Abstract
Poisoning is one of the most important health issues to the human race. Developing countries usually face greater threats from industrial chemicals, pesticides and venomous animals combined by limitation in their resources to provide medical treatment and the setting up of effective poison control system. In developed societies, despite their better-established public health system and advanced medical care, poisoning still prevails.
As a post-modern city with abundance of resources, acute poisoning from self-harm and long-term poisoning from drugs of abuse in Hong Kong is our persistent challenge. However, we are also threatened by poisoning outbreaks that emerge from time to time. The usual culprits are either emerging new poisons or changing human behaviour that results in new exposures to old poisons. Recent examples include the abuse of ketamine, male potency-enhancing supplement tainted with oral hypoglycaemic drugs, cosmetic use of illicit botulinum toxins, metals in alternative medicine and unexpected liver injuries from herbal supplements.
Public education and prompt regulation are the means to control any poisoning outbreak, but the cornerstone of success lies in early recognition. In Hong Kong, this important task is largely shouldered by emergency medicine (EM) doctors. They have been contributing to the routine surveillance of poisoning through the electronic medical record systems in Hospital Authority. They also serve as vigilant whistle-blowers against new poison exposures and new forms of poisoning through the well-established consultation process with the Hong Kong Poison Information Centre (HKPIC).
HKPIC was established in the United Christian Hospital since 2005, providing round-the-clock poison information service to all healthcare workers in Hong Kong not limited to Hospital Authority. Senior doctors in the Centre are fellows from the Hong Kong College of Emergency Medicine (HKCEM) with subspeciality fellowships in clinical toxicology (CT). Junior doctors were mostly EM trainees or young fellows receiving on-job training usually for half to one year in duration. HKCEM and HKPIC worked hand-in-hand to develop and organize structured CT training for doctors. Programmes of different knowledge levels were made available to doctors of all specialities in Hong Kong, from a certificate course for the beginners or a basic CT course that was mandatory for all EM trainees, to a quotable diploma programme at the intermediate level. For EM fellows pursuing subspeciality expertise in the field, the CT fellowship programme of HKCEM was the answer. The subspeciality fellowship was recognized by the Hong Kong Academy of Medicine in 2016. The programme consisted of structured training sessions and prescribed working experience in HKPIC or another recognized poison centre, as well as in an emergency department accredited Emergency Medicine Toxicology Training Centre status by HKCEM.
As acute poisoning is being regarded as a form of medical trauma that shared similar golden hour concept, EM doctors are providing urgent medical cares that often determine the outcomes of poisoned patients. In this special toxicology issue, there were high-quality interesting research studies from local and overseas, ranging from poisoning epidemiology, risk factor and outcome analysis, and extracorporeal treatment (ECTR) on common and important poisoning. HKPIC annual report has been published in this Journal since 2007. 1 The annual reports had been providing epidemiological information on poisoning in Hong Kong for the past 15 years. In this issue, its latest report 2 for 2020 gave an update and described interesting poisoning cases with both clinical and public health significance. Interestingly, it also explored the possibility of poisoning pattern change related to COVID-19 pandemic. Besides, Liu and Chan 3 also looked into the paediatric poisoning pattern in another study in Hong Kong and found adolescent poisoning was more related to intentional poisoning, exposure in school and poisoned by pharmaceutical products.
Calcium channel blockers (CCB) is one of the leading drug classes associated with poisoning fatality in Hong Kong. Its management is challenging despite the availability of expert consensus recommendation. 4 Lau 5 in this issue explored the use of shock index (SI) to predict the outcome in 390 CCB poisoned patients with 5.6% mortality rate and found a high SI is associated with poor outcome. Anticoagulant rodenticide ingestion, either intention or accidental, is a common toxicological presentation. Lau and Wong 6 studied 169 cases of rodenticide ingestion and 49 (29%) of them developed coagulopathy defined as international normalized ratio (INR) ⩾ 1.3, the ingestion of more than one pack of rodenticide which commonly happened in intentional exposure was found to be associated with the coagulopathy.
The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup is an international collaboration with the objective to perform systematic reviews on the use of ECTR in various poisonings and provide clinical recommendations on their use in poisoning. 7 Chow 8 analysed 112 cases of severe lithium poisoning in Hong Kong and 23 of them were treated by ECTR with respect to its indication as recommended by EXTRIP.
CT has been developed in Hong Kong for past 2–3 decades, and some of the milestones were stated in the past editorials in 2005 and 2011 by Dr FL Lau. 9 , 10 Further CT development since then included the hosting of the 11th Scientific Congress of Asia Pacific Association of Medical Toxicology in Hong Kong with over 350 overseas and local delegates in 2013, the foundation of Poisoning Resuscitation & Training Charity Fund for Greater China to support young doctors from Greater China to undergo CT training in Hong Kong, and the first emergency medicine (cum Toxicology) ward was established in Queen Mary Hospital. CT subspeciality, as well as the Board of Clinical Toxicology (BCT), was established in 2016. Currently, we have about 30 CT fellows in clinical practice, both in the public and private health care system. Hong Kong citizens are receiving a far better clinical care on poisoning nowadays. Recently, an encouraging news from 2022 HKSAR Chief Executive policy address is the establishment of a Poison Control Centre in Hong Kong to further enhance poison control and CT service.
We would also like to take this opportunity to highlight that HKCEM had established its Research Office (RO) in 2022. The function of RO includes the promotion and facilitation of researches, coordination of multi-centre researches and provision of research grants. In foreseeable future, we have confident that CT will continue to blossom in Hong Kong and another special issue on CT will appear soon in this Journal.
