In the balance

Thanh Nien News

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Ban Van Hanh, 18, from Tuyen Quang Province, at Bach Mai Hospital in Hanoi for treatment of mushroom poisoning. He was hospitalized with his father and two relatives. Photo courtesy of Cong An Nhan Dan Online 

Time has all but run out for seven patients at the Bach Mai Hospital in Hanoi who became ill after eating poisonous mushrooms.
Of 15 people who have been admitted since March 9, seven have already died.
Doctors have called for liver donors to try and save the lives of the remaining, but it is not clear if this has any chance of happening.
The 15 patients from the neighboring provinces of Thai Nguyen and Tuyen Quang have been admitted in three groups, the latest being a woman who suffered a miscarriage and lost her 4-month-old fetus.
Vu Thi Hoi, 58, Ly Thi Thom, 38, her son Ly Minh Khoi, 13, and her niece Ly Thi Thuy, 14, and three others whose identities have not been released, residents of Thai Nguyen, have died, their kidneys and liver destroyed by toxins in the mushrooms.
Dr. Do Doan Loi, deputy director of the hospital, said in a Dan Tri report that only one patient is past life-threatening moments – 58-year-old Trieu Nho Phu who is Hoi’s husband.
The others have suffered liver failure, some are in severe hepatic coma and can die any time, he said. But as all victims are family members, four have left for home to attend the others’ funerals and only the remaining four are in the hospital.
The hospital has been working with other facilities in the area including the renowned Viet Duc Hospital in the search of liver donors, and will give priority to children, he said.
Doctors say the patients were poisoned by a white wild mushroom they picked from the jungle and cooked into a soup. Each person consumed between ten to 15 mushrooms.
The mushroom is pretty similar to the safe kinds and is abundant in the jungle, especially alongside streams, during spring and summer.
 
A photo from Bach Mai Hospital showing the wild poisonous mushroom that has sent 15 people to the hospital since March 9, seven of them have died.

But tests found it contains amatoxin which is a subgroup of toxic compounds. The toxin is primarily absorbed through ingestion but can also enter the body through the skin or even inhalation, affecting other organs like the kidneys and the heart.
43-year-old Ban Van Dat, one of the four victims from Tuyen Quang, said he and his son Ban Van Hanh, 18, picked up the mushrooms on their way home from the fields on March 13 as they looked fresh and white like most safe ones.
“I only ate a little so I’m conscious now. My son ate a lot, so I don’t know what will happen to him,” Dat told Cong An Nhan Dan Online.
His son is still in a coma.
Dat said he invited a father and son, their relatives, over for lunch and the two are also being treated at the Bach Mai Hospital. His wife and daughter were not at home then and are safe.
Dr Pham Due, director of the hospital’s toxin treatment center, said the mass poisoning and subsequent tragedy happened because of poor information and inadequate first aid services.
Due said all the patients are poor and live in remote areas where they do not have much access to information through normal media outlets like television and even the radio.
One victim is an employee of a medical center staff from Thai Nguyen who had received training in poisonous mushrooms.
“She was very careful. She had brought the mushroom back to consult an old villager, confident in the latter’s experience. And when she was told that it was edible, she cooked it for her family,” the doctor told Dan Tri.
The hospital and the Health Ministry are calling for voluntary organizations to deliver the needed information to remote areas. It will have the information printed on leaflets, the hospital has said.
But Due said it’s not simple to tell a toxic one from the other white safe mushroom, especially during the monsoon season when the toxic ones really mushroom.
“Using experience to distinguish them is very risky. So I suggest that people completely stay away from wild mushrooms.”
Than Duc Nha of the plant biotechnology center at the agriculture ministry told Cong An Nhan Dan that Vietnam has nearly 2,000 mushroom species including most of the poisonous ones listed worldwide.
Some of them can quickly kill a strong young man with just 50 grams, Nha said.
Due asked local hospitals and medical centers to store activated carbon to provide first aid detoxification for the patients, instead of having them wait for treatment till they get to a major hospital.
The patients from Tuyen Quang were admitted on March 16, 58 hours after the poisoning, when their livers were already destroyed. On arrival, doctors estimated that there was little hope of saving any. They were transferred from the Tuyen Quang General Hospital that had received them a day earlier, two days after they ate the mushrooms.
“The fatality risk increases with improper and late intervention,” Due said.
He said if a patient showed poisoning symptoms, including stomachache, vomiting, dehydration and blood hypotension, less than six hours after ingestion, the toxins are not very strong and the patients can be saved just by putting them on an IV.
But if the symptoms occur after six hours, the mushroom is very dangerous and the patients have to be made to vomit, and swallow an activated carbon solution which can absorb toxins. The recommended activated charcoal dose is two grams per 15 kilograms of body weight.
He said “it’s regrettable” that most patients only received fluid transfusion and not the carbon at their medical centers.
He said families should also store some of the charcoal, and that it is effective for any kind of acute poisoning from ingested toxins.
Some medical products made from activated carbon in form of powder and liquid are available in the market at affordable prices, while special detoxification medicine is rare in Vietnam, he said.
Doctors at the center said without proper first aid, patients of mushroom poisoning face more than 80 percent of death risk and the treatment costs would be huge.
They said the medical expenses for five patients from Thai Nguyen have escalated to VND1.6 billion (US$75,900) as of early last week. Health insurance covers 90 percent of the money, but the rest will still be a burden for the poor victims.

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