vietnam poison control center an introduction

1 Vietnam Poison Control Center An introduction 2 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. 3 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 4 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 5 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 6 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) 7 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. 8 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.  9 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. 10 Member units: Laboratory   Toxicology analysis.  Study and development of antidotes.  Training of laboratory staffs in the field of toxicology [...]... 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 22nd 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...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 11 Achievements Clinical unit: the most developed one Annual number of poisoned patients addmitted 12 Achievements Clinical unit: the poisoned-related... pufferfish, many unidentified toxins in plants + Drugs of abuse: heroin, amphetamin, marijuana + Medication: cold preparations, rotundin, barbiturate, 16 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... 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 18 Achievements:... preparation method for the antidote B.Mai-ANTIPOIS + Investigation and study in to drugs overdoses commonly encountered in hospitals 17 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... causes 12 15 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 +... management - Organization of annual workshops and conferences 19                    Published researches and books - 20                  Published researches and books 21               Published researches and books 22 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... 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 14 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... 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... labs involved in toxicology analysis -Lack of overseas training courses  24 Commercial products of insecticide insecticide 25 26 Pictures of poisoned patients 27 28 29 30 31 32 Snakebite (Bungarus candidus) 33 Snakebite (cobra) 34 Snakebite (cobra, in the south of Vietnam) 35 Snakebite (viper) 36 . 1 Vietnam Poison Control Center An introduction 2 Vietnam in brief  A developing country approximately 330,900Km 2 .  Population over 80 million, with 80% farmers.  Vietnam: an agricultural. 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:. advanced courses. - Taking Counsel with the Ministry of Health for investigations, researches and guidance on toxicological prevention and management. - Organization of annual workshops and