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.. Vi
Trang 1Vietnam 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: hscca9@fpt.vn
Trang 2 Toxicologic epidemiology: General condition
Poison control centre
Organization and functions
Intoxication report
Poisoning in Children at Vietnam PCC
Trang 3Vietnam in brief
A developing country 330 900Km2
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.
Trang 4Toxicological 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%
Trang 5Toxicological epidemiology
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
Trang 6E pidemiology
reported cases (% of total)
Numeral mortality (Mortality, expressed in % of reported)
9 Other causes 10.6% 7.48%
Total 100% 3.26%
Survey in 48 local hospitals
Trang 7Vietnam 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.
Trang 8Poison 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.
Trang 9Poison Control Center
treated patients in the first 5 years
Year 1998 1999 2000 2001 2002 2003
Poisoning 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
Trang 10Poison 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
Trang 11Poison control center
epidemic study in the year 2003
Trang 12Poison 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
Trang 13Poison 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 – 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
Trang 14Children'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%
Chart of dead children, survey of
US Embassy -2000
Trang 16Op iat es
us eh old pr
od uc
ts
Sn ak
eb ite s
Be e s tin gs
Po iso
no us
an im al
He av
y m eta
ls
Pe sti cid es
Pts number
Poison Control Center
Children Poisoning in 2003
Causes of poisoning
Trang 17Poison Control Center
Poisoning in children
Trang 18Poison Control Center
Poisoning in children
Theses:
Hospital of Pediastrics of Vietnam in 4 years
Long Nary
Hospital of Pediastrics of Ho Chi Minh city in 2002
Nguyen Thi Du, Vu Dinh Thang
Trang 19 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
Trang 20Poison 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
Trang 21 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
Trang 22Thank you for your attention