vietnam poison control center an introduction

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Vietnam Poison Control Center
An introduction
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Vietnam in brief

A developing country approximately 330,900Km
2
.

Population over 80 million, with 80% farmers.

Vietnam: an agricultural country.

Blooming of economy from 1991.

Developing tourism.

Health care system: 61 provinces with only PCC placed
in Ha Noi (Bach Mai university hospital).

Other poisoned patients → EMs & ICUs at local
hospitals.
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Toxicologic epidemiology
general condition

Increasing risks of toxical industrial chemicals,
agricultural chemicals, imported drugs, venomous
animals, alcohol, drugs abuse, food poisonings.


Over 25 years since the last war, warfare toxic agents:
dioxin, CS
1996 1997 1998 1999 2000
Poisoned patients 9524 10372 8110 8339 8916
Deaths 273 335 305 252 244
% Mortality 2.86% 3.23%
3.76
%
3.02% 2.74%
Survey in 48 local hospitals
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Toxicologic
epidemiology


general condition
24.81%
17.76%
17.67%
12.16%
8.12%
4.77%
2.64%
1.47%
10.60%
0.00%
5.00%
10.00%
15.00%
20.00%

25.00%
Pesticides Sedative-
drugs
Food
poisoning
Rodenticides Venemous
animal
Opiates alcohol Chemical Other
reasons

1
st
:pesticides (OPs, carbamat,
organochloride, trifluoroacetamide, Zn
phosphide, thallium; new insecticides-
nereistoxin , herbicide)

2
nd
:sedatives and drugs abuse or
overdose, opiates and alcohol

3
rd
:venomous animals and plants:
snakebite, puffer fish, bee stings, toad
venom, poisonous plants, mushroom
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Toxicologic
Epidemiology


reported
cases.(%of
total)
Numeralmortality
(Mortality,
expressedin%of
reported)
1.Pesticides
24.81% 6.61%
2.Sedative-drugs
17.76% 0.86%
3.Foodpoisonings
17.67% 0.24%
4.Rodenticides
12.16% 3.5%
5.Venomousanimal
8.12% 3.42%
6.Opiates
4.77%
5.12%
7.Alcohol
2.64% 0.28%
8.Chemicals


1.47% 6.17%
9.Othercauses
10.6% 7.48%
Total

100% 3.26%
Survey in 48
local hospitals
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Toxicology
epidemiology
Pesticide poisoning

Annual importing ~ 30.000 tons of raw materials
and pesticides ~120 millions USD

743 types of permitted commercial insecticides,
formulated of 171different activated elements

organophosphate in the North and Paraquat in the
South.

Illegally Imported rodenticides: exessive use,
suicide, dangerous misuse in children (7% of
acute poisoning)
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poison control center
Bach Mai Hospital
Establishment and development:

1998, Department of clinical toxicology, separated from the
emergency and intensive care department.

17/9/2003: National poison control center.
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Personels

Number of patient bed: 20

Administration board:
Director :Prof. Nguyen Thi Du,
Vice directors: MD. Pham Due, MD. Nguyen Kim Son.

Staffs: 8 doctors: 3 PhD, 3 masters, 1
pharmacologist,1 pharmacist, 1 bachalor of
informatics, 21 nurses.

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Member units:
Clinical

Management of acute and chronic poisoning patients.

Management of prehospital poisoning emergency.

Research, development of new preventive and curative
measures.

Education and training.
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Member units:
Laboratory 


Toxicology analysis.


Study and development of antidotes.

Training of laboratory staffs in the field of toxicology
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Member units:
Poison information office 


Collection, processing and reporting of data and
information.

Consultation of poisoning.

Link to and exchange of information with other PCCs,
related organizations.

Organization of conferences and workshops.
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Achievements
Clinical unit: the most developed one
Annual number of poisoned patients addmitted
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Achievements
Clinical unit: the poisoned-related death (%)
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Achievements: Clinical unit
Reasons for poisoning
(The year 2004)
Homicide Misuse Suicide Accident Total

7
0,38%
14
0,76%
445
24,12%
1380
74,76%
1846
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Achievements
Clinical unit: causes of poisoning

(2004)

Causes No of patients
Food poisoning 659
Sedative/hypnotics 327
Drugs of abuse 258
Venoms 228
Pesticide 125
Other medications 87
Household chemicals 49
Toxic plants 42
Analgesic/antipyretics 41
Heavy metals 18
Other causes 12
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Achievements: Clinical
Characteristics of poisoning 

Causes are diverse, complicated and dangerous.
Special agents:
+ Pesticide: organophosphate, carbamate, organochloride,
trifluoroacetate, tetramine (possibly), nereistoxin,
cyanoacetamide and many new chemicals.
+ Metals: Pb, Hg, As, Thallium,
+ Toxic gases: CO, Chlorine,
+ Food poisoning: complicated, not only by microbial agents
+ Natural toxins: snakebite (viper, cobra, krait), beesting
(severe), pufferfish, many unidentified toxins in plants.
+ Drugs of abuse: heroin, amphetamin, marijuana.
+ Medication: cold preparations, rotundin, barbiturate,
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Achievements: Researches
38 studies at various levels:
All studies are clinical.
- State level: Study in to proposed network of poison
control in Vietnam and the management measures of
mass and acute poisonings in argriculture, industrial
activities and dailly life.
- Ministry level:
+ Development of preparation method for the antidote
B.Mai-ANTIPOIS.
+ Investigation and study in to drugs overdoses
commonly encountered in hospitals.

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Researches (continued):
1. Titration of pralidoxime doses according to clinical signs and the

doses of atropine in the treatment of acute organophosphate
poisoning.
2. Nereistoxin poisoning.
3. Clinical manifestation and treatment of acute chinese rodenicide
poisoning.
4. Treatment of snakebite (Naja Kaouthia) with antivenom.
5. Combination of charcoal and sorbitol in the treatment of acute
poisoning.
6. Improvement of gastric lavage technique in the treatment of acute
poisoning.
7. Correlation between plasma drug level and clinical features in
phenobarbital poisoning.
8. Clinical and laboratory features and treatment of alcohol withdrawal
syndrome.
And many other studies

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Achievements:

- Publication:
+ Emergency treatment of Poisoning,
+ Guideline on Rapid Diagnosis and Management of
Acute Poisoning,
+ Handbook of emergency treatment, Emergency and
Intensive Care Medicine.
+ Guideline on Emergency Treatment in 22
nd
Seagame.
+ Training materials for advanced courses.
- Taking Counsel with the Ministry of Health for investigations,

researches and guidance on toxicological prevention and
management.
- Organization of annual workshops and conferences.

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-

Published researches and books
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Published researches and books
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Published researches and books
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Remaining difficulties

Clinical:
-
Despite of large number of poisoned patients NO
clinical toxicologist has been trained.
-
Lack of important antidotes.
-
Lack of information on toxicology.


Information:
-
Not yet funded, lack of appropriate equipment.
-
No communication network from national PCC to local
health stations.
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Remaining difficulties

Toxicology analysis:
4145 tests were done in 2004 (including 131 snake
venom detection tests)
-Equiped with ONLY SIMPLE TESTs( TLC, quick tests).
-
No HPLC, GC-MS or other modern tests in the face of
large number of complicated and difficultly identified
chemicals.
-
Large number of tests have to be sent to other labs
(require modern methods).
-
Lack of experience seen in all labs involved in toxicology
analysis.
-
Lack of overseas training courses.
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Commercial products
of insecticide
insecticide