She is complaining of vomiting and dizziness. On Exmination ;vitals signs HR 120 , BP 150/60, afebrile, RR 20,Spo2 100% in R.A
Blood sugars is 6 mmol/l . Systematic exam unremarkable apart from her being drowsy with GCS 14/15 and she is noted to have tremor.
Q1.What are the expected toxicity?
Q2.How will you manage this patient?
Depressed Lady Cont'
Thank you all for your excellent comments
•Venlafaxine are serotonin-norepinephrine reuptake inhibitors ( SNRI)
•Toxicity includes CNS: ataxia , sedation ,Tremor and seizure are common after SNRI
•CVS: effects are usually not life threatening and includes tachycardia , hypotension , SNRI can cause hypertension , severe venlafaxine overdose have been associated with QRS and QT prolongation and cardiac conduction defect
•Serotonin Syndrome is described with overdose of SNRI
Management:
•Laboratory investigation includes : electrolytes , glucose , ABG , ECG , and ruling out other co ingestion
•Usually supportive with CNS and cardiac monitoring
•Activated charcoal can be given if appropriate conditions and if no contraindication, this patient is already drowsy so not indicated
•For serotonin syndrome benzo can be used for tremor and agitation and seizure
•Severe serotonin syndrome with hyperthermia needs aggressive cooling and intubation with paralysis
•Cyproheptadine is also reported to be effective in severe serotonin syndrome
•Symptomatic patient need admission for observation
References:
•Olson’s Poisoning and Drug Overdose , 6th edition ,