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