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정성필,김승호,이한식,Chung, Sung-Pil,Kim, Seung-Ho,Lee, Hahn-Shick 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.1
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.
유제성,김의중,이한식,김승호,정성필,You, Je-Sung,Kim, Eui-Chung,Lee, Hahn-Shick,Kim, Seung-Ho,Chung, Sung-Pil 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.2
Purpose: Inadequate hospital stocking and unavailability of essential antidotes is a worldwide problem. The purpose of this study was to determine the adequacy of antidote stocks in Korean hospitals based on a modified version of US antidote stocking guidelines. Methods: Both written and telephone surveys to collect information on hospital demographics and antidote stocking were given to the emergency departments or hospital pharmacies of 117 hospitals with emergency medical centers. The twenty antidotes included in the survey were taken from year 2000 US antidote stocking guidelines, except for activated charcoal and black widow spider antivenin. Antidote stocks were compared by hospital size, geographic location, and type of emergency medical center. Results: Complete responses were received from all hospitals. A mean of $12.4{\pm}2.9$ antidotes were adequately stocked per hospital. All hospitals stocked atropine, $CaCl_2$ naloxone, and sodium bicarbonate. However, digoxin Fab fragment (16%), cyanide kits (15%), EDTA (10%), BAL (9%), and fomepizole (1%) were not uniformly stocked. Large and teaching hospitals were significantly more likely to stock greater numbers of antidotes. Conclusions: Korean hospitals as a group do not have adequate antidote stocks. Korean stocking guidelines and an antidote management system are recommended in order to correct these deficiencies.
급성 Acetaminophen 중독시 복용량에 의한 N-Acetylcysteine의 사용은 적절한가?
김태근,김민정,이진희,정성필,이한식,박유석,Kim, Tae-Geun,Kim, Min-Joung,Lee, Jin-Hee,Chung, Sung-Pil,Lee, Hahn-Shick,Park, Yoo-Seok 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.2
Purpose: In many Korean hospitals, serum acetaminophen concentrations in cases of overdose cannot be measured initially because of inadequate laboratory facilities. Under these circumstances, physicians base the administration of the antidote, N-acetylcysteine, on ingestion amounts as determined by initial history taking. We therefore examined the correlated between ingested amounts and serum acetaminophen concentrations. Methods: Medical records were reviewed retrospectively for patients who presented to the ED with acetaminophen overdose between January 2002 and March 2006. Fifty-nine patients were recruited and sixteen patients were excluded. The forty-three remaining patients were placed into either the high-risk or low-risk group based on their ingested amount (140 mg/kg), and were separately categorized into the toxic or non-toxic group based on their serum acetaminophen concentrations, according to the Rurnack-Matthew nomogram. Results: Ten patients (83.3%) among twelve in the high-risk group were found to have non-toxic serum concentrations, and just one patient (3.2%) among thirty-one in the low-risk group fell into the toxic group based on their serum concentrations. The sensitivity and specificity of risk stratification of the ingested amount as a predictor of intoxication requiring antidote therapy were 66.7% and 75.0%, respectively. Conclusion: This study suggests that the therapeutic decision for acetaminophen overdose should not be based solely on ingested amount only, but requires assessment of acetaminophen concentration.
염산 흡입 후 발생한 Reactive Airways Dysfunction Syndrome (RADS) 1례
조광현,김승환,조영순,이한식,박준석,Cho, Kwang-Hyun,Kim, Seung-Hwan,Cho, Young-Soon,Lee, Hahn-Shick,Park, Joon-Seok 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1
A previously healthy 57-year-old woman with dyspnea and wheezing presented to the emergency department a few minutes after exposure to unknown gas from mixing bleach (sodium hypochlorite) and cleaning agent (hydrochloric acid) at work place. Initial physical examination revealed severe wheezing on both whole lung fields, but the chest radiograph was normal. Arterial blood gas analysis showed only moderate hypoxemia. The patient was treated with oxygen, $\beta$adrenergic bronchodilators, antihistamines and corticosteroids, after then symptoms were improved. And the patient discharged against medical advice. We report a rare case of reactive airways dysfuntion syndrome from chlorine gas exposure.
아지드화 나트륨(sodium azide) 음독 후 사망한 1례
남연우,김정언,조준호,정성필,이한식,김의중,Nam, Yeoun-Woo,Kim, Jung-Eon,Cho, Jun-Ho,Chung, Sung-Pil,Lee, Hahn-Shick,Kim, Eui-Chung 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.1
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.
수은 체온계와 관련된 손상 및 중독에 대한 체계적 고찰
이요섭 ( Yo Seop Lee ),주영선 ( Young Seon Joo ),유제성 ( Je Sung You ),정성필 ( Sung Phil Chung ),정현수 ( Hyun Soo Chung ),이한식 ( Hahn Shick Lee ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.1
Purpose: The purpose of this systematic review was to evaluate the evidence regarding injury and poisoning associated with the clinical mercury thermometer. Methods: Electronic literature searches were conducted for identification of relevant studies and case reports of injury and poisoning associated with the clinical mercury thermometer. The search outcomes were limited to literature with English and Korean languages published from 1966. Studies related to occupational mercury exposure, or mercury exposure from sphygmomanometer, barometer, and fluorescent light were excluded. Results: A total of 60 reports, including 59 case reports, were finally included. Of those, nine cases pertained to an intact thermometer as a foreign body, 25 injuries were related to a thermometer, and 26 cases involved exposures to mercury from a broken thermometer. Case reports were classified according to severity into 16 mild, 41 moderate, and two severe cases. Two cases of mortality were reported, one was deliberate intravenous injection of mercury and the other was acute vapor inhalation of mercury from broken thermometers. Conclusion: Findings of this systematic review suggested that the mercury thermometer could cause various forms of poisoning and injury. In particular, inhalation of mercury vapor from a broken thermometer can lead to systemic toxicity requiring chelating therapy.
2002년 농약중독 사망자 통계청 자료 분석 및 제초제 중독으로 인한 사망사고 예방 대책
김욱진,김효윤,김승환,김선욱,조영순,정성필,이한식,Kim Uk Jin,Kim Hyo Yun,Kim Seung Hwan,Kim Sun Wook,Cho Young Soon,Chung Sung Pil,Lee Hahn Shick 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.2
Backgrounds: Deaths from pesticides poisoning has increased annually, but no studies have been reported. Especially paraquat is suspected to be a major material in pesticide poisoning deaths. In Korea, simple epidemiology of pesticides poisoning is not well known. So, there is no effective method to prevent pesticides poisoning. We tried to investigate the present status of pesticides poisoning with data from Korea National Statistical Office and suggest an effective counterplan. Methods: We analysed death cause data derived from Korean Statistical association, deaths causes being pesticides poisoning in the year 2002. Also, we investigated data from internet, mainly from Korea National Statistical Office home page. Results: Total 2,875 persons died after pesticides poisoning in 2002 year. Average age is 54.2 year, standard deviation being 17.7 year. Many victims (about $41\%$) died during the herbicides' non-necessary period (JanuaryMarch, October-December) Conclusion: Herbicides sale should be restricted only during herbicides' necessary period, and so called a pesticides safety supervisor system shall effectively prevent herbicides poisoning.