II. Pharmacokinetics
- See Bupropion
III. Findings: General
- Tachycardia (23%)
- Nausea and Vomiting (14%)
- Intraventricular conduction abnormalities (Wide QRS, Prolonged QTc)
- May occur with large Overdoses
- See Management below
IV. Findings: Neurologic
- Delirium
- Lethargy
- Confusion
- Tremors
-
Seizures (11-20%)
- Occur up to 14 hours after ingestion (esp. sustained release products)
- May occur with Overdose >600 mg (but typically occurs with Overdose >2500 mg)
- Prolonged and recurrent Seizures may occur with extended release preparations
- Treat Seizures with Benzodiazepines (other antiepileptics in Status Epilepticus are not indicated)
- If intubated, Propofol is preferred for sedation
- Status Epilepticus with Bupropion Overdose is rare
V. Labs
- See Unkown Ingestion
-
Electrocardiogram
- Intraventricular conduction abnormalities (Wide QRS, Prolonged QTc
VI. Management
- See Unknown Ingestion
- ABC Management and supportive care
-
Decontamination
- Exercise caution due to aspiration risk
- Consider Activated Charcoal if <1 hour from ingestion
- Consider Whole Bowel Irrigation when ingestions >10 extended release pills (Bezoar risk)
- Intraventricular conduction abnormalities (Wide QRS, Prolonged QTc)
- Give 1-2 ampules bicarbonate IV frequently until QRS narrows (goal pH 7.45-7.55)
- Risk of decompensation to Cardiac Arrest
- Other measures
- Consider ECMO for refractory shock
- Consider Intravenous Lipid Emulsion (Intralipid) in severe cases (e.g. cardiac toxicity)
- Disposition
- Discharge if asymptomatic, reassuring findings at >6 hours after ingestion
- Extended release products are a risk for Seizures for >18 hours after ingestion (or while symptomatic)
VII. References
- Nordt and Shoenberger in Herbert (2019) EM:Rap 19(3): 8-9
- Riddle and Tomaszewski (2017) Crit Dec Emerg Med 31(9): 24
- Yen (2015) Crit Dec Emerg Med 29(10):18-23