Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report. Issue 1 (30th November 2021)

• Record Type: Journal Article
• Authors: O'Brien, Michael E.; Chary, Michael; Moonsamy, Philicia; Burns, Michele M.; Tom, Andrew; Cudemus, Gaston
• Is Part Of: Toxicology communications. Volume 5:Issue 1(2021)
• Page Start: 85
• Page End: 87
• Publication Date: 2021-11-30
• Subjects: Bupropion -- ECMO -- lipid emulsion -- pharmacokinetics -- case report; Toxicology -- Periodicals; 615.9005
• DOI: 10.1080/24734306.2021.1903725
• Languages: English
• ISSNs: 2473-4306

Abstract

Abstract: Introduction: Bupropion overdose can produce seizures, arrhythmias, and shock. The toxicokinetics of massive bupropion ingestions are not well characterized. Case report: A 22-year-old female ingested an estimated 40.5 g (644 mg/kg) of extended release bupropion. Subsequently she experienced seizures, required intubation, developed torsades des pointes that progressed to cardiac arrest, and required cannulation with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Intravenous lipid emulsion was administered without adversely affecting the ECMO circuit. The patient was successfully decannulated after 84 h of ECMO support and discharged neurologically intact. Serial bupropion and hydroxybupropion serum concentrations were drawn every 6-12 h starting on hospital day one and continuing for seven days, for a total of 22 serum concentrations each. Discussion: The patient's first bupropion and hydroxybupropion serum concentrations were 4000 ng/mL and 5300 ng/mL, respectively. Clearance of bupropion followed first order kinetics (t ½ = 20.6 h) while hydroxybupropion had zero order kinetics (t ½ = 118.5 h). Conclusion: This bupropion overdose was treated with VA-ECMO with 20% lipid emulsion therapy, without complications. In this patient, the toxicokinetics of bupropion were first-order.