Tetrahydrocannabinol - friend or foe? - Debate.

Tetrahydrocannabinol (THC) is a psychoactive cannabinoid that has been used to treat various conditions. However, due to various adverse effects, its widespread promotion and use has been controversial. It is this aspect (encouraged by various state legislatures) that forms the basis for an edited debate between an Integrative Family Medicine physician and a Medical Toxicologist.

The financial impact of the medical toxicology specialty code on a private practice.

We describe the financial impact following the implementation of this unique specialty taxonomy code after October 1, 2017 on an established private medical toxicology practice. Clinical financial data over a 1-year period (October 2016 through September 2017) prior to medical toxicology specialty CMS code implementation was compared to financial data (October 2017 through September, 2018) following implementation. The encounters were billed by current procedural terminology (CPT) codes through the same biller during these time periods.

The X factor: Lack of bleeding after an acute apixaban overdose.

We present an acute apixaban overdose without reported coingestants; it is the first such case report associated with multiple serum drug levels to assist in determining overdose kinetics. A 62 year old female presented to an emergency department (ED) 2 hours after ingesting sixty 5 mg tablets (5mg/kg) of her spouse's apixaban medication. She denied coingestants, and did not take her prescribed medications that day.

Cholinergic symptoms with low serum cholinesterase from therapeutic cholinesterase inhibitor toxicity.

Although cholinesterase inhibitors have been frequently used in the treatment of Alzheimer disease, its effects on serum cholinesterase concentrations have been rarely described. We described significant depression of serum cholinesterase levels due to cholinesterase inhibitor toxicity from redundant use of donepezil and rivastigmine in a 78-year-old man. Recovery of serum cholinesterase level was noted upon drug discontinuation and cholinergic symptom resolution.

Outpatient toxicology clinic experience of patients with hip implants.

Context: With regard to biological effects, the increasing number of early failure of metal-on-metal (MoM) hip arthroplasties and possible parenteral exposure to orthopedic metal alloys have caused concern for patients and providers alike.

Objective: We sought to characterize our outpatient clinical experience of patients with MoM and other forms of hip implants and associated serum/blood chromium and cobalt levels, with a focus on possible systemic sequelae.

Methods: This was an observational and retrospective chart review of consecutive patients presenting to two outpatient medical toxicology clinics from January 1, 2010-June 1, 2012 with history of hip implants.

Use of clonidine in the prevention and management of neonatal abstinence syndrome.

Introduction: Neonatal abstinence syndrome (NAS) is a complicated medical condition with treatment regimens that traditionally have included methadone and other opioids, barbiturates, and benzodiazepines. We describe a case series in which clonidine was used for the prevention and management of patients with NAS.

Patients And Methods: Medical records of infants treated with clonidine for NAS from January 2003 to March 2006 were reviewed for gestational age, birth weight, NAS score, dose of clonidine, duration of treatment, and additional medications required.