vietnam poison control center challenges in poisonings of children

1
Vietnam Poison Control Center
Challenges in poisonings of children

Prof. Nguyen Thi Du, MD, PhD
Director, Vietnam Poison Control Center
Bach Mai University Hospital
Head, Dept. of Emergency, Intensive
Care Medicine and Toxicology
Hanoi Medical University

Pham Due, MD, PhD
Vice Director, Vietnam PCC
Email:
2
Introduction

Toxicologic epidemiology: General condition

Poison control centre

Organization and functions

Intoxication report

Poisoning in Children at Vietnam PCC
3
Vietnam in brief


A developing country 330 900Km

2


Population > 80 million

Vietnam is an agricultural country, farmers: 80%

Explosion of economic from 1986, but imbalance in social
development and state management

Health care system based on 64 provincial hospitals, 500
district medical stations, but only PCC placed in Ha Noi (Bach
Mai university hospital), other poisoning patients admitted to
EM & ICU at local hospitals.
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Toxicological epidemiology
general condition

Economic explosion developed increasing risks from using toxic
chemicals in agriculture and industry

Tropics: venomous animals, poisonous plants
1996 1997 1998 1999 2000
Poisoning patients 9524 10372 8110 8339 8916
Poison-related deaths 273 335 305 252 244
% Mortality 2.86% 3.23% 3.76% 3.02% 2.74%
Reported from 48 local hospitals in 2000, Vietnam MoH
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Toxicological
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

First range: pesticides (rodenticide-
trifluoroacetamide, OPs, new insecticides-
nereistoxin , herbicide)


Second: sedatives and drugs abuse or overdose,
opiates and alcohol

Third: 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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Vietnam Poison Control Center

Vietnam Poison Control Center (PCC)
established in 1998, was the first Clinical
Toxicology Center in Vietnam.

PCC: organized with 4 units: Clinical Toxicology
Unit, Toxicology Lab, Information Unit, Venom
Research & Antivenom Unit.

PCC personnel: Head: Prof. Nguyen Thi Du,
7 doctors, 22 nurses, 1 pharmacists, 1 bachelor of
Chemistry and 1 IT engineer.
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Poison Control Center


Treatment for >1500
poisoning patients per year

Training for under and
postgraduate students

Laboratory support

Establish toxicology
database, case report system, treatment
protocols.

Consult for doctors in
other hospital

Some TV programs for antipoison
knowledges.
main activities
L i b r a r y d a t a b a s e s , H a n d b o o k s , R e c o r d s .
I n t e r n e t w e b - s i t e s o t h e r p o i s o n i n f o . c e n t e r s
M e d l i n e ,
V i e t n a m e s e P o i s o n i n g C a s e D a t a b a s e
I n t e r n a t i o n a l r e s e a r c h c o l l a b o r a t i o n
U n d e r - a n d p o s t - g r a d u a t e e d u c a t i o n
M a s s m e d i a p u b l i c i n f o r m a t i o n
P o i s o n R e s e a r c h a n d
I n f o r m a t i o n C e n t e r
L a b o r a t o r y s e r v i c e s
C h e m i c a l i d e n t i f i c a t i o n b l o o d , u r i n e , s a m p l e s
C l i n i c a l c h e m i s t r y a n a l y s i s o f t o x i c e f f e c t s

6 1 P r o v i n c i a l h o s p i t a l s
E m e r g e n c y c a r e d e p a r t m e n t s
C l i n i c a l u n i t
2 0 i n t e n s i v e c a r e b e d s a t B a c h M a i h o s p i t a l
B e d s a t e m e r g e n c y w a r d s , c o l l a b o r a t i n g h o s p i t a l s
N a t i o n a l P o i s o n C o n t r o l C e n t r e
o f V i e t N a m
L o c a t e d a t B a c h M a i H o s p i t a l
H a N o i , V i e t N a m
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Poison Control Center
treated patients in the first 5 years
Year 1998 1999 2000 2001 2002 2003
P
oisoning patients 118 526 740 1100 1817 1669
Deaths of poisoning 10 6 10 15 18 14
Mortality (%) 8.5 1.14 1.35 1.36 0.99 0.84

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Poison Control Center
epidemic study in the year 2003
Humicide Misuse Suicide Accidental Total
5
0.3%
9
0.5%
395
23.7%
1260
75.5%

1669

Reasons of poisoning
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Poison control center
epidemic study in the year 2003
Causes Total
Food poisoning 567
Sedative/hypnotics 305
Evenomation 227
Substance of abuse 205
Pesticide 149
Houshold products 47
Plant 31
Heavy metals 9
Accidental 8

Causes of
poisoning
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Poison control center
toxicological lab work in 2003
-
Tox. tests for pts treated in PCC: 4198
-
Tox. tests for pts in other hospitals: 199
-Sending samples to other Labs: 305
-Co-operation in toxicological analysis with experts in Pharmacology
School and botanists
Results of toxicologic analysis

Medications Pesticides Drugs
of abuse
Alkaloide Household
products
Total
2456 625 877 234 6 4198
58.5% 14.9% 20.9% 5.6% 0.1%

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Poison control center
some recent publications
-
Use PSS to classify the acute poisoning patients, Nguyen Thi Minh Tam, Nguyen Thi Du
-
Study of correlation between serum-cholinesterase and clinical signs in
organophosphate poisoning, Pham Due, Nguyen Thi Du
-
Use atropin and hight dose of PAM in organophosphat poisoning, Pham Due, Nguyen
Thi Du
-
Nereistoxin poisoning, Nguyen Thi Du, Pham Due
-
Lead and mercury poisoning from traditional medicine, Pham Due, Nguyen Thi Du
-
Thallium poisoning – case series, Nguyen Thi Du
-
Treatment of Naja Kaothia envenomations using monospecific antivenom, Nguyen Kim
Son, Vu Van Dinh
-
Buffotoxin poisoning, Pham Due, Nguyen Thi Du

-
Acute renal failure in acute poisoning of fish bile, Pham Due, Nguyen Thi Du
-
Acute poisoning in children in Pediastric Hospital I and II in 2002, Nguyen Thi Du, Vu
Dinh Thang

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Children's vulnerability

More children died in drownings than from plague, cholera, typhoid and malaria
combined

More children die of poisonings in the home than Japanese B encephalitis (The US
Ambassador-Pete Peterson-2000)

Over 7% admitted poisoning patients are children.

Most are accidental poisonings

Mass poisonings in school caused by remain warfare in the South and
BuonMathuot province (CS)
fall
2%
drowning
29%
traffic acci.
8%
unknown
8%
electric shock

2%
other injuries
45%
poisoning
6%
Chart of
dead
children,
survey of
US
Embassy
-2000
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Poison Control Center
Children Poisoning in 2003
Male Female
Age (year) 0 - 4 5 - 14 15 - 19 0 - 4 5 - 14 15 -19
Poisoning pts 4 47 84 3 27 108
Suicide 0 4 25 0 5 61
Misuse 1 1 0 0 0 0
Homicide 0 0 1 0 0 0
Accident 3 42 53 3 22 47

* Report of Vietnam Poison Control Center
16
0
20
40
60
80

Pts number
Poison Control Center
Children Poisoning in 2003
Causes of poisoning
17
Poison Control Center
Poisoning in children
18
Poison Control Center
Poisoning in children
Theses:

2002: Acute poisoning in children at the
National Hospital of Pediastrics of Vietnam in 4
years
Long Nary

2003: Acute poisoning in children in 2 National
Hospital of Pediastrics of Ho Chi Minh city in
2002
Nguyen Thi Du, Vu Dinh Thang
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Poison Control Center
Poisoning in children
Some important findings:

male > female

main reason: accidental (479/517 cases, 92.6%)


common poisons: pesticides, snakebites, bee stings,
medications (hypnotics, cough and cold )

causes of death: North: rodenticides
South: paraquat, snakebite
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Poison Control Center
Poisoning in children
Problems and challenges:

Lack of knowledge and information for effectively preventive
policy and measures

Lack of programs for educating public, children in schools

No hot line for couselling people in community, medical
staffs in hospitals

No National network for intoxication information, especially
for building intoxication database

Lack of antidotes and effective treatment protocols,
qualification toxicologists
21
Poison Control Center
Poisoning in children
What should we do ?

Investigation, in-depth researchs focusing on preventable
reasons of poisonings in children


Create educational programs on intoxication for mass media,
comunication activities, in schools

Set up website, hotline for couselling

Establish the national network of PCCs and network system
for poisoning information

Clinical researchs to improve diagnosis and treatment
capacity for children poisonings
Thank you for your attention
Thank you for your attention