Patricia Bacus1, Khadija Jadun2, Zahra Haghighat1, Ima Ebong1
1University of Kentucky, 2Punjab Rangers Teaching Hospital
Objective:
To discuss a case of Bupropion overdose in a pediatric patient who lost brainstem reflexes and experience focal seizures.
Background:
Bupropion, a selective inhibitor of dopamine and norepinephrine reuptake, is employed in managing various neuropsychiatric conditions such as anxiety and depression. It is linked to presenting a 'brain death' mimicry in three adult cases and one pediatric case. To our knowledge prior presentations have reported generalized seizures with no focal seizures and burst suppression on encephalogram (EEG) with three patients making a full neurological recovery once the metabolite had been excreted
Design/Methods:
Literature review using terms “Wellbutrin Overdose”, “bupropion overdose”, “seizures”, “brainstem reflexes” alongside with chart review
Results:
A 16-year-old female with a history of depression and prior suicidal ideation presented to the ED after ingesting a combination of ethanol and a substantial quantity of extended-release Bupropion. The patient ingested Bupropion XR 300 mg tablets totalling 9-12 g (30-40 tablets) combined with 8-9 alcoholic beverages, with a QTc of 610 on electrocardiogram (EKG). The patient had a complex clinical course marked by focal seizures that showed brief electrographic seizures seen over the temporal regions and diffuse delta slowing, altered mental status, hemodynamic instability, and ultimately, loss of brainstem reflexes. The CT scan was normal, and the patient returned to baseline within 3 days
Conclusions:
This is the second case to be reported in a pediatric patient of bupropion overdose with loss of brainstem reflexes and the only survival to date in a pediatric population. This is the only patient reported without burst suppression on EEG with an abnormal neurological exam that showed no brainstem reflexes and the only one noted to have focal seizures. This case shows the importance in considering medication overdose when a patient presents without brainstem reflexes and broadens the seizure semiology that has been previously reported in bupropion overdoses.