2022년 질병관리청 응급실 기반 중독 심층 실태조사 및 사례분석 연구결과 보고

이은선,김수진,조규종,이미진,소병학,김경수,송주현,이성우 대한임상독성학회 2023 대한임상독성학회지 Vol.21 No.1

Purpose: This study investigated the actual incidence of acute poisoning in Korea on a nationwide scale, with the aim of laying the groundwork for future initiatives in prevention, strategic antidote distribution, and the development of effective emergency treatment for acute poisoning. Methods: The study analyzed data from 3,038 patients who presented to emergency departments with poisoning-related conditions from June 1, 2022 to December 31, 2022 at 10 sites in nine cities across the country. We extracted data on general characteristics of the poisoning cases, including demographic characteristics (age and gender), place of exposure, reason for poisoning, route of exposure, and the substance involved in the poisoning incident. Age-related patterns in reasons for poisoning, medical outcomes, frequent and primary poisoning substances, and deaths were also analyzed. Results: The population analyzed in our study was predominantly female, with women constituting 54.74% of all cases. Among infants and children, non-intentional poisoning due to general accidents was the most common cause, accounting for 71.43% of cases. Conversely, suicidal poisoning was more prevalent among teenagers and adults over 20. Fifty-two patients died during the study period, with males comprising approximately two-thirds (67.31%) of these fatalities. Pesticides were the most common poisoning substance among those who died, accounting for 55.77% of such cases. Notably, a significant majority of the victims were elderly individuals aged 60 and above. Conclusion: This study holds substantial significance, since it represents the first comprehensive investigation and analysis of the symptoms, treatment, and causes of death due to poisoning in Korea on a national scale. By substantially expanding the range and types of poisonous substances examined, we were able to more precisely identify the characteristics and clinical patterns of poisoning cases nationwide.

Risk factors contributing to the incidence and mortality of acute childhood poisoning in emergency department patients in Iran: a hospital-based case-control study

Hamideh Feiz Disfani,Mostafa Kamandi,Seyed Mohammad Mousavi,Sayyed Majid Sadrzadeh,Roohie Farzaneh,Najme Doolabi,Kazem Rahmani 한국역학회 2019 Epidemiology and Health Vol.41 No.-

OBJECTIVES: Since poisoning is one of the most important preventable factors contributing to the hospitalization and death of children who present to emergency departments, this study was carried out to investigate the risk factors contributing to the incidence and mortality of acute childhood poisoning. METHODS: This hospital-based case-control study included 243 cases and 489 controls, drawn from daily admissions to the emergency departments of the included hospitals according to the inclusion and exclusion criteria. RESULTS: Gastrointestinal poisoning was the most common poisoning type, found in 87.7% of subjects, and medications were the most common cause of poisoning (49.8%). Multiple logistic regression analysis showed that a history of poisoning (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.58 to 19.51; p<0.001) and the availability of poisonous substances (OR, 8.88; 95% CI, 5.41 to 14.56; p<0.001) were among the most important predictors of childhood poisoning. Respiratory poisoning (OR, 6.72; 95% CI, 1.40 to 32.07; p<0.05) and the presence of addiction in the family (OR, 4.54; 95% CI, 1.10 to 18.68; p<0.05) were the most important predictors of mortality among children with poisoning. CONCLUSIONS: Addiction and the presence of physical or psychological disorders in family members, a history of poisoning, and the availability of poisonous substances were significantly associated with the incidence of childhood poisoning and resultant mortality.

아세트아미노펜 사용 편의성 증가 후 중독발생 위험의 지속적 관리 필요성

조승직 ( Seung Jik Jo ),강현영 ( Hyun Young Gang ),이시진 ( Si Jin Lee ),배규현 ( Gyu Hyun Bae ),이의중 ( Eui Jung Lee ),한갑수 ( Kap Su Han ),김수진 ( Su Jin Kim ),이성우 ( Sung Woo Lee ) 대한임상독성학회 2020 대한임상독성학회지 Vol.18 No.2

Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). Conclusion: Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

급성 약물 중독 환자에서 의도성 여부에 따른 임상적 분석

고승현,이경원 대한응급의학회 2012 대한응급의학회지 Vol.23 No.5

Purpose: Korea has one of the highest suicide rates of countries belonging to the Organization for Economic Cooperation and Development (OECD). In development of emergency medical services (EMS) and emergency medicine in Korea, one of the characteristics of suicide in Korea is the means of committing suicide, which is intentional acute drug poisoning. The aim of this study is to compare the characteristics of acute drug poisoning victims between intentional poisoning and accidental poisoning. Methods: A retrospective study was conducted for the year 2011. The study group included adults (over 16 years old)with acute drug poisoning. We followed the American Association of Poisoning Control Center definition of acute poisoning. Exclusion criteria were 1) a victim of adverse effect of therapeutic dose, 2) a victim of chronic exposure,3) missing data on emergency medical records, and 4)unknown cause of poisoning. During the study period, 195patients were enrolled. Results: In comparison between the intentional poisoning group and the unintentional poisoning group, no statistical difference was observed in mean age, sex ratio, initial vital signs in the emergency department (ED), and time from exposure to ED. However, the initial mental state in the ED,transportation, previous suicide history, ED treatment,length of stay in the ED, and Poisoning Severity Score (PSS) showed statistical difference (p<0.05). Conclusion: We concluded that intentional drug poisoning is associated with more serious progress and outcome than unintentional poisoning in a group of Korean adults. Prevention and public education will be needed in order to decrease the rate of suicide poisoning in Korea.

응급실 일산화탄소 중독 환자 추이 분석: 국가응급의료정보체계

이순형,이지숙,김경환,박준석,신동운,김현종,박준민,김훈,전우찬,김정언 대한응급의학회 2021 대한응급의학회지 Vol.32 No.1

Objective: We aimed to investigate the epidemiological characteristics and trends of carbon monoxide (CO) poisoning in the National Emergency Department Information System (NEDIS). Methods: Using the NEDIS data from 2014 to 2018, we included patients who had visited the emergency department (ED) with CO poisoning (T58.0 in 7th Korean Standard Classification of Diseases [KCD-7]). We excluded patients with an uncertain time of onset, uncertain intentionality of poisoning, mental state, and unknown clinical outcome. We surveyed age, sex, time of onset, the intentionality of poisoning, mental state, results of emergency treatment, the proportion of admissions to intensive care units (ICU), the outcome of hospitalization, and the regional distribution. We analyzed the rate of incidence and trends of CO poisoning in patients using time series analysis. Results: A total of 18,533 patients, including 10,671 (57.6%) males and 7,862 (42.4%) females, with a mean age of 40.38±18.41 years, were included in this study. Gyeonggi Province (n=6,354, 34.3%) had the highest distribution of patients, followed by Seoul (n=3,357, 18.1%). The incidence of unintentional CO poisoning was more frequent in January and December, and less frequent in August and September. However, the incidence of intentional CO poisoning showed no seasonal variation. The severity, ICU hospitalization rate, and mortality rate for intentional CO poisoning were higher than unintentional CO poisoning (4.1% vs. 0.8%, 29.9% vs. 16.7%, and 2.0% vs. 0.8% respectively) (P<0.001). Applying Winter’s additive method, we could predict that the rate of unintentional CO poisoning would continue to increase and the seasonal fluctuation, such as cases increasing in January-December and decreasing in August-September, would also increase. Conclusion: Intentional CO poisoning showed higher severity than unintentional CO poisoning. In the time series analysis, the rate of unintentional CO poisoning and seasonal fluctuation is predicted to increase.

일산화탄소 중독의 역학적 특징: 전국 20개 병원 응급실 손상환자 표본 심층조사

배소현 ( Sohyun Bae ),이지숙 ( Jisook Lee ),김경환 ( Kyunghwan Kim ),박준석 ( Junseok Park ),신동운 ( Dongwun Shin ),김현종 ( Hyunjong Kim ),박준민 ( Joonmin Park ),김훈 ( Hoon Kim ),전우찬 ( Woochan Jeon ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Purpose: This study was conducted to describe the characteristics of patients with carbon monoxide (CO) poisoning. Methods: We retrospectively surveyed data from the Emergency Department based Injury In-depth Surveillance of 20 hospitals (2011-2014). We included patients whose mechanism of injury was acute CO poisoning caused by inhalation of gases from charcoal or briquettes. We surveyed the annual frequency, gender, age, result of emergency treatment, rate of intensive care unit (ICU) admission, result of admission, association with alcohol, and place of accident. We also surveyed the cause and experience of past suicide attempts by intentional poisoning. Results: A total of 3,405 patients were included (2,015 (59.2%) and 1,390 (40.8%) males and females, respectively) with a mean age of 39.83±18.51 year old. The results revealed that the annual frequency of CO poisoning had increased and the frequency of unintentional CO poisoning was higher than that of intentional CO poisoning in January, February and December. The mean age of intentional CO poisoning was younger than that of unintentional CO poisoning (38.41±13.03 vs 40.95±21.83) (p<0.001). The rates of discharge against medical advice (DAMA), ICU care and alcohol association for intentional CO poisoning were higher than for unintentional CO poisoning (36.4% vs 14.0%, 17.8% vs 4.7%, 45.2% vs 5.6%) (p<0.001). The most common place of CO poisoning was in one`s residence. Conclusion: The annual frequency of total CO poisoning has increased, and unintentional CO poisoning showed seasonal variation. DAMA, ICU care, and alcohol association of intentional CO poisoning were higher than those of unintentional CO poisoning.

응급실로 내원한 소아 청소년 중독 환자의 특성 분석

김도영 ( Do Young Kim ),김지혜 ( Ji Hye Kim ),백진휘 ( Jin Hui Paik ),한승백 ( Seung Baek Han ),정현민 ( Hyun Min Jung ) 대한임상독성학회 2017 대한임상독성학회지 Vol.15 No.2

Purpose: This study was conducted to analyze the features of poisoning in individuals aged 0-18 years to understand the characteristics of potential victims and eventually prevent poisoning. Methods: We retrospectively analyzed poisoned children and adolescents (0-18 years) who visited the emergency department of one tertiary hospital from January 2003 through December 2013. We collected data including their age, sex, reason for poisoning, components and dose of poison, results of treatment, and psychiatric diagnosis. Results: During the study period, there were 436 cases of poisoning (male 47.2% (n=206); female 52.8% (n=230)). Subjects were classified into four groups (0-1 years, 2-5 years, 6-12 years, 13-18 years). The most common cause of poisoning in all age groups was accidental poisoning (72.9%), but intentional poisoning increased as age increased (p<0.001). Moreover, females were more often subject to intentional poisoning than males (p<0.001). The most common poisoning material was drugs (41.7%). Among intentional poisoning patients, 62.7% patients had consulted a psychiatrist, and their most common diagnosis was adjustment disorder (44.6%). Conclusion: The most common cause of poisoning in individuals aged 0-18 years was accidental poisoning, while intentional poisoning was most common among adolescents. Guardians should take care to prevent accidental poisoning, while psychiatric consultation and national moderation will be needed to prevent intentional poisoning.

A study of risk factors for the possible cases of acute occupational pesticide poisoning of orchard farmers in some parts of south Chungcheong province

Jihyun Shin,Sangchul Roh 대한직업환경의학회 2019 대한직업환경의학회지 Vol.31 No.-

Background: The objective of the present study is to identify differences in the prevalence of acute occupational pesticide poisoning across Korean orchard farmers" farming characteristics and the risk factors that have an effect on acute occupational pesticide poisoning. Methods: For 3 years (2014, 2015, and 2017), a questionnaire survey was conducted on 394 orchard farmers in some parts of south Chungcheong Province in relation to pesticide poisoning. 323 orchard farmers who responded to acute occupational pesticide poisoning were included for final analysis. With acute occupational pesticide poisoning as the dependent variable, a χ2 test and a multiple logistic regression analysis were conducted. Results: The results of the prevalence of acute occupational pesticide poisoning across farming characteristics showed that the group wearing 4 or more pesticide personal protective equipment (PPE) had a lower prevalence of acute occupational pesticide poisoning than the group wearing 3 or less pesticide PPE (p < 0.05). Furthermore, an analysis by area of fruit farming revealed that the group with more than 12,000m² in the area of fruit farming had a higher prevalence of acute occupational pesticide poisoning (p < 0.05). Orchard farmers mainly use a speed sprayer to spray pesticides, and the speed sprayer can be categorized by presence of cabin. The analysis of the prevalence of acute occupational pesticide poisoning by speed sprayer"s cabin existence found that existence of speed sprayer"s cabin did not show a statistically significant difference in the prevalence of acute occupational pesticide poisoning. Conclusions: The present study analyzed the prevalence of acute occupational pesticide poisoning depending on the speed sprayer"s cabin existence and found no significant difference. The fact that famers using the cabinless style speed sprayer shows a higher percentage in wearing PPE than those using the cabin style speed sprayer is suggested to elucidate the result. As the first study in Korea which examined the prevalence of acute occupational pesticide poisoning by speed sprayer"s cabin existence, the present study proposes the expected effect that increase of wearing pesticide PPE along with employ of speed sprayer"s cabin can reduce the prevalence of acute occupational pesticide poisoning among orchard farmers.

충남 일부 지역 병의원의 농약살포 중 중독 사례 분석 및 보건관리방안 연구

문선인,최지희,노상철 한국산업보건학회 2019 한국산업보건학회지 Vol.29 No.4

Objectives: This study aims to examine patients who developed acute pesticide poisoning while spraying or using pesticide and presented to the emergency department in hospitals in Chungcheongnam-do Province. Based on the findings, this study will provide implications for safety and health management pertaining to the use of pesticides. Methods: Pesticide poisoning data collected by the Chungnam Center for Farmers’ Safety and Health from 2014 to 2018 was cross-sectionally analyzed. A total of 331 patients with pesticide poisoning presented to one of hospitals and four of medical centers in the region(Dankuk University Hospital, Gongju and Hongsung, Cheongyang, Cheonan Medical Center). Seventeen of these patients (15 men and two women) developed poisoning while spraying pesticide. The patients’ charts were reviewed to collect data on pesticide poisoning, namely currently working in farming-related occupation, means of transportation to the hospital, place of poisoning, symptoms of acute pesticide poisoning, treatment, pesticide used when poisoning occurred, and classification by technical ingredients. Results: Fifteen out of 17 patients who developed poisoning while spraying pesticide were men. Insecticide was used in 35.3% of the cases, and herbicide was used in 29.4% of the cases, which was different from cases of poisoning from ingestion poisoning. The major symptoms were vomiting (35.3%), nausea (29.4%), dizziness (29.4%), and headache (23.5%). A total 11 ingredients were identified in 12 patients, and the most common ingredient was glyphosate, which is an herbicide. Most patients showed a state of mild toxicity, but two patients showed a state of severe toxicity. These patients respectively used glyphosate and paraquat. Conclusions: Our findings can be useful for suggesting the need for a national healthcare system to manage occupational pesticide poisoning among farmers. Further, these findings can be used to increase the awareness of the risk of acute poisoning during pesticide spraying and suggest the need for a safety health education to increase farmers’ awareness of pesticide poisoning.

향가피(香加皮)의 독성(毒性)과 부작용에 관한 문헌적 고찰

이지혜 ( Ji Hye Lee ),노성수 ( Seong Soo Roh ),김정자 ( Jeong Ja Kim ),서부일 ( Bu Il Seo ) 한약응용학회 2015 한약응용학회지 Vol.15 No.1

Periplocae Radicis Cortex is in use in the Korean medicine. The Korean medical doctors use Periplocae Radicis Cortex for eliminating wind and dampness(祛風濕), strengthening tendons and bones(强筋骨), eliminating hidropesia(消水腫), etc. We investigated toxicity, poisoning symptoms, side effects, poisoning treatment and prevention against poisoning of Periplocae Radicis Cortex. The results were summarized as follows: 1. The main ingredients of poisoning are periplocin, etc. The ingredients of poisoning from Periplocae Radicis Cortex mainly can cause stimulating symptoms on digestive system in the case of slight poisoning, and mainly cause stimulating symptoms on nervous system, cardiovascular system in the case of severe poisoning. 2. The representative methods of poisoning treatment in the Korean medicine take advantage of herbs, such as Glycyrrhizae Radix(甘草), Phaseoli Radiati Semen(綠豆), etc. And Korean medical doctors should meet symptoms as patients call for attention. 3. The representative methods of poisoning treatment in the western medicine are promotion of vomiting, washing out the stomach, causing diarrhea, supplies of grape sugar and symptomatic treatment, etc. 4. In order to prevent against poisoning of Periplocae Radicis Cortex, the patients should keep usage, dosage and notes.