Bupropion toxicity: Difference between revisions
| Line 23: | Line 23: | ||
==Management== | ==Management== | ||
* | *Activated charcoal or gastric emptying are not indicated | ||
**Consider whole-bowel irrigation for sustained-release formulations | **Consider whole-bowel irrigation for sustained-release formulations | ||
*[[Seizure|Seizure Treatment]] | *[[Seizure|Seizure Treatment]] | ||
| Line 29: | Line 29: | ||
**[[Barbiturates]] are 2nd line | **[[Barbiturates]] are 2nd line | ||
*Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility) | *Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility) | ||
*[[Sodium bicarbonate]] if QRS prolongation | |||
*Intralipid for refractory cases | *Intralipid for refractory cases | ||
Revision as of 14:37, 1 September 2019
Background
- Bupropion is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation
- Toxicity occurs with ingestion of >450mg/d
Clinical Features
- Agitation
- Dizziness
- Tremor
- Nausea/vomiting
- Drowsiness/lethargy
- Tachycardia
- Seizure
- May develop in isolation from other symptoms
- Develops within first 1-4hr for regular-release, up to 8hr for delayed release forms
- Hypotension and cardiogenic Shock
Differential Diagnosis
Seizure
- Epileptic seizure
- First-time seizure
- Seizure with known seizure disorder
- Status epilepticus
- Temporal lobe epilepsy
- Non-compliance with anti-epileptic medications
- Hyponatremia
- INH toxicity
- Non-epileptic seizure
- Meningitis
- Encephalitis
- Brain abscess
- Intracranial hemorrhage
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Barbiturate withdrawal
- Baclofen withdrawal
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia, hepatic failure, uremia
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Acute hydrocephalus
- Arteriovenous malformation
- Seizure with VP shunt
- Toxic ingestion (amphetamines, anticholinergics, cocaine, INH, organophosphates, TCA, salicylates, lithium, phenothiazines, bupropion, camphor, clozapine, cyclosporine, fluoroquinolones, imipenem, lead, lidocaine, metronidazole, synthetic cannabinoids, theophylline, Starfruit)
- Psychogenic nonepileptic seizure (pseudoseizure)
- Intracranial mass
- Syncope
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
Evaluation
- CBC, CMP
- ECG to eval for QRS and QT prolongation
Management
- Activated charcoal or gastric emptying are not indicated
- Consider whole-bowel irrigation for sustained-release formulations
- Seizure Treatment
- Benzos are 1st line
- Barbiturates are 2nd line
- Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)
- Sodium bicarbonate if QRS prolongation
- Intralipid for refractory cases
Disposition
- Consider discharge if asymptomatic after 8hr for regular-release ingestions