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This document contains summaries from the Proceedings of the Toxicology and Poisons Network Australasia (TAPNA) 2023 Annual Scientific Meeting. The summaries cover various topics related to toxicology and poisoning, including the neurological effects of nitrous oxide abuse, managing poisoned patients at risk for QT interval prolongation, the misuse of amygdalin/cyanogenic glycoside products for cancer therapy, premature death after self-poisoning, a state-wide poisoning data linkage cohort in New South Wales, methaemoglobinemia caused by ingesting alkyl nitrites, and using screening questions to identify substance use disorder in patients presenting with deliberate self-poisoning. Other summaries discuss cases of aspiration pneumonitis in a clinical toxicology unit, marine animal envenomation and poisoning in Malaysia, the partitioning of methadone in blood and plasma, the management of accidental pediatric liquid paracetamol exposures, a case of non-fatal intoxication from the inhalation of synthetic opioid protonitazene through a vape product, and the use of funnel-web spider antivenom in hospitals in New South Wales and the Australian Capital Territory. The summaries provide valuable information for further research and highlight emerging risks and recommendations in the field of toxicology and poisoning. [Extracted from the article]

A 53-year-old male patient presented to a regional hospital Emergency Department approximately 2 h post an intentional ingestion of Coopers Instant Wetting Powder Sheep Dip (66% arsenic trioxide, 23% sulphur and 0.42% rotenone), mixed in 600 mL water, as a suicide attempt. On arrival to the Emergency Department, the patient had nausea, vomiting and diarrhoea. Seven hours post ingestion, hypotension developed (BP 90/60 mmHg) and intravenous fluids were commenced. He later developed QTc prolongation. He was treated with 2,3-Dimercapto-1-propanesulfonic acid (DMPS) and N -acetylcysteine and improved without development of neurology. Further investigation of NAC efficacy in humans in the setting of acute arsenic poisoning is required and the optimal duration of treatment and dosing needs to be established. This case highlights an uncommon poisoning which presented to the Emergency Department, the acute symptoms of arsenic toxicity and considerations for management. [ABSTRACT FROM AUTHOR]

Objective: To illustrate the toxicosurveillance role of the Emerging Drugs Network of Australia - Victoria (EDNAV) project in informing timely harm minimisation interventions. Methods: Utilisation of an ethics approved clinical registry storing de-identified clinical and analytical data on Victorian ED illicit drugrelated presentations. Results: In April 2022, six adults presented to hospital with varying levels of sedation, following the use of counterfeit benzodiazepines. Comprehensive toxicological analysis identified five separate novel benzodiazepines within blood samples from each patient. A public 'Drug Alert' was subsequently issued, and local emergency physicians were notified. Conclusion: Toxicosurveillance projects, such as EDNAV, are critical to the continued monitoring and reporting of illicit substance use in the community. [ABSTRACT FROM AUTHOR]

The Emerging Drugs Network of Australia – Victoria (EDNAV) project is a newly established toxicosurveillance network that collates clinical and toxicological data from patients presenting to emergency departments with illicit drug related toxicity in a centralised clinical registry. Data are obtained from a network of sixteen public hospital emergency departments across Victoria, Australia (13 metropolitan and three regional). Comprehensive toxicological analysis of a purposive sample of 22 patients is conducted each week, with reporting of results to key alcohol and other drug stakeholders. This paper describes the overarching framework and risk-based approach developed within Victoria to assess drug intelligence from EDNAV toxicosurveillance. Risk management principles from other spheres of public health surveillance and healthcare clinical governance have been adapted to the EDNAV framework with the aim of facilitating a consistent and evidence-based approach to assessing weekly drug intelligence. The EDNAV Risk Register was reviewed over the first two years of EDNAV project operation (September 2020 – August 2022), with examples of eight risk assessments detailed to demonstrate the process from signal detection to public health intervention. A total of 1112 patient presentations were documented in the EDNAV Clinical Registry, with 95 signals of concern entered into the EDNAV Risk Register over the two-year study period. The eight examples examined in further detail included suspected drug adulteration (novel opioid adulterated heroin, para-methoxymethamphetamine adulterated 3,4-methylenedioxymethamphetamine (MDMA)), drug substitution (25B-NBOH sold as lysergic acid diethylamide, five benzodiazepine-type new psychoactive substances in a single tablet, protonitazene sold as ketamine), new drug detection (N,N-dimethylpentylone), contamination (unreported acetylfentanyl) and a fatality subsequent to MDMA use. A total of four public Drug Alerts were issued over this period. Continued toxicosurveillance efforts are paramount to characterising the changing landscape of illicit drug use. This work demonstrates a functional model for risk assessment of illicit drug toxicosurveillance, underpinned by analytical confirmation and evidence-based decision-making. [ABSTRACT FROM AUTHOR]