To cite this article: Winai Wananukul, Charuwan Sriapha, Achara Tongpoo, Umaporn
Sadabthammarak, Sunun Wongvisawakorn & Sming Kaojarern (2007) Human poisoning in
Thailand: The Ramathibodi Poison Center's experience (20012004), Clinical Toxicology, 45:5,
582-588, DOI: 10.1080/15563650701382789
Article views: 77
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Clinical Toxicology (2007) 45, 582588
Copyright Informa Healthcare
ISSN: 1556-3650 print / 1556-9519 online
DOI: 10.1080/15563650701382789
ARTICLE
LCLT
Objective. To identify poisoning and toxic exposure pattern, severity, and clinical outcome in Thailand during 2001 to 2004. Method.
This is a prospective study. All inquiries were registered, followed up, and verified. Interlocutors, poisons, patients profiles, severity, and
medical outcome after exposure or poisoning were analyzed. Results. A total 14,428 events was suspected as human poisoning or
exposure. After follow-up and verification, 98.9% were confirmed as poisoning or poison exposure. These involved 15,016 patients and
accounted for 6.0 per 100,000 populations per year. The vast majority of calls (92.4%) were from physicians. Pesticides, household
products, and pharmaceutical products were the most common poisons involved in human exposure, which were 41.5%, 19.5%, and 18.9%,
respectively. Patients aged 06 years, teenagers and adults with 2029 years of age had the highest rates of exposure, which were 33.0,
24.5, and 10.5 exposures per 100,000 per year, respectively. Unintentional accidental exposure is the major reason of exposure in children,
but intentional suicide was the main reason of exposure in teenagers and adults. The death rate of all exposure was 5.5%. Pesticides cause
more severe clinical course and the highest death rate (10.0%). Conclusion. Features of poisoning in Thailand were different from those in
Western countries. Pesticide poisoning was the major problem in Thailand. Intentional suicide was the major circumstance of poison
exposure in adults, but accidental exposure was the major reason of exposure in children.
Keywords Poison center; Acute poisoning; Poison; Toxicity; Pesticide; Toxico-vigilance; Thailand
Table 4. Pesticides most frequently involved in human exposures Table 8. Household products most frequently involved in human
exposures
Type of pesticide No. of cases (%)
Major/subgroup classification No. of cases (%)
Insecticides 3,217 50.0
Herbicides 1,588 24.7 Cleaning agent for laundry 863 27.7
Rodenticides 911 14.2 Cleaning agent for toilet 742 23.8
Miticides 297 4.6 Cleaning agent for floor 250 8.0
Plant hormone & growth regulators 145 2.3 Dish washing (manual) 287 9.2
Others 262 4.0 Moisture absorbent 195 6.3
Unknown pesticides 17 0.3
Total 6,437*
*The number of cases was higher than those in Table 3 because some Table 9. Pharmaceutical products most frequently involved in
patients took more than one substance in the same category and were human exposures
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of all household products. The acid concentration ranged Poison exposure and poisoned patient profile
from 6 to 21%. Ingestion of these products caused more severe Table 10 shows the age distribution of the patients. There
gastroesophageal injury than the others in the category. were two separate populations: children and adults.
Table 9 shows a list of pharmaceutical products which Unintentional exposure was the major circumstance of
were commonly involved. Benzodiazepines were drugs clas- exposure in children between the ages of 05 and 612 years
sified in both tranquilizer and hypnotic-sedative groups. old. It was different from teenagers and adults whose
Human poisoning in Thailand 585
Table 10. Number of human poison exposure and rate of human exposure (exposures/100,000 populations/year) in age interval and gender
during 2001 to 2004
intentional exposure was the main circumstance (Table 11). stances, followed by household products and pharmaceutical
The patients were merged into two groups according to their products (Table 13). The unintentional occupational and acci-
major circumstances of exposure; children aged less than dental exposure to pesticides was only 8.6%. Exposure to
13 years and teenagers to adults. Table 12 shows substances technical and occupational products was from unintentionally
that were commonly involved in both unintentional and accidentally exposed.
intentional exposures in children aged less than 13 years old.
In teenagers and adults, intentional suicide was the common Clinical severity and outcome
mode of exposure. Pesticides were the most common sub- When interlocutors, who were mainly physicians or health
personnel, called the center, 30.4% (4,567) of cases had a his-
Table 11. Circumstances of exposures among the age groups tory of toxic exposure but no sign or symptom of poisoning
and were defined as poison exposure group in this study
Age Circumstances of exposure (% in row) (Table 14). The other 69.6% (10,444) of cases had clinical
groups manifestations of poisoning and were defined as poisoning
(years) Unintentional Intentional ADRs Others Total
group in this study (Table 14).
05 2,246(98.2) 29(1.3) 5(0.2) 7(0.3) 2,287 Patients in the poisoning group developed a more severe
612 498(77.7) 125(19.5) 7(1.1) 11(1.7) 641 clinical course and clinical outcome when compared to the
1339 1,284(14.1) 7,589(83.6) 54(0.6) 149(1.6) 9,077 poison exposure group (Table 14). The initial severity and
>40 907(30.9) 1,908(65.0) 44(1.5) 77(2.6) 2,936 clinical outcome of patients were tabulated in a separate
*Seventy-five cases in which the circumstances were not identified were
category, especially the three major substances: pesticides,
excluded. ADRs: adverse drug reactions. household products, and pharmaceutical products (Tables 15
Table 12. Substances involved in unintentional and intentional Table 13. Substances involved in unintentional and intentional
exposure in children aged less than 13 years old exposure in teenagers and adults
Category of Category of
substances Unintentional Intentional Others Total substances Unintentional Intentional Others Total
Pesticide 473(93.3) 30(5.9) 4(0.8) 507 Pesticide 490(8.6) 5,139(89.8) 93(1.6) 5,722
Household products 669(98.2) 9(1.3) 3(0.4) 681 Household 308(13.7) 1,933(85.9) 10(0.4) 2,251
Pharmaceutical 751(94.7) 30(3.8) 12(1.5) 793 products
products Pharmaceutical 193(9.5) 1,726(85.4) 103(5.1) 2,022
Technical & 435(99.3) 2(0.5) 1(0.2) 438 products
occupational Technical & 620(66.4) 296(31.7) 18(1.9) 934
products occupational
Poisonous plants 247(75.5) 76(23.2) 4(1.2) 327 products
Others 169(92.9) 7(3.8) 6(3.3) 182 Others 621(53.6) 438(37.8) 100(8.6) 1,159
Total 2,744(93.7) 154(5.3) 30(1.0) 2,928 Total 2,232(18.5) 9,532(78.9) 324(2.7) 12,088
586 W. Wananukul et al.
Table 14. The clinical outcome of patients who initially presented with clinical manifestation of poisoning and only history of poison
exposure
Table 15. The initial severity of the poison exposure patients and poisoning patients who were exposed to the most common substances
which were pesticides, household products, pharmaceutical products, and all kinds of toxic substances
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Table 16. The clinical outcome of the poison exposure patients and poisoning patients who were exposed to the most common substances
which were pesticides, household products, pharmaceutical products, and all kinds of toxic substances
important issues in this field. This would be another aspect should focus on psychiatric measurement. To delay or make
that the poison center should aim at (3,9). it more difficult to reach the drugs or toxic substances may
As the calls were mainly from physicians and health per- partially reduce the number of cases. To restrict the availabil-
sonnel, the cases were likely to be a significant exposure or ity of the highly toxic substances, especially pesticides,
those with potentially serious health effects. Minimal risk or should be another measure to decrease toxic exposure. The
mild poisoning was likely to be omitted in this study. There- poison center should have a role in monitoring, registration,
fore, the severity and medical outcome from this study may and informing society regarding this problem.
be more unfavorable than those comprising a large portion of
calls from the general public. This system is sensitive and
effective for response to acute poisoning. In contrast, it is not Conclusions
fit for detecting chronic toxicity or long-term effects, and
these kinds of health effects are also missing in this study. The poison center provides services mainly to physicians and
We realized that a limitation of this study is that it did not health personnel in managing the poisoned patients. Pesti-
represent all of the features of poisoning in Thailand. cides, household products, and pharmaceutical products were
Unfortunately, official reports of poisoning cases from health the most common substances involved in toxic exposures and
facilities are usually underreported. Neither a relevant report- poisoning in Thailand. The overall death rate was relatively
ing system of poisoning cases nor a monitoring system has high because pesticide poisonings were associated with a
been developed in Thailand. An actual feature of toxic expo- higher death rate and a more severe clinical course than other
sure and poisoning in the country is not available. This report poisonings. Most of the exposures were intentional suicide,
may partly reflect poisoning problems of the country. especially in teenagers and adults. Accidental exposure was
Pesticide poisoning is the most common and important in the main reason of exposure and poisoning in children. Public
Thailand. It contributed to nearly half of all poisonings. This relation activities including education, provoking awareness,
finding was different from that of Western countries, where and poisoning prevention should be implemented.
pesticide poisoning is a minor problem. Poisoning from
household products and pharmaceutical products, which are
most common in Western countries, is second after pesticide Acknowledgments
poisoning (2,10). However, our finding is similar to those
found in China, Taiwan, Sri Lanka, and India which are in the This study was partially supported by the Royal Thai Gov-
same continent and have similar cultures (4,1114). Pesticide ernment World Health Organization Collaborative Program
poisoning is one of the popular modes of self-assault in these and Syngenta Crop Protection Limited. The authors grate-
countries (6,1517). As it caused higher morbidity and death fully acknowledge all part-time scientists and the assistance
than other kinds of poisoning, it was an important factor that of Professor Amnuay Thithapandha in editing and preparing
contributed to a higher death rate in our study compared to this article.
those in developed countries. As highly toxic organophos-
phates such as methylparathion and methamidophos as well
as endosulfan were banned in the year 2003 2004, clinical References
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