• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.2
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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.

• Journal of The Korean Society of Clinical Toxicology
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• v.19 no.2
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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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• v.20 no.1
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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.

• Journal of The Korean Society of Clinical Toxicology
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• v.15 no.2
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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.

• Journal of The Korean Society of Clinical Toxicology
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• v.2 no.2
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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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• 2000.10a
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• pp.306-307
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• 2000

• Journal of The Korean Society of Clinical Toxicology
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• v.8 no.2
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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.

• The Korean Journal of Pesticide Science
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• v.2 no.2
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• pp.102-107
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• 1998

The objective was to know if seed potato farmers in Kangwon alpine area control weeds effectively and use herbicides properly to control weeds. Seed potato farmers in Pyongcbang, Hoengsong, and Kangnung have noxious weeds, such as marsh pepper, lambsquarters, barnyard grass, mugwort, asiatic dayflower, hairy carbgrass, ladysthumb, common chickweed, field horsetail, and common purslain, in their farmyard. These are controlled by a combination of physical and chemical weed control methods. However, several weeds such as marsh pepper, field horsetail and, mugwort are poorly controlled by 2-fold amount of several herbicides, including paraquat, pendimethalin, and metribuzin (58% of the answered). Herbicides are not selected and used in a proper manner by seed potato farmers: most of farmers selected herbicides by their experience (51% of the answered) and dealers recommendation (34% of the answered), while only a few farmers of the answered took advantage of the Farmers Handbook for Herbicide Application. In addition, the selected herbicides, including non-registered ones such as paraquat and fluazifop-butyl, are applying three to five years in a succession. With these improper selection and usage of herbicides, sixty-seven percent of the answered farmers have experienced crop damage and seventy-five percent have poisoning. We conclude that a systemic educational program for the proper selection and use of herbicides is needed for seed potato farmers in Kangwon alpine area.

• The Korean Journal of Pesticide Science
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• v.3 no.3
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• pp.54-59
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• 1999

The objective was to know if corn growers at Hongchcel County, Kangwon-do, where corn is the major agricultural product, control weeds effectively and use herbicides properly to control weeds. Sixty-eight corn growers at Hongchon were participated in this survey. Corn growers have noxious weeds, such as hairy carbgrass, common purslane, lambsquarters, Asiatic dayflower, mugwort and barnyard grass in their corn fields. Forty-four percents of the answered corn growers control weeds by hand weeding, and the others by a combination of physical and chemical methods. Corn growers have a preference of paraquat and alachlor for a pre-emergence treatment (94% of the answered) and of paraquat, glufosinate, glyphosate and fluazifop-P-butyl for a post-emergence treatment (87% of the answered). Corn growers did not select and use herbicides in a proper manner. fifty-four percent of the answered corn fevers selected herbicides by their own experience and 18 percent by neighbors recommendation. Herbicides were not selected and used in a proper manner by corn growers: 54 percent of the answered selected herbicides by the experience of growers and 18 percent by the recommendation of neighbors. In addition, a half of the answered applied over two-fold higher amounts of herbicides than the recommended rate. With these improper- selection and use of herbicides, 37 percent of the answered have experienced the crop damage and 42 percent the herbicide poisoning. We conclude that the development of the educational program for the proper selection and use of herbicides is needed for corn growers in Kangwon-do.

• Journal of The Korean Society of Clinical Toxicology
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• v.7 no.2
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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.