SHM Converge Scientific Abstract ePoster Gallery-Status: A Seizing Case of Bupropion

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This case describes a 20-year-old woman with a history of major depressive disorder and anxiety who presented after a large intentional overdose involving up to 85 pills of bupropion extended-release, escitalopram, and alprazolam. Initial evaluation showed hypokalemia and metabolic acidosis. Urine toxicology was positive for amphetamines, benzodiazepines, and cannabis, while acetaminophen, salicylates, and ethanol testing were negative.<br /><br />Poison Control guided treatment with nasogastric tube placement, activated charcoal, and whole bowel irrigation using 2 liters of GoLYTELY. When repeat EKG revealed prolonged QTc, intravenous lipid emulsion (ILE) was started. The patient then developed multiple witnessed generalized tonic-clonic seizures requiring repeated lorazepam and propofol, followed by intubation for airway protection due to status epilepticus. She was admitted to the ICU.<br /><br />Soon after, she became hypotensive and required norepinephrine. Echocardiography was unremarkable, and EEG showed no ongoing seizure activity. Imaging later demonstrated bilateral infiltrates and a small right pleural effusion, which were treated with ampicillin-sulbactam and furosemide. She was successfully extubated on hospital day 3, her cognition improved, and she was discharged voluntarily to a psychiatric unit.<br /><br />The discussion highlights that bupropion overdose can cause seizures, coma, hypotension, and cardiotoxicity, with no specific antidote available. Treatment is usually supportive, with benzodiazepines as first-line therapy for seizures and decontamination when appropriate. The authors note that while evidence is limited and controversial, ILE may be useful in severe bupropion toxicity, especially in delayed deterioration or refractory cardiogenic shock, particularly where ECMO is unavailable.

Asset Subtitle

Tochukwu G. Mbolu

Meta Tag

Author List Ali Elsayed, Aquino Williams, Divya Cheruku, Sydnee Lim, Tochukwu G. Mbolu

Category Clinical Vignettes

Concept Bupropion Overdose

Concept Seizure

Concept Hypotension

Concept Cardiotoxicity

Concept Status Epilepticus

Distinguished Non-Finalist

Presenter Organization Mountainside Medical Center

Presenting Author Tochukwu G. Mbolu

Track Adult

Keywords

bupropion overdose

intentional overdose

seizures

status epilepticus

intravenous lipid emulsion

QTc prolongation

hypotension

ICU admission

whole bowel irrigation

toxicology

Bupropion Overdose

Seizure

Hypotension

Cardiotoxicity

Status Epilepticus