Multiple Seizures After Bupropion Overdose in a Small Child

Abstract

Unintentional ingestion of bupropion in young children has generally resulted in limited toxicity. We report a case of pediatric bupropion ingestion resulting in multiple seizures. The patient experienced hallucinations, agitation, vomiting, tachycardia and seizures after ingestion of 1050 (48 mg/kg) of extended-release bupropion. The potential for severe toxicity in the setting of pediatric overdose should be recognized.

Bupropion Induced Serotonin Syndrome: A Case Report

“…Givens and Gabrysch reported an ingestion of 2 g of bupropion by a 3-year-old child that resulted in seizures and profound hemodynamic instability in conjunction with complications from whole bowel irrigation [20]. Finally, Spiller and Schaeffer report seizures, hallucinations, ataxia, mydriasis, and moist mucous membranes in a 7-year-old boy following ingestion of 1,050 mg of bupropion [21]. None of the above reports describe the classic findings of lower extremity hyperreflexia and clonus that are seen in SS.…”

Bupropion Overdose Presenting as Status Epilepticus in an Infant

“…It has a plasma half-life of 10 hours, but longer half-lives have been reported for the metabolites. 6 Bupropion, erythrohydrobupropion, and threohydrobupropion have chemical structures similar to amphetamine, which may result in cross-reactivity with antibodies used in urine drug screen immunoassays. [8][9][10] Three reports demonstrated false-positive amphetamine urine drug screens associated with bupropion.…”

“…6 It is this second mechanism that might be partially responsible for the status epilepticus seen in our patient and the seizures reported in other cases of bupropion overdose.…”

“…3 Status epilepticus and cardiogenic shock after massive bupropion ingestion has been reported in adults. 4 Seizures have been reported after bupropion overdose in an infant and children, [5][6][7] but no cases of status epilepticus have been reported in children. Refractory hypotension and transient cardiac dysfunction in an infant from a massive bupropion overdose have been described.…”

Seizures After Overdoses of Bupropion Intake

“…Bupropion has a different chemical structure to selective serotonin reuptake inhibitors, cyclic antidepressants, and other agents typically used in depression treatment. Its chemical structure is similar to dietylpropion, an anorexiant, and sympathomimetic amine, which was developed to be used in intermittent or short-period obesity treatment (1). Although the mechanism of the effect of bupropion has not been completely elucidated, the drug and its metabolites have a weak inhibitor effect on noradrenalin and dopamine reuptake.…”