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[Circulatory failure after bupropion overdose].

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A massive bupropion overdose led to severe complications, including cardiac arrest, requiring extracorporeal membrane oxygenation (ECMO). This case highlights a concerning rise in serious bupropion poisoning incidents.

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Area of Science:

  • Pharmacology
  • Toxicology
  • Emergency Medicine

Background:

  • Bupropion, an antidepressant, can cause severe toxicity in overdose.
  • Sustained-release formulations may present unique challenges in managing overdose.

Observation:

  • A patient presented with GCS 3, tachycardia, and vasoplegic shock after ingesting a large quantity of sustained-release bupropion tablets.
  • Despite initial stabilization, the patient developed wide complex arrhythmias and cardiac arrest, necessitating cardiopulmonary resuscitation (CPR) and venoarterial extracorporeal membrane oxygenation (VA-ECMO).
  • Gastroscopy revealed a significant number of undissolved bupropion tablets in the stomach 34 hours post-ingestion.

Findings:

  • Bupropion and hydroxybupropion blood levels were significantly elevated (790 and 1300 µg/l, respectively) at 36 hours.
  • Analysis of evacuated tablets showed no active substance, suggesting rapid absorption or degradation.
  • The patient recovered fully after VA-ECMO support and subsequent gastroscopy.

Implications:

  • This case underscores the potential for life-threatening complications from sustained-release bupropion overdose.
  • The findings suggest a need for enhanced monitoring and potentially earlier gastrointestinal decontamination in severe bupropion ingestions.
  • A recent increase in severe bupropion poisonings reported by the Swedish Poisons Information Centre warrants further investigation and public health awareness.