A Lazarus effect: A case report of Bupropion overdose mimicking brain death

Stranges, Douglas; Lucerna, Alan; Espinosa, James; Malik, Neveen; Mongeau, M; Schiers, Kelly; Shah, Syed Omar; Wiley, Joan; Willsie, Philip

doi:10.5847/wjem.j.1920-8642.2018.01.011

Cited by 15 publications

(8 citation statements)

References 12 publications

(9 reference statements)

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“…We propose bupropion should be considered a clinically important confounder with unique and dramatic effects on the neurological examination. There have been several descriptions of comatose patients with fixed mydriasis and a burst suppression cEEG secondary to bupropion overdose but without an accompanying cardiopulmonary arrest [5][6][7]. This supports the notion of bupropion playing a role in a clinically comatose patient apart from any concurrent anoxic brain injury.…”

Section: Discussionmentioning

confidence: 53%

Bupropion overdose as a clinically significant confounder of the neurological examination

Reyes

Figueroa

2020

J Neurocrit Care

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Section: Discussionmentioning

confidence: 53%

Bupropion overdose as a clinically significant confounder of the neurological examination

Reyes

Figueroa

2020

J Neurocrit Care

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“…The search algorithm produced 961 manuscripts; 86 were reviews or discussions on the topic of brain death and 26 contained cases that fulfilled criteria, including one duplicated case [5,6]. A hand search of the references of all relevant papers resulted in an additional 27 manuscripts with cases that met criteria.…”

Section: Resultsmentioning

confidence: 99%

“…We grouped substances with greater than five cases into separate descriptive tables. Snake envenomation (Table 1) [7][8][9][10][11][12][13][14][15][16] was the most frequent cause of a brain death mimic, followed by baclofen (Table 2) [17][18][19][20][21][22][23][24][25][26][27], tricyclic antidepressants (TCA) ( Table 3) [28][29][30][31][32][33][34] and bupropion (Table 4) [5,6,[35][36][37][38][39][40]. We grouped all cases with three or fewer cases into Table 5 [41][42][43][44][45][46][47][48...…”

Section: Resultsmentioning

confidence: 99%

“… Neuroimaging Normal CT x3 –arrival –24-h –40-h CT at 48 h: diffuse edema 6-h: Burst suppression; 18-h: generalized slowing with faster frequencies; 24-h: generalized slowing; 48-h: electrical silence NR Died; CT after cardiac arrest displayed edema, EEG silent [ 38 ] 32/M 27 g ~ 24 h Fixed and dilated pupils. Absent corneal, oculocephalic, and gag reflex NR NR NR [Bupropion] 5898.8 ng/mL; [Hydroxybupropion] 3521.8 ng/mL “Discharged without appreciable motor or cognitive deficits” [ 5 ] [ 6 ] 47/F Unk 24–36 h Pupils fixed and dilated. “She lacked all brainstem reflexes” Neuroimaging Normal CT Burst suppression NR Tracheostomy; full neurologic recovery [ 39 ] 18/F 27 g 24–120 h Fixed and dilated pupils.…”

Section: Resultsmentioning

confidence: 99%

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Toxicologic Confounders of Brain Death Determination: A Narrative Review

2020

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The aim of this narrative review is to describe the toxicologic confounders of brain death currently reported in the literature to offer guidance for physicians assessing brain death after a toxic exposure. We established an a priori definition of a "brain death mimic" as an unresponsive, intubated patient missing some, but not all brainstem reflexes. We completed a review of the literature utilizing MEDLINE and EMBASE to find case reports of patients of all ages in English, French, and Spanish meeting the criteria and hand searched the references of the results. We recorded xenobiotic dose, duration of physical exam suggesting brain death, and how the cases failed to meet full brain death criteria, when available. Fifty-six cases representing 19 different substances met the a priori definition of brain death mimic. Xenobiotic toxicities included: snake envenomation (13), baclofen (11), tricyclic antidepressants (8), bupropion (7), alcohols (4), antiepileptic agents (3), barbiturates (2), antidysrhythmics (2), organophosphates (2), and one case each of magnesium, succinylcholine, tetrodotoxin, and zolpidem. All patients except one survived to discharge and the majority at their baseline physical health. The most common means by which the cases failed brain death examination prerequisites was via normal neuroimaging. The xenobiotics in this review should be considered in cases of poisoning resulting in loss of brainstem reflexes and addressed before brain death determination. Brain death diagnosis should not be pursued in the setting of normal cerebral imaging or incomplete evaluation of brain death prerequisites.

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“…Some cases have reported such extreme somnolence that brain stem reflexes are completely absent, and patients may be considered brain dead, only to awake days later as the drug is cleared. 65 The mechanism by which these non-sympathomimetic manifestations occur in bupropion overdose is not known.…”

Section: Introductionmentioning

confidence: 99%

Part I: Case series: Acute management of prescription and nonprescription drug overdoses

Feldman,

Leonard

2024

J Am Coll Clin Pharm

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Reviewed by Julianne Yeary, Pharm.D., BCCCP; and Monica Owen, Pharm.D., BCPS, BCCCP LEARNING OBJECTIVES 1. Classify prescription drug overdose by patient presentations.2. Evaluate the causative agents of a drug overdose based on history and clinical findings of presentation.3. Develop a treatment paradigm that may be applied in all prescription drug overdoses.4. Assess the relevance of each therapeutic target in drug overdose in a specific drug overdose scenario.5. Devise a plan for treatment of anticholinergic, sodium channel blocker, tricyclic antidepressant, bupropion, digoxin, sulfonylurea, alpha-2 agonist, iron, valproic acid, clonidine, and salicylate overdose.6. Justify the use of specific antidotes in overdose.Target audience for this application-based activity: Pharmacotherapy specialists and advanced level clinical pharmacists whose practice involves the direct care and management of critically ill patients in the ICU and emergency department.

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A Lazarus effect: A case report of Bupropion overdose mimicking brain death

Cited by 15 publications

References 12 publications

Bupropion overdose as a clinically significant confounder of the neurological examination

Bupropion overdose as a clinically significant confounder of the neurological examination

Toxicologic Confounders of Brain Death Determination: A Narrative Review

Part I: Case series: Acute management of prescription and nonprescription drug overdoses

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