928 Abstracts

worker ate all the noodles, while the eight others stopped, com-plaining about an unusual smell. One worker died on the scene,with the other workers immediately transferred to the Emer-gency Department. Results: They complained that the noodletasted ‘‘unpleasant’’ and soon afterwards experienced nausea,vomiting, dizziness, weakness, sweating, and diarrhea. Theynoted cyanosis and sinus tachycardia, hypotension. Subsequentinvestigation demonstrated a methemoglobin concentration of64.6%, which was corrected by the intravenous administrationof 1 mg/kg methylene blue 3 h after the onset of symptoms.The patients made a prompt, uncomplicated recovery and weredischarged home 4 days later. Conclusions: Antifreeze "ingredi-ents label" contains sodium nitrite 20%, surfactant 10%, silicondioxide 5%, water 60%, and others 5%. Accidental poisoning ofindustrial antifreeze causes methemoglobinemia, and its con-tinuing commercial availability necessitates that physiciansconsider the diagnosis and institute treatment with methyleneblue promptly to prevent a fatal outcome.

, A CLINICAL REVIEW OF ACUTE POISONING INGERIATRIC PATIENTS FROM RURAL GANWONPROVINCE. J. Y. Lee, Department of Emergency Medicine,Hallym University Chuncheon Sacred Heart Hospital, Seoul,KOREA.

Objective: Recently, there has been an increase in acute poi-sonings in the elderly, which may be associated with attempts atsuicide. The purpose of this study was to compare and analyzethe clinical aspects and outcomes of acute poisonings in aged in-dividuals with those of younger individuals. Methods: We per-formed a retrospective analysis of 207 patients seen in theEmergency Department (ED) with acute poisoning from Janu-ary 2009 to December 2010. Two groups were created, > 65years and < 65 years. The following were carefully compared:annual frequency, gender distribution, cause of poisoning, poi-soning substance, motive for suicide, past psychiatric history,psychiatric interview, psychiatric diagnosis, disposition afterED visit, disposition after admission, poisoning severity score(PSS), duration of hospitalization, intensive care unit admissionrate, and mortality. Results: The annual frequency was 0.1% inthe > 65 group and 0.3% in the < 65 group, 0.4% in total. Thecause of poisoning was accidental more often in those > 65years than in those < 65 years. As motive for suicide, healthproblem was cited more often in the older group (p = 0.000).The older group had fewer interviews with psychiatrists andwere more often diagnosed with depressive disorder(p = 0.010, p = 0.041, respectively). PSS and mortality werehigher in the older group (p = 0.002, p = 0.010,respectively). Conclusions: A better understanding for the causeof poisonings and the poisonous substance used in the aged pop-ulation is needed. And because of the more serious effects ofacute poisonings to the elderly patient, they should readily re-ceive regular comprehensive care including psychiatric care.

, A CASE OF TRANSIENT DIABETES INSIPIDUS AS-SOCIATED WITH TETRODOTOXIN POISONING.D. H. Wi, School of Medicine, Department of EmergencyMedicine, Wonkwang University, Iksan, KOREA; S. H. Kim,Emergency Medicine, Gunsan Medical Center, Gunsan,KOREA.

Objective: Ingestion of puffer fish can result in severe andpotentially lethal intoxication. Tetrodotoxin is a potent neuro-toxin well known for its ability to inhibit neuromuscularfunction. To our knowledge, the only previous report ondiabetes insipidus occurring in association with tetrodotoxin isone case in Singapore. Case Report: A married couple (69-year-old man and 57-year-old woman) ingested two greenrough-backed puffer fish (Lagocephalus lunaris). Results:They complained of paraesthesia of the perioral area and ex-tremity and developed not only grade IV intoxication but alsoan increased urine output (4455 mL/day, 5035 mL/day), ele-vated serum sodium (157.4 mEq/L, 166.7 mEq/L), and elevatedserum osmolality (324mosmol/kg, 339mosmol/kg), which sug-gested the development of diabetes insipidus. The administra-tion of desmopressin was successful in normalizing urinevolume. Conclusions: The patients were discharged the 20thand 18th hospital day without any complications.

, BRUGADA ELECTROCARDIOGRAPHIC PATTERNAND SEIZURE INDUCED BY PROPRANOLOL OVER-DOSE. P. S. Leung, C. Wan, S. Tsui, Accident and EmergencyDepartment, Queen Mary Hospital, Hong Kong, CHINA.

Objective: Since the first description of Brugada syndromein 1992, it has become the focus of interest among cardiologistsand Emergency Physicians. Apart from its inherited form asso-ciated with SCN5A gene mutation, the acquired or drug-in-duced form was a relatively new concept. Although manyagents had been implicated for manifestation of Brugada elec-trocardiographic pattern, it was not commonly described amongpatients with propranolol overdose. Case Report: We reporta 44-year-old Chinese woman with history of bipolar affectivedisorder and drug overdose being admitted to the Accidentand Emergency Department with generalized tonic-clonic con-vulsion after ingestion of around 500 mg propranolol. Initial as-sessment showed reduced consciousness, hypotension, andrepeated brief seizures. Electrocardiogram showed sinus brady-cardia, widened QRS complex, terminal R wave in aVR, normalcorrected QT interval, and right bundle branch pattern withcoved type ST-segment elevation > 2 mm with downward slop-ing over right precordial leads at conventional positions, whichwas consistent with ‘‘type one’’ pattern. Fluid boluses, sodiumbicarbonate solution, and glucagon were administered. Serumcardiac markers and biochemistry results were within normallimits. Neither her personal nor family histories revealed syn-cope, documented arrhythmia, aborted or complete sudden car-diac death. Results: Propranolol was well known for itsmembrane-stabilizing ability and high lipophilicity. It couldreadily cross the blood-brain barrier, reduce seizure threshold,and alter consciousness. There was significant correlation be-tween widened QRS complex and seizure. The sodium channelblocking effect in the context of propranolol overdose led toelectrical heterogeneity of epicardial and endocardial action po-tentials. Avoidance of the offending agent, installation of an im-plantable cardioverter-defibrillator, and quinidine therapy mightbe treatments of choice. Early referral to a cardiologist, riskstratification, and family screening might also help in suspectedcases. Conclusions: It was important to recognize the Brugadaelectrocardiographic pattern and ventricular arrhythmia as