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This article presents two years of billing and collection data for a bedside toxicology consultation service. The collections rate was 34% or $26.19 per hour of consultative time. There was an inverse correlation between collection rates and patient acuity. Keywords Toxicology economics; Reimbursement, INTRODUCTION Very few board certified medical toxicologists are engaged in the private practice of medical toxicology. Furthermore, little has been published regarding the medical economics of the private practice of [...]

Case Report: This is a case of severe intravascular hemolysis, without significant coagulopathy, following envenomation by a North American crotalid. A MEDLINE search from 1966-1997, and a review of older literature, revealed no similar cases. A 4-year-old girl was envenomated in her right foot by a 2.5 foot-long rattlesnake whose description matched that of the Hopi rattlesnake (Crotalus viridis nuntius). The snake was not captured. Her initial hematocrit was 45%. In spite of treatment with antivenin and improvement in her lower extremity pain and swelling, her hematocrit decreased to 20.4%. Laboratory tests and clinical exam showed a Coombs positive hemolytic anemia without significant signs of coagulopathy., INTRODUCTION Snake venoms are a well-known cause of coagulopathy and syndromes of disseminated intravascular coagulation (DIC).[1-12] As many as 40 % of people envenomated by North American crotalids suffer from [...]

Background: Animal and human laboratory studies suggest marijuana may cause hyperthermia. However, there are no clinical case reports of life-threatening hyperthermia associated with use of marijuana alone. Case Re o : We report a patient who developed severe hyperthermia after smoking a marijuana cigarette and jogging on a warm day. He presented with delirium: hot, red, dry skin; and a rectal temperature of 41.7[degrees]C Historical and laboratory data indicated he had used cannabinoids and no other drugs. This is the first report of life-threatening hyperthermia temporally associated with use of marijuana alone., INTRODUCTION Heatstroke can be defined as a combination of an elevated body temperature of 40.0[degrees]C or more; central nervous system dysfunction such as delirium, coma, or seizures; and an exogenous [...]

Antidotal therapy for acetaminophen poisoning is routinely based on a single acetaminophen level obtained four or more hours after ingestion. Some experts recommend additional acetaminophen levels if there are coingestants. This case report describes a 20-year-old woman who ingested acetaminophen 13 g, propoxyphene napsylate 2 g and naproxen sodium 3.75 g. A 4.5 h acetaminophen level was 83.5 mg/L (nontoxic). A 6.75 h acetaminophen level was 124.6 mg/L (toxic). The patient was treated with N-acetylcysteine and recovered without sequelae. This is the first published report of a delayed toxic acetaminophen level occurring after an initial nontoxic level. Although rare, the possibility of a delayed peak acetaminophen level merits consideration, particularly with coingestions that delay gastric emptying., INTRODUCTION Antidotal therapy for acetaminophen (APAP) poisoning is routinely based on a single APAP level obtained four or more hours after ingestion[1,2]. Additional APAP levels have been recommended if there [...]

This case report describes seizures and encephalopathy in a nine year-old boy treated with iodoquinol for amebiasis. The toxicity of iodoquinol and other 8-hydroxyquinolines is discussed. The radiopacity of this medication, used worldwide for the treatment of diarrheal illnesses and dermatitis, may be diagnostically useful., INTRODUCTION Neurotoxicity from the 8-hydroxyquinolines, such as iodoquinol, is well documented[1,2], but seizures in man have not been reported during use of these medications. A number of ingested medications can [...]

Case Report: A suicidal, epileptic patient ingested ethanol, valproic acid, and gabapentin, a new antiepileptic drug. He did well clinically despite elevated blood gabapentin, valproic acid, and ethanol. Conclusions: Preliminary data from this case and one previous report indicate relatively mild clinical signs and symptoms with gabapentin poisoning., INTRODUCTION In 1993 the FDA approved gabapentin (GBP) as add-on therapy for adults with unsatisfactory control of partial seizures.[1] To date, five GBP overdoses have been published but only one [...]