Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report
AbstractIntroduction 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 se...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2021-11-01
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| Series: | Toxicology Communications |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/24734306.2021.1903725 |
| _version_ | 1797300158091755520 |
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| author | Michael E. O’Brien Michael Chary Philicia Moonsamy Michele M. Burns Andrew Tom Gaston Cudemus |
| author_facet | Michael E. O’Brien Michael Chary Philicia Moonsamy Michele M. Burns Andrew Tom Gaston Cudemus |
| author_sort | Michael E. O’Brien |
| collection | DOAJ |
| description | AbstractIntroduction 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. |
| first_indexed | 2024-03-07T23:03:12Z |
| format | Article |
| id | doaj.art-788ad2a9ae4f4cc99db09640eb5a7131 |
| institution | Directory Open Access Journal |
| issn | 2473-4306 |
| language | English |
| last_indexed | 2024-03-07T23:03:12Z |
| publishDate | 2021-11-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Toxicology Communications |
| spelling | doaj.art-788ad2a9ae4f4cc99db09640eb5a71312024-02-22T09:16:09ZengTaylor & Francis GroupToxicology Communications2473-43062021-11-0151858710.1080/24734306.2021.1903725Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case reportMichael E. O’Brien0Michael Chary1Philicia Moonsamy2Michele M. Burns3Andrew Tom4Gaston Cudemus5Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USARegional Center for Poison Control and Prevention, Boston, MA, USADivision of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USARegional Center for Poison Control and Prevention, Boston, MA, USADepartment of Pharmacy, Massachusetts General Hospital, Boston, MA, USADivision of Cardiac Anesthesiology, Massachusetts General Hospital Harvard Medical School, Boston, MA, USAAbstractIntroduction 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.https://www.tandfonline.com/doi/10.1080/24734306.2021.1903725BupropionECMOlipid emulsionpharmacokineticscase report |
| spellingShingle | Michael E. O’Brien Michael Chary Philicia Moonsamy Michele M. Burns Andrew Tom Gaston Cudemus Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report Toxicology Communications Bupropion ECMO lipid emulsion pharmacokinetics case report |
| title | Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report |
| title_full | Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report |
| title_fullStr | Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report |
| title_full_unstemmed | Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report |
| title_short | Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report |
| title_sort | successful use of ecmo and lipid emulsion for massive bupropion overdose a case report |
| topic | Bupropion ECMO lipid emulsion pharmacokinetics case report |
| url | https://www.tandfonline.com/doi/10.1080/24734306.2021.1903725 |
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