Bupropion overdose
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Seizures, hypotension and bradycardia in a child following accidental ingestion: case report A 3-year-old boy developed various toxicities following accidental bupropion ingestion. The boy ingested eight extended-release 300mg bupropion tablets (140 mg/kg). He vomited en route to an emergency department (ED) and, on arrival, had a 3-minute generalised tonic-clonic seizure [time to reaction onset not clearly stated]. The boy received IV lorazepam and, approximately 5 hours postingestion, he arrived at a paediatric ED mildly sleepy, with tachycardia, tachypnoea and hypertension. He had slight myoclonic jerks in all limbs every 5–6 minutes. His potassium level was 3.1 mEq/L and he had sinus tachycardia. He underwent whole bowel irrigation with polyethylene glycol and electrolyte solution. Six hours after bupropion ingestion, he had a 5-minute generalised tonic-clonic seizure. His breathing became more sonorous and a nasal trumpet was placed. Lorazepam was given. He was somnolent, but rousable; his tachycardia persisted. His creatinine level was 0.4 mg/dL and an arterial blood gas showed a pH of 7.4, a PCO2 of 45mm Hg and a PO2 of 295mm Hg on oxygen. A chest x-ray showed a right lower lobe infiltrate. He was admitted to the paediatric ICU 8 hours postingestion with sinus tachycardia. Around 14 hours postingestion, he had increased work of breathing and abdominal distension. Nasopharyngeal suction returned polyethylene glycol and electrolyte solution. His respiratory state continued to decline, necessitating intubation 15 hours postingestion. Chest x-ray showed progression of his right lower lobe infiltrate and, 16 hours postingestion, he had two short seizures that were treated with midazolam. His BP decreased to 50/30mm Hg and he received saline. He desaturated to 60% and had pulmonary oedema on suctioning. His HR remained between 140–160 beats/min through the day but, 22 hours postingestion, his HR decreased to 50 beats/min. His pulses were lost and he received chest compressions and epinephrine [adrenaline]; his HR increased to 130 beats/min. He received dopamine with little response. Epinephrine and norepinephrine maintained his BP at appropriate levels. He had no further bradycardia or hypotension. His cardiovascular status continued to improve and he was gradually weaned from cardiotonics by day 4. Subsequently, he received antibiotics for aspiration pneumonia and he developed severe acute respiratory distress syndrome. He gradually improved and was extubated on hospital day 21; he was discharged on hospital day 30. Author comment: "Although therapeutic half-lives cannot be extrapolated to the overdose setting, it is likely that bupropion or its metabolites were still present in this patient’s system when complications ensued. . . This case also highlights the risk of aspiration in patients undergoing [whole bowel irrigation" Givens ML, et al. Cardiotoxicity associated with accidental bupropion ingestion in a child. Pediatric Emergency Care 23: 234-237, No. 4, Apr 2007 801078038 USA
0114-9954/10/1159-0001
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