This year’s International Emergency Medicine conference 2010 held at Singapore, has witnessed several renowned EM practitioners and speakers from India. Among several other speakers, one of the presentations was on the Importance of the Analytical Toxicology Laboratory in the Management of Poisoning Emergencies by Dr. V. V. Pillay Chief, Poison Control Center & Head, Analytical Toxicology, Professor in Forensic Medicine & Medical Toxicology at the Amrita Institute of Medical Sciences & Research, Kerala, India.
It’s one of those hard realities that we have to analyze and swiftly act upon to the fact that we seriously lack sufficient centers to effectively manage and control poisoning. As per Yellowtox directory of WHO, in India there are only 3 listed Poison Information centers (PIC’s), are located at All India Institute of Medical Sciences (AIIMS), New Delhi, National Institute of Occupational Health (NIOH), Ahmedabad, Govt. General Hospital, Chennai and there is only 1 Poison Control Center (PCC) which is at AIMS, Cochin, Kerala.
The Poison Information Centre (PIC) is specialized unit providing information on prevention, early diagnosis, treatment of poisoning and hazard management. Most of the developed countries have well established the Poison control center, which is a specialized unit, attached to a Hospital that Deals with Information Resource Facility on Poisoning and an Analytical Laboratory.
According to Dr. Pillay, In many countries of the world, poisoning constitutes a significant proportion of medical emergencies presenting to hospitals, many of which are accidental or suicidal in nature and a few homicidal. For long, the clinical management of poisoning has languished in developing countries like India and other countries of the Asian region, because of neglect of the specialty of toxicology by physicians, owing to mishandling of the teaching-learning aspects of this specialty. Only of late, the importance of the specialty is being recognized in these countries and attempts are being made from various quarters to uplift toxicology to its rightful place in the field of medicine. One of the most important aspects that need to be addressed in effective management of poisoning/overdose is analysis of body fluid samples for confirmation/exclusion and in some cases, for assessing the severity by quantifying the toxin in the samples.
Unfortunately, the concept of toxicological analysis of samples from living victims of poisoning has not yet caught on in a big way in many developing countries, mainly because of a lack of specialized laboratories that can undertake such analysis. The only units that undertake such work are part of government-controlled forensic science laboratories or chemical examiner’s laboratories, which accept samples only if they are registered as medico-legal cases, and if the victims have already died and been subjected to postmortem examination! In other words, such laboratories undertake toxicological analysis only for forensic purposes, and not for clinical purpose.
The World Health Organization has been trying to redress this distressing situation in developing countries such as India, by promoting the creation of Poison Control Centers in major hospitals, which can improve the clinical management of poisoning by providing accurate and latest information resources, as well as analytical facilities for sampling body fluids from living victims. Even though a few institutes have set up such centers, the number is grossly inadequate and physicians in general are unaware as to how exactly to utilize the facilities.
There may arise several situations where such facilities need to be utilized, especially when the cause of poisoning/toxicity is unknown, poisoning/toxicity due to Pesticides, Heavy Metals, Alcohols, Inhalant Gases, Sedatives, Narcotics, Anticholinergic, Analgesics/ Antipyretics, and Steroids etc…that have several subgroups or variants, that are to be managed differently.
There are several guidelines and procedures that are followed at PCC’s in the management of poison/toxicant induced patients, the PCC at all major hospitals can help people reap the benefits of correct analysis and better management in time, which will also help avoid pitfalls in collecting and sending samples as well as correct interpretation of the results that would help physicians in proper management.
Hope the government and health ministry would take necessary action in setting up such centers across the country that would help save several hundred lives every year, which now are lost needlessly with out proper management/treatment in time.