Successful Management of Adolescent Bupropion Overdose with Intravenous Lipid Emulsion Therapy

Bornstein, Kasha; Montrief, Tim; Parris, Mehruba Anwar

doi:10.1055/s-0039-1693483

Cited by 14 publications

(24 citation statements)

References 31 publications

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“…Bupropion is a common behavioral modulator used to treat depression, mood disorders, and tobacco dependence [6]. Bupropion is a synthetic norepinephrine/dopamine/serotonin reuptake inhibitor and is available in three formulations including immediate release, sustained release, and extended release [7]. Bupropion has three major bioactive metabolites, of which hydroxybupropion is the most clinically relevant [7,8].…”

Section: Introductionmentioning

confidence: 99%

The Utility of Ecmo and Intraaortic Balloon Pumps in Lipophilic Beta Blocker and Bupropion Overdose

Akpunonu¹

2021

Corpus J Case Rep

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Patient: Female, 21 year old Final Diagnosis: Cardiogenic shock due to ingestion Symptoms: Encephalopathy, seizures Medication: Propranolol, Bupropion Clinical Procedure: ECMO, Intraaortic Balloon Pump Specialty: Critical Care, Toxicology Background Combined massive ingestion of Beta Adrenergic Blocking Medications (BBs), Calcium Channel Blockers (CCBs), and behavioral modulators can be dangerous due to their cardiotoxicity leading to hypotension and severe refractory cardiogenic shock. Beta blockers can cause serious myocardial depression by decreasing calcium influx into cells. Some beta blockers exhibit sodium channel blockade, while others cross the blood brain barrier due to their lipophilicity causing CNS toxicity. Behavioral modulators, specifically Bupropion, cause significant cardiac depression as well by acting as a potential cardiac gap junctions blocker and therefore decreasing intercellular communication. Case Report We present a case of combined massive drug ingestion leading to severe refractory cardiogenic shock where invasive mechanical support was implemented. Patient was a 21-year-old female who presented after polyingestion in a suicide attempt. Patient took a large amount of propranolol and bupropion. She initially presented in cardiogenic shock, and seizing. She was intubated for airway protection, started multiple vasopressors, and high - dose insulin. Despite multiple therapies, she continued to deteriorate and her ejection fraction continued to worsen, at which point she was cannulated for Extracorporeal Membrane Oxygenation (ECMO) and an Intraaortic Balloon Pump (IABP) for refractory cardiogenic shock. She was in the intensive care unit for multiple weeks. Her cardiac function improved and she was able to be weaned off the mechanical support devices and vasopressors. She was discharged to a rehab facility with a good neurological outcome. Conclusion The use of ECMO contributed to the overall outcome of our patient. ECMO has a direct impact on drug pharmacokinetics. ECMO can be used to alter drug levels based on altering clearance as well as direct extraction from the circuit. Based on these results, implementation of early ECMO should be considered in patients with massive overdoses in refractory cardiogenic shock.

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Section: Introductionmentioning

confidence: 99%

The Utility of Ecmo and Intraaortic Balloon Pumps in Lipophilic Beta Blocker and Bupropion Overdose

Akpunonu¹

2021

Corpus J Case Rep

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“…3 As suggested by Bornstein et al, the lipid sink theory, which is considered the mechanism underlying the effect of lipid emulsion as a nonspecific antidote, states that lipid emulsion absorbs highly lipid-soluble drugs, such as bupivacaine (log [octanol/water partition coefficient]: 3.41), from the heart. 1,4 However, the following comments should be considered to understand this case report well. First, the first administration of lipid emulsion improved the mental status of the patient.…”

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confidence: 98%

“…We have read with interest the case report, "Successful Management of Adolescent Bupropion Overdose with Intravenous Lipid Emulsion Therapy," recently published in the Journal of Pediatric Intensive Care. 1 Lipid emulsion is effective in the treatment of acute toxicity induced by local anesthetics or nonlocal anesthetic drugs, including amitriptyline, bupropion, and verapamil, in pediatric patients. 2 A previous in vitro study reported that the magnitude of the reduction of the serum concentration of bupropion, which is a highly lipid-soluble antidepressant (log [octanol/water partition coefficient]: 3.2), was 46 by 2% lipid emulsion (Intralipid).…”

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confidence: 99%

“…First, the first administration of lipid emulsion improved the mental status of the patient. 1 On day 3, the second administration of lipid emulsion was performed due to the recurrence of an altered mental status. 1 The elimination half-life of bupropion is 29 AE 9 hours.…”

mentioning

confidence: 99%

“…1 On day 3, the second administration of lipid emulsion was performed due to the recurrence of an altered mental status. 1 The elimination half-life of bupropion is 29 AE 9 hours. 5 In addition, the absorption of a toxic dose following oral administration (enteral route) is more prolonged than that following intravenous administration, leading to extended toxicity.…”

mentioning

confidence: 99%

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