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: hscca9@fpt.vn 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. 4 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 5 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 6 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 7 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. 8 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 9 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 10 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 [...]... 17 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 18 Poison Control Center Poisoning in children Some important findings:  male > female  main reason: accidental... Children Poisoning in 2003 Male Age (year) Female 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 15 Poison Control Center Children Poisoning in 2003 Pts number Causes of poisoning 80 60 40 20 0 16 Poison Control Center Poisoning in children 17 Poison Control. .. 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) 14 Poison Control Center Children. .. 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 13 Children' s vulnerability other injuries drowning 29% 45% unknown 8%      electric shock 2% poisoning 6% fall 2% Chart of dead children, survey of US Embassy... 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 20 Poison Control Center Poisoning in children What should we do ?      Investigation, in- depth researchs focusing on preventable reasons of poisonings in children Create... 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... common poisons: pesticides, snakebites, bee stings, medications (hypnotics, cough and cold )  causes of death: North: rodenticides South: paraquat, snakebite 19 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.. .Poison control center epidemic study in the year 2003 Causes of poisoning 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 11 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... 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 21 Thank you for your attention ... -Co-operation in toxicological analysis with experts in Pharmacology School and botanists Results of toxicologic analysis Medications Pesticides Drugs Alkaloide Household of abuse Total products 2456 625 877 234 6 58.5% 14.9% 20.9% 5.6% 4198 0.1% 12 Poison control center some recent publications - Use PSS to classify the acute poisoning patients, Nguyen Thi Minh Tam, Nguyen Thi Du Study of correlation . 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. 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. 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