Mental Health Book

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Bupropion Overdose

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

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