Addiction Toxicology Case Conference - March 2021

Case 1
A 29-year-old G2P10012 female delivers a 7 lb 2.8 oz baby boy at 38 3/7 weeks. Apgars at 1 min and 5 min 7 and 8. At 33 hours the newborn is noticed to be “jittery, have increased tone, very spitty” and has 6 x stools and 7 x emesis. Scoring 11 and 9 for NAS and transferred the following day to a tertiary care center. Mother has been diagnosed with BPAD and was taking a variety of medications, including venlafaxine, throughout pregnancy. No urine or meconium testing done. Toxicology consulted as patient’s NAS have increased to >15 on day 3 despite use of clonidine 1 mcg/kg/6 hours and phenobarbital 2.5 mg/kg/day. Is this SNRI withdrawal/discontinuation? How do you proceed?

Case 2
A 27-year-old female with a long history of polydrug dependence, including opioids and stimulants, had been staying in a local YWCA-associated program for women in recovery. She was prescribed 8/2 mg buprenorphine/naloxone SL TID and had been taking that for 6 months. She was also prescribed gabapentin 800 mg PO TID (though reported taking extra at times). Other meds include clonidine (taken intermittently). After delivery, her baby is scoring much higher than anticipated, despite treatment for NAS, and the NICU consults Toxicology for evaluation regarding possible gabapentin and other substance withdrawal as well.

Series Moderators

• Timothy J. Wiegand, MD, FACMT, DFASAM (ACMT/ASAM Expert), Director of Toxicology and of the Toxicology Consult Service, University of Rochester Medical Center, Rochester, NY  
• Gloria J. Baciewicz, MD (ASAM Expert), Medical Director, Strong Recovery; Professor of Clinical Psychiatry, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY

Panelists

• Nancy Onisko, DO, FACEP (Guest Expert) Assistant Professor of Emergency Medicine, Faculty in Medical Toxicology, University of Texas Southwestern Medical Center; Co-Director, Perinatal Intervention Program, Parkland Hospital and Health System, Dallas, TX
• Neil S. Seligman, MD, MS (Guest Expert) Director, Labor & Delivery, Strong Memorial Hospital; Associate Professor, Division of Maternal- Fetal Medicine, University of Rochester Medical Center, Rochester, NY
• Tricia Wright, MD, MS, FACOG, DFASAM (ASAM Expert) Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Francisco, San Francisco, CA

About The Series: The ACMT/ASAM Addiction Toxicology Case Conference webinar series discusses Addiction/Toxicology cases in an interactive fashion featuring experts from Addiction Medicine, Addiction Psychiatry, and Medical Toxicology.

This webinar is open to the public.