Misdiagnosis of Bupropion Intoxication

Tarik Acar, Nurettin Onur Kutlu, Huseyin Caksen, Suleyman Sahin, Mehmet Ergin, Basar Cander

Abstract


Bupropion inhibits catecholamine’s neuronal reuptake selectively but has a minimal effect on indolamine reuptake. It can be used in the treatment of major depressive disorder. A 3.5-year-old 15 kg girl had vomiting and disorders in her speech. After a time, she did not take breath and stared at one point and had a seizure. She was diagnosed with epilepsy and diazepam and then phenytoin was given intravenously. Midazolam infusion was performed. Although phenytoin loading and midazolam infusion, she had seizures intermittently. Her anamnesis in terms of drug story was rechecked but her family did not give any important data. Due to atypical process in clinical picture, multi-drug survey, stomach irrigation and activated charcoal were performed. The parent found bupropion which patient’s mother had used. During 14 days follow-up, she was intubated and mechanical ventilation was performed. She had resuscitation for three times due to cardiopulmonary arrest. Fortunately, after successful conservative treatment, she was discharged without any neurological sequel. Neurologic effects are tremor, pain, hallucinations, coma and seizures. Cardiovascular effects are tachycardia and widening in QRS and lengthened QT interval. Gastrointestinal effects are nausea and vomiting. Deaths were reported rarely. In our case, the patient had most of the findings stated above. So that wide QRS tachycardia firstly, then bradycardia and asystole finally had developed. When child is admitted to emergency service with seizures, their parents must be asked about intoxication.




J Med Cases. 2015;6(7):322-324
doi: http://dx.doi.org/10.14740/jmc2180w

Keywords


Bupropion; Poisoning, Complication; Convulsion; Cardiac support; Critical and intensive care

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