Venlafaxine withdrawal
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Venlafaxine withdrawal Neonatal abstinence syndrome and encephalopathy: case report
A female neonate developed neonatal abstinence syndrome (NAS) presenting as encephalopathy following withdrawal of venlafaxine. The mother of the neonate received venlafaxine 12.5 mg/day during her pregnancy, which was increased to 150mg, 2 months before delivery for the treatment of depression. The neonate was delivered via caesarean section secondary to placenta previa at 37 weeks gestation. Her Apgar score was 7 at 1 minute and 5 minutes. Her weight was noted to be 2930g. After delivery her mother discontinued the drug. She was breast-fed and had stable vital signs. She was discharged on day 3, with a known weight loss of 6.3%. On day 5, she was presented to the emergency department with decreased activity and feeding, feeling cold to touch and a rectal temperature of 34.7°C. Her vital signs were normal. A full sepsis workup showed CRP level of 27 mg/L and absolute bands of 2 × 109/L. An increased concentration was observed during urinalysis. A lumbar puncture was attempted two times, but was unsuccessful. She received sodium-chloride [Normal saline] followed by ampicillin and gentamicin empirically. Hypothermia resolved within 12h along with decrease in CRP. Excessive sleepiness and poor oral feeding along with poor suck and ineffective latching was observed. Based on lack of progress and persistent weight loss, a decision was made to start a nasogastric tube (NGT) feedings. Twenty-four hours after hospitalisation, NGT was started with expressed breast milk at a daily total volume of 150 mL/kg/day and 24 kcal/oz fortified formula. An increase in weight was noted. On day 11, rapid normalising activity was seen with more interest in oral feedings. She was eventually started on full oral feeds by day 13. On day 15, she was discharged with good clinical condition and full oral feedings. Her weight at discharge was noted to be 3025g. No developmental or clinical abnormalities were observed at 2 months age follow-up. It was reported that, the neonate had developed NAS presenting as encephalopathy secondary to withdrawal of venlafaxine. Maalouli WM, et al. Venlafaxine-induced encephalopathy in term newborn. SAGE Open Medical Case Reports 8: 1-3, 2020. Available from: URL: http:// doi.org/10.1177/2050313X20952981
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Reactions 26 Sep 2020 No. 1823
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