Proceedings of the toxicology and Poisons Network Australasia (TAPNA) 2022 Annual Scientific Meeting

A 19-year-old male prisoner attended a medical appointment, during which he was observed inhaling or ingesting a clear liquid. Following this, he became agitated, requiring mechanical and chemical restraint. Extreme agitation persisted despite intramuscular midazolam (10 mg). On arrival to ED he appeared flushed with dry skin, mydriasis, severe tachycardia (130 bpm), and hypertension (180/110 mmHg). He was subsequently intubated for agitation and behavioural control. His admission was complicated by mild rhabdomyolysis and five generalised tonic-clonic seizures over 2 d, with persistent mydriasis and sinus tachycardia. Peak temperature was 39 °C. The Victorian Poisons Information Centre was contacted. Given the limited exposure history, ongoing seizure activity, and general anaesthetic control of agitation, physostigmine was not recommended despite evidence of a possible anticholinergic toxidrome. The patient was extubated uneventfully on day three and made a full recovery. Total length of hospital stay was 67 h, Intensive Care Unit length of stay was 44 h. Whole blood was analysed for atropine using high-performance liquid chromatography with tandem mass spectrometry. Atropine concentration was 0.01 mg/L (10 ng/mL). This sample was analysed as part of the Emerging Drugs of Australia VIC project – a Health. vic supported, multi-institutional initiative providing intelligence on Victorian ED illicit drug presentations.