ( Si Young Jung ) , 어은경 ( Eun Kyung Eo ) , 김찬웅 ( Chan Woong Kim ) , 박혜숙 ( Hye Sook Park ) , 김영택 ( Young Tak Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 16-24 (9 pages)

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Purpose: There has been no nationwide surveillance survey of poisoning cases in Korea. This study examined the clinical characteristics of poisoning admissions in order to obtain preliminary data for future planning. Methods: This study retrospectively reviewed the data on poisoning admissions of 150 hospitals based on the hospital discharge injury surveillance data of Center for Disease Control and Prevention in Korea from January to December in 2004. The demographic data, poisons used, causes of poisoning, reasons for attempted suicide and mortality rate was investigated according to the age group. The factors associated with mortality were also evaluated. Results: A total 836 patients admitted for poisoning were analyzed. Their mean age was 46.5±19.5 years (male 415, female 421). The most frequent age group was the 4th and 5th decades. The most common poisons involved were pesticides (45%) and medications (23%). The majority (64%) involved intentional poisoning except for those in the 1st decade. The most common reason for the attempted suicide was family problems. However, individual disease was the most common reason in those over 60 years. The overall mortality rate was 8.7% (73/836). Pesticides and being elderly (over 65 years old) were strongly correlated with fatality. Conclusion: The incidence of intentional poisoning increases from the 2nd decade making it a preventable injury. “Overall, the incidence of intentional poisoning increases from the 2nd decade”. Therefore, there is a need to frame a prevention policy corresponding to each factor related to fatality, such as an elderly population and pesticides.

4원저 : 유기인계 농약 중독 환자에서 초기 적혈구 아세틸콜린에스테라제 활성도의 임상적 의의

저자 : 김훈 ( Hoon Kim ) , 한승백 ( Seung Baik Han ) , 김준식 ( Jun Sig Kim ) , 이미진 ( Mi Jin Lee ) , 박준석 ( Joon Seok Park ) , 권운용 ( Woon Yong Kwon ) , 어은경 ( Eun Kyung Eo ) , 오범진 ( Bum Jin Oh ) , 이성우 ( Sung Woo Lee ) , 서주현 ( Joo Hyun Suh ) , 노형근 ( Hyung Keun Roh )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 25-31 (7 pages)

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Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.

5원저 : 장기간 인공환기가 필요한 유기인계 중독환자의 연관인자 분석

저자 : 신황진 ( Hwang Jin Shin ) , 이미진 ( Mi Jin Lee ) , 박규남 ( Kyu Nam Park ) , 박준석 ( Joon Seok Park ) , 박성수 ( Seong Soo Park )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 32-36 (5 pages)

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Purpose: The major complication of acute organophosphate (OP) poisoning is respiratory failure as a result of cholinergic toxicity. Many clinicians find it difficult to predict the optimal time to initiate mechanical ventilation (MV) weaning, and as a result have tended to provide a prolonged ventilator support period. The purpose of this study is to determine any clinical predictors based on patients characteristics and laboratory findings to assist in the optimal timing of mechanical ventilator weaning. Methods: We reviewed medical and intensive care records of 44 patients with acute OP poisoning who required mechanical ventilation admitted to medical intensive care unit between July 1998 and June 2007. Patient information regarding the poisoning, clinical data and demographic features, APACHE II score, laboratory data, and serial cholinesterase (chE) levels were collected. Base on the time period of MV, the patients were divided into two groups: early group (wean time < 7 days, n = 28) and delayed group (≥ 7 days, n = 16). Patients were assessed for any clinical characteristics and predictors associated with the MV weaning period. Results: During the study period, 44 patients were enrolled in this study. We obtained the sensitivity and specificity values of predictors in the late weaning group. APACHE II score and a reciprocal convert of hypoxic index but specificity (83.8%) is only APACHE II score. Also, the chE concentration (rho = -0.517, p = 0.026) and APACHE II score (rho = 0.827, p < 0.001) correlated with a longer mechanical ventilation duration. Conclusion: In patients with acute OP poisoning who required mechanical ventilation, the APACHE II scoring system on a point scale of less than 17 and decrements in cholinesterase levels on 1-3 days were good predictors of delayed MV weaning.

6Exchange Transfusion Treatment for Dapsone-induced Methemoglobinemia

저자 : Hwa Yoen Yi , Jang Young Lee

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 37-41 (5 pages)

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Methemoglobinemia can be caused by dapsone toxicity. We report a case dapsone induced methemoglobinemia unresponsive to methylene blue successfully treated by exchange transfusion. A 52-year-old male ingested a handful of dapsone. He presented with severe peripheral cyanosis in lips and fingertips and his methemoglobin level was found to be 21.9%. After admission, methylene blue (1%) at 1 mg/kg was injected each time peripheral cyanosis and rising serum methemoglobin occurred. Despite methylene blue therapy, the patient's methemoglobin level continued to fluctuate. Five days after the injections of methylene blue, many Heinz bodies were visualized in the peripheral blood, suggestive of hemolytic anemia occurrence. By hospital day 6, serum methemoglobine levels were elevated and not measurable (> 50%) and the patient was constantly in a semi-comatose mental state. An exchange transfusion carried out by utilizing 6 units of packed red blood cells and 4 units of fresh frozen plasma was performed. The patient's methemoglobin levels were subsequently kept up below 20% and his peripheral cyanosis receded. Physicians should recognize the important role of exchange transfusion in refractory dapsoneinduced methemoglobinemia.

7증례 : 혈당 강하제 metformin 중독 후 발생한 심각한 산혈증 1례

저자 : 김보인 ( Bo In Kim ) , 정진희 ( Jin Hee Jung ) , 어은경 ( Eun Kyung Eo )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 42-44 (3 pages)

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Metformin which is an oral hypoglycemic agents, acts by enhancing insulin sensitivity, decreasing hepatic glucose production and increasing peripheral utilization of glucose. Deliberate self poisoning with oral hypoglycemic agents is rare. The lactic acidosis associated with metformin toxicity is well described in the medical literature. Metformin overdose even in otherwise healthy patients may produce a profound and life threatening lactic acidosis. We report a case of massive metformin ingestion(75g) in a patient presenting with lactic acidosis and hypotension. She died 24h after presenting to our emergency department despite bicarbonate treatment and hemofiltration therapy.

8증례 : Benzodiazepine withdrawal syndrome에 의한 Status Epilepticus 1례

저자 : 오영민 ( Young Min Oh ) , 최경호 ( Kyoung Ho Choi )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 45-48 (4 pages)

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A 57-year-old man was transferred to our emergency department with decreased mental status after organophosphate intoxication. He had a four year history of benzodiazepine and hypnotic medication use for chronic insomnia and a depressive mood disorder. He had no previous history of seizures, diabetes mellitus, and hypertension. By hospital day 5, the patient was noted to be awake and to have repetitive jerking movements involving the left upper extremity, and appeared apathetic, depressed and less responsive to external stimuli. A benzodiazepine withdrawal syndrome was subsequently apparent when he developed several generalized tonic clonic seizures and status epilepticus. Using a continuous midazolam intravenous infusion, we successfully controlled the refractory seizure without complications. We present a rare case of status epilepticus from a benzodiazepine withdrawal that developed during the treatment for organophosphate intoxication.

9증례 : 아지드화 나트륨(sodium azide) 음독 후 사망한 1례

저자 : 남연우 ( Yeoun Woo Nam ) , 김정언 ( Jung Eon Kim ) , 조준호 ( Junho Cho ) , 정성필 ( Sung Pil Chung ) , 이한식 ( Hahn Shick Lee ) , 김의중 ( Eui Chung Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 49-51 (3 pages)

다운로드

(기관인증 필요)

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Sodium azide (NaN3) is a white to colorless, crystalline powder that is highly water soluble, tasteless, and odorless. It is used mainly as a preservative in aqueous laboratory reagents and biologic fluids and also as an automobile airbag gas generant. Although it has caused deaths for decades, the toxic properties and effects of sodium azide in humans remains unknown. A 31-year-old comatose female was transported to the emergency department with an empty bottle labeled sodium azide. She developed cardiac arrest 15 minutes after arrival and expired in spite of 30 minutes of resuscitative effort. Subsequently, resuscitation team members incidentally suffered from sodium azide's exposure and developed eye discomfort, skin rashes parasthesias, pruritus, sore throat, and headache.

10증례 : 많은 양을 음독한 급성 amitraz 살충제 중독 1례

저자 : 서주현 ( Joo Hyun Suh ) , 노형근 ( Hyung Keun Roh )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 6권 1호 발행 연도 : 2008 페이지 : pp. 52-56 (5 pages)

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Amitraz is used as farm-animal insecticide. Its side effects in humans are related to its pharmacological activity on alpha 2-adrenergic receptors. The case describes a previously healthy 46-year-old woman who intentionally ingested approximately 250mL of liquid amitraz. She presented with vomiting, altered mental status, miosis, dry mouth, hypopnea, metabolic and respiratory acidosis, hypotension, hypothermia, polyuria, metabolic acidosis, elevated serum aminotransferase and abdominal distension. Supportive treatments including mechanical ventilation, hydration, dopamine infusion, bicarbonate infusion and gastric decompression resulted in improvement. By hospital day 3, she recovered with resolution of abdominal distension. It is paramount to recognize amitraz poisoning when a pesticide-intoxicated patient presets with signs and symptoms consistent with organophosphate intoxicated patients but with greater alpha 2-adrenergic related symptoms such as decreased bowel motility and xerostomia.

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