CLINICAL TOXICOLOGY
Research Group

Australian Toxicology Monitoring Study (ATOM)

ATOM aims to collect data on specific cases of poisoning and involves recruiting drug overdose patients in conjunction with NSW Poisons Information Centre. ATOM consists of a group of studies focusing on different drugs in overdose. The overall aim of the studies is to improve the risk assessment in each of these different overdoses and investigate the potential benefit and safety of various antidotes and treatments.

Australian Paracetamol Project (APP)

The APP study aims to investigate the pharmacokinetics and dynamics of paracetamol; in overdose. In particular large overdoses, overdoses with sustained release preparation and those with established hepatotoxicity.

This study involves collecting clinical information on paracetamol overdoses and using serum already collected while the patient is in hospital to measure paracetamol and its metabolites and N- acetylcysteine (NAC) levels. This study will allow us to better understand paracetamol in overdose, particularly the effects and treatment of massive overdoses and overdoses from sustained release preparations.

Digoxin Overdose and Response to Antibodies (DORA)

The DORA study aims to investigate the pharmacokinetics and dynamics of digoxin and response to digoxin Fab in acute overdoses and chronic poisonings.

This study involves a structured audit of the outcomes of standard management of digoxin poisoning, including collecting electrocardiograms, clinical observations (pulse, BP), and taking blood. Free and total digoxin concentrations as well as digoxin antibody concentrations are then measured to ascertain the pharmacokinetics and pharmacodynamics of digoxin and the response to treatment.

Anticoagulation Project Time and Treatment (aPTT)

The aPTT study aims to investigate the pharmacokinetics and dynamics of anticoagulants in overdose. This includes warfarin, longer acting superwarfarin poisons (eg. rat poisons) and newer anticoagulants (e.g. dabigatran). Patients with anticoagulant poisoning/overdose are recruited to the study and clinical and laboratory information is collected on datasheets. Additional blood is collected from the patient where possible (at the time of normal blood collections) to measure anticoagulant concentration and clotting factor levels. This information will be used to better understand the clinical course of different anticoagulant poisonings and the potential treatments.

Dihydropyridine Toxicity Project (DTP)

Dihydropyridine calcium antagonists are now one of the commonest prescribed groups of anti-hypertensive agents in Australia. The DTP study aims to investigate the pharmacokinetics and dynamics of these, focusing on amlodipine and lercarnidipine in single and combination products with or without other anti-hypertensive co-ingestion.

This study involves a structured audit of the clinical effects and outcomes of dihydropyridine calcium antagonist overdose, including collecting ECGs, clinical observation (pulse, BP) taking blood samples and documenting clinical outcomes. The study aims to better understand the severity of effects from these antihypertensive agents and response to standard treatments.

Cardiac Arrest & Toxins (CATS )

The Cardiac Arrest & Toxins (CATS) study aims to investigate whether the suspected overdose was the cause of the cardiac arrest and to have a better understanding of the epidemiology of overdoses resulting in cardiac arrest in Australia as well as identifying areas where we can improve in our management of these patients. This study involves a structured audit of the types of overdose and outcomes of standard management – ECGs, clinical observation (pulse, BP), taking blood samples and documenting common clinical symptoms.

Dialysis of Toxins Study (DOTS)

The aims of Dialysis Of Toxins Study (DOTS) is to investigate the pharmacokinetics and pharmacodynamics of those drug overdoses that require extracorporeal elimination. That is either intermittent haemodialysis or continuous renal replacement therapy. In particular calculating drug half-life and clearance during the patient’s treatment. Patients who present with any ingestion requiring extracorporeal elimination either intermittent haemodialysis (IHD) or continuous renal replacement therapy (CRRRT) will be recruited to this study. This study involves access to the patients’ medical records and collecting blood and urine samples at set time points. These samples will be analysed for drug levels and metabolite levels.

Herbicide Intoxication & Pharmacokinetics (HIP)

The aim of this study is to investigate the pharmacokinetics and pharmacodynamics of herbicides following an acute ingestion. In particular, looking at the clinical outcomes and comparing this to blood concentrations. Any patient presenting with an acute ingestion of a herbicide such as MCPA, Bromoxynil, Glyphosate or Paraquat will be recruited to the study.  This study involves using serum already collected & obtaining additional serum samples, while the patient is in hospital. Samples are tested for drug levels. As a part of this study we will also be accessing the patient’s medical records. This study will allow us to better understand the toxicity of herbicides when ingested.

Lipid Study

The LIPID study aims to investigate the use of Intralipid in overdose and determine its effectiveness. In particular we will determine drug levels in overdose prior to Intralipid and after to determine exactly how Intralipid affects drug levels. Any patient who has taken an intentional or accidental overdose and has Intralipid as part of their treatment, will be recruited to the study. This study involves using serum already collected & obtaining additional serum samples, while the patient is in hospital. Samples are tested for drug levels. As a part of this study we will also be accessing the patient’s medical records. This study will allow us to better understand the use of Intralipid in managing overdoses.

Metformin Toxicity Study (METOX)

The aim of this study is to investigate the pharmacokinetics and pharmacodynamics of Metformin in acute and chronic toxicity. Any patient presenting with an acute Metformin ingestion (accidental or intentional) will be recruited to the study. This study involves a structured audit of the outcomes of standard management including, clinical observation (heart rate, blood pressure, Glasgow coma score), taking blood samples, taking urine samples (or effluent samples if undergoing renal replacement therapy) and documenting clinical symptoms. Patients on renal replacement therapy will have additional circuit blood and effluent samples taken for measurement of Metformin and lactate levels.

Methotrexate Intoxication & Antidotes (MIA)

The Methotrexate Intoxication & Antidotes (MIA) study aims to investigate acute methotrexate poisoning and its response to antidotes. Any patient presenting with an acute or chronic methotrexate poisoning will be recruited to the study. This study involves a structured audit of the outcomes of standard management – clinical observation (pulse, BP), taking blood samples and documenting common clinical symptoms and follow up with GP for follow up blood tests at 1 and 2 weeks post ingestion.

Sotolol, Propanolol, Atenolol, Metoprolol (SPAM)

The SPAM study aims to investigate the pharmacokinetics & dynamics of beta-blockers in overdose. In particular we want to examine the benefits & risks of various management options in beta blocker toxicity. Any patient taking an intentional or accidental overdose of a beta-blocker will be recruited to the study. This study involves using serum already collected & obtaining additional serum samples, while the patient is in hospital. Samples are tested for drug levels. As a part of this study we will also be accessing the patient’s medical records. This study will allow us to better understand the toxicity of beta-blockers in overdose.

Valproate Toxicity Study (VATS)

The aim of this study is to investigate the pharmacokinetics and pharmacodynamics of Valproate in acute and chronic toxicity. Patients presenting with an acute immediate or extended release Valproate poisoning (accidental or intentional) will be recruited to the study. This study involves a structured audit of the outcomes of standard management including ECGs, clinical observation (heart rate, blood pressure, Glasgow coma score), taking blood samples, and documenting clinical symptoms.