• 대한임상독성학회지
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• 제18권2호
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• pp.85-93
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• 2020

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.

• 대한임상독성학회지
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• 제19권2호
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• pp.133-138
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• 2021

Glufosinate-containing herbicides is a non-selective herbicide commonly used worldwide. As the use of them increased gradually since paraquat was banned in 2012, the number of suicides by their ingestion is also increasing continuously. Complications of glufosinate-containing herbicide poisoning include various central nervous system (CNS) toxicities such as convulsions, loss of consciousness, memory impairment, and respiratory depression, which may be accompanied by hemodynamic changes such as bradycardia and hypotension. However, it is very rare that arrhythmias other than bradycardia occurred and Takotsubo cardiomyopathy was combined due to cardiotoxicity. A 71-year-old female patient was transferred to our hospital after ingesting 500 mL of glufosinate-containing herbicide and receiving 5 L of gastric lavage at a local hospital. A few hours later, she presented stuporous mentality, respiratory depression, and convulsions, and was accompanied by hypotension and bradycardia. On the second day of admission, electrocardiogram (ECG) showed bradycardia and QTc prolongation with hemodynamic Instability. Accordingly, we conducted the early treatment with continuous renal replacement therapy (CRRT) and the application of temporary cardiac pacemaker. An echocardiogram demonstrated decreased ejection fraction (EF) and Takotsubo cardiomyopathy on the third day of admission. Then, she was discharged safely with conservative treatment. At the follow-up after 1 year, Takotsubo cardiomyopathy, EF and QTc prolongation were recovered on echocardiogram and ECG. Because cardiac toxicity after glufosinate-containing herbicide poisoning may cause life-threatening consequences, caution is required while treating the patient. Therefore, if electrocardiogram changes are seen in the elderly with a large amount of glufosinate herbicide ingestion, additional cardiac function test through echocardiography should be concerned, and early treatment through CRRT or artificial cardiac pacing should be considered.

• The Korean Journal of Physiology and Pharmacology
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• 제20권1호
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• pp.35-39
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• 2016

To conduct a kinetic study of paraquat (PQ), we investigated 9 patients with acute PQ intoxication. All of them ingested more than 20 ml of undiluted PQ herbicide to commit suicide and arrived at our hospital early, not later than 7 h after PQ ingestion. The urine dithionite test for PQ in all of the nine patients was strongly positive at emergency room. Blood samples were obtained every 30 min for the first 2~3 h and then every 1 or 2 h, as long as the clinical progression was stable among the patients for 30 h after PQ ingestion. The area under the plasma concentration-time curve ($AUC_{inf}$), which was extrapolated to infinity, was calculated using the trapezoidal rule. Toxicokinetic parameters, such as the terminal elimination half-life, apparent oral clearance, and apparent volume of distribution ($V_d/F$) were calculated. The maximum PQ concentration ($C_{max}$) and the time to reach maximum PQ concentration ($T_{max}$) were also obtained. Plasma PQ concentrations in nine patients were well described by a bi-exponential curve with a mean terminal elimination half-life of $13.1{\pm}6.8h$. $C_{max}$ and $AUC_{inf}$ were $20.8{\pm}25.7mg/l$ and $172.5{\pm}160.3h{\cdot}mg/l$, respectively. Apparent volume of distribution and apparent oral clearance were $50.9{\pm}61.3l/kg$ and $173.4{\pm}111.2l/h$, respectively. There were a significant correlation (r=0.84; p<0.05) between the PQ amount ingested and $C_{max}$. $AUC_{inf}$ also showed a significant correlation (r=0.83; p<0.05) with the PQ amount ingested. These correlations provide evidence that PQ has dose-linear toxicokinetic characteristics.

• 대한임상독성학회지
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• 제15권2호
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• pp.131-139
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• 2017

Purpose: The purpose of this study was to investigate the epidemiologic characteristics of patients who visited emergency departments (EDs) after intentional poisoning in Korea. Methods: This study retrospectively analyzed the data of of 23 hospitals during a five-year period, between 2011 and 2015. We included patients who inflicted injury to themselves - attempt of suicide - by means of poisoning. Results: A total of 18,121 patients visited an ED after intentional poisoning. Among them, 58.3% were females; however, there were more males among those aged 60 years or older. The mortality rate for males was 8.6%, which was 3.1 times higher than that for females with 2.8%. The most common poison was pesticides (35.4%) in males and sedative-hypnotics (44.0%) in females. The most common causative agent of death was pesticide in both sexes (75.2% and 65.3%, respectively). Since the production of paraquat was discontinued in 2011, the number of deaths from pesticide poisoning has decreased. The mortality rate declined in both males and females, from 12.6% and 4.5% in 2011 to 7.1% and 2.1% in 2015, respectively. Conclusion: In this study, we analyzed the epidemiologic characteristics of intentional poisoning, especially the frequency of suicide attempts by gender and age group, the cause of suicide, and the causative agent. This can be used as basic data for establishing policies to reduce and prevent suicide attempts by poisoning.

• 대한임상독성학회지
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• 제2권2호
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• pp.83-89
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• 2004

Acute poisoning is one of the diseases which need the most fastest emergency measures at the very beginning. However, at present, The Korea doesn't manage the toxication all over the country, and in particular, there is no guide to medical cure paying due regard to the traits of each area. This paper focused on the issue that the necessary data in preparing the facilities for the treatment of the poisoned patients and materials for medical treatment including antidote would have to be collected, after finding the special features of the symptoms by searching the present conditions of the poisoning in small towns next to farm villages in the North area of Youngseo, Kangwon province. This study was based on the questionnaires from 111 patients who were carried into the emergency room by the poisoning in two university hospitals of the North area of Youngseo, Kangwon, for one year, 2002. Upon investigation, the patients(111) visiting emergency room by the acute poisoning during the research period was found to be 0.37 percent of all patients(30,085) visiting emergency room. Among them, the most high percentage was given in their twenties and thirties at the rate of $39.6\%$, and the ratio($40.5\%$) of the poisoned patients after their fifties was much higher than a research($10\%$) of other areas. Many poisoned patients came to their rescue in an emergency room generally in spring and in winter, from 7 a.m. to 3 p.m. Agricultural chemical of the toxic materials had a majority at a ratio of $57.7\%$, and paraquat of the agricultural chemicals was found to have a lot of toxicity by $31.7\%$. As the trace of the toxication, the oral poisoning was common by $89.2\%$, and $55.9\%$ in the case of operating gastric lavage and nasogastric irrigation, but only $14.4\%$ for prescribing antidote. The mortality of the acute poisoned patients was $17.2\%$, and the toxication by paraquat held a majority. As a result, the acute poisoning of the North area in Youngseo, Kangwon had both of the characteristics of the rural and the city, and the patients over their fifties by the population aging had more attack of the disease than other regions. Also, with the high ratio of the toxication by the agricultural chemicals, especially, the lethal agricultural chemical was used frequently. Therefore, these dangerous situations need to find the ways to cope with.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2000년도 제52차 추계학술대회 연제집
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• pp.306-307
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• 2000

• 대한임상독성학회지
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• 제8권2호
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• pp.51-60
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• 2010

Purpose: The aim of this study was to investigate toxic exposures in emergency centers with using a toxic exposure surveillance system-based report form as a preliminary study. Methods: We retrospectively reviewed the medical records of toxic exposure patients who visited emergency centers from January to December 2008. Results: 3,157 patients from 11 emergency centers were enrolled. Males were involved in 47.9% of the total cases of exposure and in 60.1% of the cases of fatal exposure. Suicidal intent was the most common (61.0%) reason and most (87.4%) fatal exposures were suicidal. Pesticides were involved in 30.7% of the cases and sedative/hypnotics/antipsychotics were involved in 20.5%. The substances most frequently involved in fatalities were pesticides, and a 48.4% fatality rate was recorded for paraquat exposure. Conclusion: The toxic exposure data showed the preliminary poisoning events in emergency centers. It is recommended that toxicology professionals should develop a toxic surveillance system and serial reporting should be performed.

• 농약과학회지
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• 제2권2호
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• pp.102-107
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• 1998

본 연구의 목적은 강원도 고냉지 씨감자 경작자들의 잡초방제 및 제초제 사용에 따른 문제점을 파악하는데 있다. 강원도 평창군, 횡성군, 강릉시에 거주하는 씨감자 경작자 196명을 대상으로 설문조사를 실시한 후, 결과를 통계 분석하였다. 씨감자 경작자들은 경작지에 문제가 되는 주요 잡초로 여뀌, 명아주, 쑥, 닭의장풀, 바랭이, 봄여뀌, 별꽃, 쇠뜨기, 쇠비름을 들었다. 전체 응답자의 58%는 paraquat, pendimethalin, metribuzin 등 많은 제초제들을 단독 혹은 혼합하여 기준약량보다 2배처리하여도 여뀌, 쇠뜨기, 쑥, 둑새풀, 닭의장풀, 피는 방제가 힘들다고 답하였으며, 또 응답자의 34%는 현재 사용중인 제초제들을 $3{\sim}5$년 정도 연용하고 있다고 밝히고 있다. 조사대상자들은 paraquat, fluazifop-butyl 등 감자경작용으로 등록되지 않는 제초제들도 사용하고 있으며, 현재 사용되고 있는 제초제는 경작자 본인의 경험에 의한 선택(51%)과 농약상의 추천(34%)에 의하여 주로 선정되고 있는 것으로 밝혀졌다. 전체 응답자의 67%는 제초제의 남,오용으로 인하여 작물피해를 입은 경험이 있고, 75%는 제초제 처리시 혹은 후 제초제에 중독된 경험이 있다고 응답하였다. 강원도 고냉지 씨감자 경작자들은 제초제의 남,오용으로 경제적 피해는 물론 중독증상까지 경험하고 있으므로, 이 지역 경작자를 대상으로 한 올바른 제초제의 선정 및 사용법에 대한 체계적인 교육프로그램이 개발, 보급되어야할 것이다.

• 농약과학회지
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• 제3권3호
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• pp.54-59
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• 1999

본 연구의 목적은 강원도 옥수수 경작자들의 잡초방제 및 제초제 사용에 따른 문제점을 파악하는데 있다. 강원도 홍천군에 거주하는 옥수수 경작자 68명을 대상으로 1:1 설문조사를 실시하였고, 이를 통해 얻어진 결과를 통계분석하였다. 옥수수 경작자들은 경작지에 문제가 되는 우점잡초로 1년생인 바랭이, 쇠비름, 명아주, 닭의장풀을 들었으며, 전체 응답자의 44%가 손제초를 선호하고 있었다. 제초제 사용자 중 94%는 초기제초제로 paraquat와 alachlor를 사용하였고, 87%는 중기제초제로 paraquat, glufosinate, glyphosate, fluazifop-P-butyl을 사용하고 있는 것으로 조사되었다. 이와 같은 특정한 제초제를 기준량의 2배이상 살포한다고 응답한 경작자가 전체 응답자의 48%에 달하여 조사대상 지역에서의 제초제 내성 혹은 저항성 잡초의 출현이 우려되고 있다. 사용된 제초제는 본인의 농사경험(55%), 이웃의 추천(18%), 판매상의 권유(13%), 농약사용지침서 이용(11%), 농업연구자 및 지도사의 추천(3%)에 의해 선정된 것으로 조사되었으며, 경작자들은 제초제의 올바른 사용법을 지키지 않아 작물약해 및 농약에 의한 중독경험이 있는 것으로 조사되었다. 응답자의 37%는 작물약해를 경험하였으며, 42%는 제초제 처리시 혹은 처리 후 농약중독을 경험하였다. 경작자들에 의한 제초제 남 오용은 올바른 제초제 선정 및 사용법, 효율적인 잡초방제법에 대한 교육과 관련이 있기에 경작자들을 대상으로 올바른 제초제의 선정 및 사용법, 그리고 효율적인 잡초방제법에 관한 체계적인 교육프로그램이 개발, 보급되어야 할 것이라 사료된다.

• 대한임상독성학회지
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• 제7권2호
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• pp.83-89
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• 2009

Purpose: Rhabdomyolysis is one of the most important complications of pesticide intoxication. It affects a patient's clinical prognosis and can cause acute renal failure. It is important that patients diagnosed with pesticide intoxication receive an accurate initial diagnosis and proper treatment to prevent significant complications. This study's objective was to investigate and confirm related factors causing acute renal failure by verifying clinical observations and laboratory findings collected following pesticide intoxication. Methods: A retrospective analysis was made of 734 patients who presenting to our emergency medical center after ingesting pesticides between January 2006 and December 2008, Of these, 513 patients were selected for the study. Two hundred and twenty-one patients were excluded because of paraquat intoxication, age (if under 18), or chronic renal failure. Seventy-four patients were diagnosed with rhabdomyolysis, based on serum creatinine phosphokinase levels were > 1,000U/L. Acute renal failure was diagnosed when creatinine levels were > 2.0 mg/dL. Results: Among the 74 patients diagnosed with rhabdomyolysis, 26 (35.1%) experienced acute renal failure. The most meaningful related factor in the prediction of acute renal failure was initial arterial pH and creatinine level. Conclusion: Initial arterial pH and creatinine level are predictors of complications such as acute renal failure in patients with rhabdomyolysis.