Staff Profile

Career Summary

Qualifications

• Doctor of Medicine, University of New South Wales
• Bachelor of Science, University of New South Wales
• Bachelor of Medicine & Surgery, University of New South Wales

Research

Research keywords

• Clinical Toxicology
• Clinical Toxinology
• Emergency Medicine
• Pharmacokinetics and pharmacodynamics
• Toxinology

Research expertise

Dr Isbister is a clinician researcher in clinical toxicology and his research has focused on understanding poisoning and envenoming in patients and undertaking studies to determine the effectiveness of antidotes and antivenoms in treatment of these conditions. He has published over 140 original research publications and holds a second NHMRC Clinical Career Development Award. The benefits of the research include improving our understanding of the pathophysiology of both envenomation and poisoning. Much of his research challenges long held views about the treatment of poisoned and envenomed patients, including whether antivenom works. He has made clinicians re-look at what evidence there is for various treatments and why we use these treatments.

His first study of spider bite showed that the majority of spider bites cause minor effects, and the major effects only occurred with funnel-web spider bites and redback spider bites. The research also debunked the myth of the Whitetail Spider, showing that severe ulceration of the skin was due to a variety of causes but not spider bite. Other studies of bites and stings by venomous creatures, including scorpions, insects, marine animals and continues with snake bites in a national snake bite study formed the basis of his Doctor of Medicine titled: Data collection in clinical toxinology: debunking myths and developing diagnostic approaches to bites and stings

Ongoing major areas of research include:

1) Clinical Toxinology: observational and interventional studies in envenomed patients; this includes the Australian Snakebite Project ASP. The study has changed the way antivenom is dosed, decreasing the dose used and demonstrating the efficacy of antivenom. This study continues now investigating other treatments for snake bite and is funded by the NHMRC. A similar study has commenced in Sri Lanka in 2005 and has recently received NHMRC funding. The clinical toxinology laboratory based at the Calvary Mater Newcastle undertakes assays for venoms, toxins and antivenom in human blood, with very low limits of detection allowing their use in clinical and forensic cases. The Redback Spider Antivenom Evaluation (RAVE) Study, funded by the NHMRC is investigating the effectiveness of redback spider antivenom for the treatment of pain and systemic effects. A previous study established hot water as a safe and easily applied treatment for blue bottle stings which changed the Australian Resuscitation Councils recommendations on the first aid treatment and was awarded the Medical Journal of Australia and Wyeth Australia award for best research published in the journal in 2006.

2) Modelling and simulation in toxicology: This is multicentre research into the pharmacokinetics and pharmacodynamics of drugs in overdose with patient blood samples and clinical data to develop clinical guidelines for treatment using novel drug modeling and simulation techniques. These studies of treatments for drug overdose have rationalized the treatment for particular drug overdoses streamlining the care for patients. This includes research into the effects of drugs on the electrocardiogram and the effect on the QT interval which is associated with fatal arrhythmias, developing a risk assessment tool (QT nomogram). Other projects include prospective studies of overdose patients and the relative toxicity of psychotropic medications, and one of these publications is now highly cited comparing the newer antidepressants toxicity. There is ongoing research on serotonin toxicity and a study that developed new diagnostic criteria for serotonin toxicity. This work has changed our understanding and approach to the treatment of serotonin toxicity over the last 5 years.

3) Acute behavioural Disturbance: Recent research has been commenced on the sedation of violent and aggressive patients in the health care setting, with a focus on drug and alcohol induced delirium in the emergency department.

Fields of Research

Appointments

Teaching

Teaching keywords

• Clinical Toxicology
• Clinical Toxinology
• Emergency Medicine

Teaching expertise

Clinical pharmacology, clinical toxicology and emergency medicine to undergraduates and post-graduates.