The Poison Lab

Mini Episode: Who Seizes in Bupropion Overdose with Dr Ari Filip MD

Episode Summary

In this episode guest Dr Ari Filip MD (medical director of Arkansas Poison Center, medical toxicologist, emergency physician) joins Ryan to discuss what symptoms in overdose can help categorize bupropion overdoses as high or lower risk for seizure.

Episode Notes

  1. TL;DR
    1. Your patient can seize 8-24 hours in, usually they have neurologic symptoms and tachycardia before hand
    2. Tachycardia may be masked by coingestions and symptoms may be very delayed
    3. Do not discharge a patient without discussing observation time with a toxicologist or poison center
    4. Do not dismiss tachycardia and anxiety as situational in a bupropion overdose
  2. Spiller 1994- Review of instant release product overdoses 
  3. Shepherd 2004- Seizures in primarily sustained release products
    1. Most seizures had prodromal neuropsychiatric symptoms
  4. Starr 2009- Seizure in XL products. 
    1. Tachycardia, tremor, agitation most associated with seizures
    2. Seizure occured as late as 24 hours and 25% occurred after 8 hours 
  5. Offerman 2020- Primarily sustained/extended release products
    1. Tachycardia duration, and extent (>120) predicted seizure. (Hypotnesion and neuropsych symptoms also predict)
    2. Late seizure occurred only in those with symptoms on presentation
    3. Those who had cardiac arrest had prehospital seizure= bad sign
  6. Rianprakaisang 2021- ToxIC review of risk factors for seizures
    1. QTc and HR>140 predict seizures