High yield highlight- Managing a Bupropion overdose

The Poison Lab

Ready for a high-octane dose of knowledge? 🔥🧠 Ryan's got you covered with this electrifying mini-episode on managing a bupropion overdose! 💊💥 Beware - there are plenty of pitfalls you'll want to avoid. Check out the full episode and other mini-episodes for even more tips and tricks! 🎧👀

1. Bupropion is the #1 antidepressant cause of major (life threatening) reported to U.S. Poison Centers
2. It is difficult to manage due to
   1. Potential for delayed seizures
   2. Unique cardiogenic shock in overdose
   3. Potential wide complex arrhythmia refractory to Sodium Bicarbonate
   4. Potential interference with brain death testing
3. Treatment
   1. Decontamination
      1. Aggressive whole bowel irrigation or charcoal may be indicated if large ingestion
   2. Supportive care
      1. Intubation if airway compromised
      2. Benzodiazepine for agitation
      3. Benzodiazepines and GABA-ergic AED's for status epileptics
         1. Tachycardia, tremor, and agitation are risk factor for seizures
         2. Tachycardia may be masked by alpha 2 agonist co ingestions
         3. Seizures may occur 24 hour out
      4. Sodium bicarbonate for wide QRS (it may be refractory)
      5. Inodilators and vasopressors for cardiogenic shock
      6. ECMO for refractory shock or arrhythmia
      7. Awareness that severe bupropion toxicity can mimic brain death
         1. send analytical confirmation of bupropion if possible to rule out confounding
   3. Enhanced elimination
      1. limited options due to protein binding, not routine
   4. Focused antidote
      1. Consider IV fat emulsion if the patient is peri arrest
   5. Observation times
      1. Talk to a toxicolleague about observation times, decontamination, and use of invasive therapies to avoid falling into a trap