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Cyclic vomiting syndrome (CVS) is a well-established cause of recurrent vomiting in the pediatric population. Severe vomiting with chronic cannabis use, known as cannabinoid hyperemesis syndrome, has recently been more widely recognized as an etiology of persistent episodic vomiting. In turn, patients presenting with frequent episodes of CVS are now increasingly being screened for cannabinoid use. Because patients with persistent vomiting are also frequently prescribed a proton pump inhibitor (PPI) for their gastrointestinal symptoms, it is important to be aware of the potential for a PPI to cause an interaction that can lead to false-positive urine cannabinoid screening. We describe a case of a false-positive urine cannabinoid screen in a patient with CVS who received a dose of intravenous pantoprazole. The primary reference regarding drug screen interference from PPIs can be found in the pantoprazole package insert that refers to pre-Food and Drug Administration approval data. Although multiple sources on the Internet report the possibility of positive cannabinoid screens from pantoprazole, there are no known published reports of the phenomenon in the medical literature.
Diana Felton; Naamah Zitomersky; Shannon Manzi; Jenifer R. Lightdale. 13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire. Pediatrics 2015, 135, e1060 -e1063.
AMA StyleDiana Felton, Naamah Zitomersky, Shannon Manzi, Jenifer R. Lightdale. 13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire. Pediatrics. 2015; 135 (4):e1060-e1063.
Chicago/Turabian StyleDiana Felton; Naamah Zitomersky; Shannon Manzi; Jenifer R. Lightdale. 2015. "13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire." Pediatrics 135, no. 4: e1060-e1063.
A 24-year-old female with idiopathic end-stage renal disease (ESRD) for the past 8 months, currently on home peritoneal dialysis, presented to an outside hospital with progressive confusion, tremulousness, clumsiness and a sensation of being “outside her own body.” The patient had been in her usual state of health until 2 days prior, around the time she concomitantly began to have a breakout of her genital herpes. The patient was previously prescribed valacyclovir, dosed at 1000 mg twice daily × 3 days, to be taken during outbreaks. This was the first outbreak of her genital herpes since the development of her renal disease. Since starting the valacyclovir, her neurologic symptoms had gradually worsened, to the point that on the evening prior to admission, she was too confused to even complete her scheduled peritoneal dialysis. She was seen that night at an outside hospital (OSH A) where she regularly receives her care. There, she was noted to be hypertensive but other ...
Colin Huguenel; Diana Felton; Rebecca Bruccoleri; Steven Salhanick. Case Files of the Harvard Medical Toxicology Fellowship: Valacyclovir Neurotoxicity and Unintentional Overdose. Journal of Medical Toxicology 2014, 11, 132 -136.
AMA StyleColin Huguenel, Diana Felton, Rebecca Bruccoleri, Steven Salhanick. Case Files of the Harvard Medical Toxicology Fellowship: Valacyclovir Neurotoxicity and Unintentional Overdose. Journal of Medical Toxicology. 2014; 11 (1):132-136.
Chicago/Turabian StyleColin Huguenel; Diana Felton; Rebecca Bruccoleri; Steven Salhanick. 2014. "Case Files of the Harvard Medical Toxicology Fellowship: Valacyclovir Neurotoxicity and Unintentional Overdose." Journal of Medical Toxicology 11, no. 1: 132-136.
Most patients who receive unconventional testing for metals do not have any remarkable exposure history and typically lack symptoms or objective findings compatible with classic heavy metal intoxication. Unconventional tests results are usually promoted by alternative practitioners as the basis for recommending, promoting, and selling to the patient questionable and often inappropriate therapies/interventions supposedly aimed at “detoxification”. Most of these patients will have no evidence of overexposure to metals on the basis of a thorough history and will have levels of metals on conventional tests performed at reliable laboratories that are undetectable, within population background ranges or above population background, but well below levels associated with toxicity.
Diana J. Felton; Stefanos N. Kales; Rose H. Goldman. An Update and Review of Unconventional Metals Testing and Treatment. Toxics 2014, 2, 403 -416.
AMA StyleDiana J. Felton, Stefanos N. Kales, Rose H. Goldman. An Update and Review of Unconventional Metals Testing and Treatment. Toxics. 2014; 2 (3):403-416.
Chicago/Turabian StyleDiana J. Felton; Stefanos N. Kales; Rose H. Goldman. 2014. "An Update and Review of Unconventional Metals Testing and Treatment." Toxics 2, no. 3: 403-416.
Diana Felton; Michael Ganetsky; Anders H Berg. Osmolal Gap without Anion Gap in a 43-Year-Old Man. Clinical Chemistry 2014, 60, 446 -448.
AMA StyleDiana Felton, Michael Ganetsky, Anders H Berg. Osmolal Gap without Anion Gap in a 43-Year-Old Man. Clinical Chemistry. 2014; 60 (3):446-448.
Chicago/Turabian StyleDiana Felton; Michael Ganetsky; Anders H Berg. 2014. "Osmolal Gap without Anion Gap in a 43-Year-Old Man." Clinical Chemistry 60, no. 3: 446-448.