A Case of Transient Diabetes Insipidus Associated with Tetrodotoxin Poisoning

928 worker ate all the noodles, while the eight others stopped, complaining about an unusual smell. One worker died on the scene, with the other workers immediately transferred to the Emergency Department. Results: They complained that the noodle tasted ‘‘unpleasant’’ and soon afterwards experienced nausea, vomiting, dizziness, weakness, sweating, and diarrhea. They noted cyanosis and sinus tachycardia, hypotension. Subsequent investigation demonstrated a methemoglobin concentration of 64.6%, which was corrected by the intravenous administration of 1 mg/kg methylene blue 3 h after the onset of symptoms. The patients made a prompt, uncomplicated recovery and were discharged home 4 days later. Conclusions: Antifreeze "ingredients label" contains sodium nitrite 20%, surfactant 10%, silicon dioxide 5%, water 60%, and others 5%. Accidental poisoning of industrial antifreeze causes methemoglobinemia, and its continuing commercial availability necessitates that physicians consider the diagnosis and institute treatment with methylene blue promptly to prevent a fatal outcome. , A CLINICAL REVIEW OF ACUTE POISONING IN GERIATRIC PATIENTS FROM RURAL GANWON PROVINCE. J. Y. Lee, Department of Emergency Medicine, Hallym University Chuncheon Sacred Heart Hospital, Seoul, KOREA. Objective: Recently, there has been an increase in acute poisonings in the elderly, which may be associated with attempts at suicide. The purpose of this study was to compare and analyze the clinical aspects and outcomes of acute poisonings in aged individuals with those of younger individuals. Methods: We performed a retrospective analysis of 207 patients seen in the Emergency Department (ED) with acute poisoning from January 2009 to December 2010. Two groups were created, > 65 years and < 65 years. The following were carefully compared: annual frequency, gender distribution, cause of poisoning, poisoning substance, motive for suicide, past psychiatric history, psychiatric interview, psychiatric diagnosis, disposition after ED visit, disposition after admission, poisoning severity score (PSS), duration of hospitalization, intensive care unit admission rate, and mortality. Results: The annual frequency was 0.1% in the > 65 group and 0.3% in the < 65 group, 0.4% in total. The cause of poisoning was accidental more often in those > 65 years than in those < 65 years. As motive for suicide, health problem was cited more often in the older group (p = 0.000). The older group had fewer interviews with psychiatrists and were more often diagnosed with depressive disorder (p = 0.010, p = 0.041, respectively). PSS and mortality were higher in the older group (p = 0.002, p = 0.010, respectively). Conclusions: A better understanding for the cause of poisonings and the poisonous substance used in the aged population is needed. And because of the more serious effects of acute poisonings to the elderly patient, they should readily receive regular comprehensive care including psychiatric care. , A CASE OF TRANSIENT DIABETES INSIPIDUS ASSOCIATED WITH TETRODOTOXIN POISONING. D. H. Wi, School of Medicine, Department of Emergency Medicine, Wonkwang University, Iksan, KOREA; S. H. Kim, Emergency Medicine, Gunsan Medical Center, Gunsan, KOREA.

Abstracts Objective: Ingestion of puffer fish can result in severe and potentially lethal intoxication. Tetrodotoxin is a potent neurotoxin well known for its ability to inhibit neuromuscular function. To our knowledge, the only previous report on diabetes insipidus occurring in association with tetrodotoxin is one case in Singapore. Case Report: A married couple (69year-old man and 57-year-old woman) ingested two green rough-backed puffer fish (Lagocephalus lunaris). Results: They complained of paraesthesia of the perioral area and extremity and developed not only grade IV intoxication but also an increased urine output (4455 mL/day, 5035 mL/day), elevated serum sodium (157.4 mEq/L, 166.7 mEq/L), and elevated serum osmolality (324 mosmol/kg, 339 mosmol/kg), which suggested the development of diabetes insipidus. The administration of desmopressin was successful in normalizing urine volume. Conclusions: The patients were discharged the 20th and 18th hospital day without any complications. , BRUGADA ELECTROCARDIOGRAPHIC PATTERN AND SEIZURE INDUCED BY PROPRANOLOL OVERDOSE. P. S. Leung, C. Wan, S. Tsui, Accident and Emergency Department, Queen Mary Hospital, Hong Kong, CHINA. Objective: Since the first description of Brugada syndrome in 1992, it has become the focus of interest among cardiologists and Emergency Physicians. Apart from its inherited form associated with SCN5A gene mutation, the acquired or drug-induced form was a relatively new concept. Although many agents had been implicated for manifestation of Brugada electrocardiographic pattern, it was not commonly described among patients with propranolol overdose. Case Report: We report a 44-year-old Chinese woman with history of bipolar affective disorder and drug overdose being admitted to the Accident and Emergency Department with generalized tonic-clonic convulsion after ingestion of around 500 mg propranolol. Initial assessment showed reduced consciousness, hypotension, and repeated brief seizures. Electrocardiogram showed sinus bradycardia, widened QRS complex, terminal R wave in aVR, normal corrected QT interval, and right bundle branch pattern with coved type ST-segment elevation > 2 mm with downward sloping over right precordial leads at conventional positions, which was consistent with ‘‘type one’’ pattern. Fluid boluses, sodium bicarbonate solution, and glucagon were administered. Serum cardiac markers and biochemistry results were within normal limits. Neither her personal nor family histories revealed syncope, documented arrhythmia, aborted or complete sudden cardiac death. Results: Propranolol was well known for its membrane-stabilizing ability and high lipophilicity. It could readily cross the blood-brain barrier, reduce seizure threshold, and alter consciousness. There was significant correlation between widened QRS complex and seizure. The sodium channel blocking effect in the context of propranolol overdose led to electrical heterogeneity of epicardial and endocardial action potentials. Avoidance of the offending agent, installation of an implantable cardioverter-defibrillator, and quinidine therapy might be treatments of choice. Early referral to a cardiologist, risk stratification, and family screening might also help in suspected cases. Conclusions: It was important to recognize the Brugada electrocardiographic pattern and ventricular arrhythmia as