Shortly thereafter the patient experienced a third seizure and was administered 2 mg (0.02 mg/kg) IV lorazepam with termination of seizure activity. Intravenous (IV) access was established and the patient was administered a 20 mL/kg normal saline bolus. Further examination disclosed no other focal abnormalities. Electrocardiogram (ECG) revealed sinus tachycardia with borderline prolonged QTc at 461 milliseconds (ms) and normal QRS interval at 84 ms ( Her blood pressure was 121/87 mm Hg respiratory rate, 24 temperature, 38.6☌ and oxygen saturation, 98% on room air. Her abdomen was soft and nontender with normal bowel sounds. Her airway was intact and she had clear lung sounds. Physical examination revealed the patient to be tachycardic to 138 beats per minute with strong pulses in all extremities. Following this seizure, the patient became somnolent with a Glasgow Coma Score of 11 spontaneous eye opening, incomprehensible speech, and purposeless movements. Upon ED arrival, the patient experienced a self-limited second seizure lasting 30 seconds. Emergency medical services were called and transported the patient to the emergency department (ED). Although ingested pill quantity was unknown, the patient's mother counted approximately eleven pills (1,650 mg) in the patient's emesis. Approximately 1-hour postingestion, the patient experienced a generalized tonic-clonic seizure. This case represents a successful application of toxicologist-recommended ILE use with prompt and effective reversal of bupropion induced neurotoxicity and symptomatology.Ī 15-year-old, 67.2-kg female patient with no significant past medical or psychiatric history intentionally ingested between an estimated 1,650 to 9,000 mg (24–133 mg/kg) of bupropion in the form of 150 mg bupropion extended-release tablets belonging to her recently deceased grandmother. ![]() While recognized off-label as a salvage therapy for bupropion overdose resulting in hemodynamic instability and cardiovascular collapse, ILE use is not standard in the setting of status epilepticus. ILE use as an antidotal agent came into vogue in the past two decades based on pharmacologic principles and case reports, despite sparse high-quality data supporting its use and limited recommendation by the American College of Medical Toxicology (ACMT) and Poison Control Centers (PCC). We report a case of adolescent bupropion ingestion resulting in multiple seizures with subsequent derangements to blood chemistries managed with intravenous lipid emulsion (ILE) therapy. Many reports in the literature describe massive ingestions in adolescents presenting challenges in management. ![]() ![]() Its primary toxic effects include seizure, tachycardia, and agitation. Bupropion (Wellbutrin, GlaxoSmithKline) is a synthetic cathinone norepinephrine/dopamine reuptake inhibitor commonly used as an antidepressant.
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