Neurocritical Care

, Volume 26, Issue 1, pp 119–121 | Cite as

Coma with Absent Brainstem Reflexes and Burst Suppression after Bupropion Overdose in a Child

  • Raquel Farias-Moeller
  • Jessica L. Carpenter


Coma associated with absent brainstem reflexes and an initial normal computed tomography (CT) scan is a diagnostic challenge. Spontaneous burst suppression on an electroencephalogram (EEG) may also require explanation. Though unusual, bupropion overdose can present with this constellation of findings. With drug clearance, patients can fully recover. We present a pediatric patient with burst suppression pattern on EEG associated with coma and absent brainstem reflexes following bupropion overdose.

Case Presentation and Management

A 13-year-old girl with history of depression was taken to the local emergency department (ED) after ingesting 21,000 mg of bupropion in an attempt to commit suicide. She was initially conscious but deteriorated shortly after arrival to the ED, when she developed a generalized seizure with subsequent apnea for which she was intubated.

Upon arrival to the pediatric intensive care unit (PICU), her physical examination was significant for a heart rate...


Bupropion Burst suppression Brain death 


  1. 1.
    Hurt RD, Sachs DP, Glover ED, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med. 1997;337:1195–202.CrossRefPubMedGoogle Scholar
  2. 2.
    Patel K, Allen S, Haque MN, Angelescu I, Baumeister D, Tracy DK. Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacol. 2016;6:99–144.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fava M, Rush AJ, Thase ME, et al. 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Prim Care Companion J Clin Psychiatry. 2005;7:106–13.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mundi JP, Betancourt J, Ezziddin O, Tremayne B, Majic T, Mosenifar Z. Dilated and unreactive pupils and burst-suppression on electroencephalography due to buproprion overdose. J Intensive Care Med. 2012;27:384–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Harris CR, Gualtieri J, Stark G. Fatal bupropion overdose. J Toxicol Clin Toxicol. 1997;35:321–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Heise CW, Skolnik AB, Raschke RA, Owen-Reece H, Graeme KA. Two cases of refractory cardiogenic shock secondary to Bupropion successfully treated with veno-arterial extracorporeal membrane oxygenation. J Med Toxicol. 2016. doi: 10.1007/s13181-016-0539-7.Google Scholar
  7. 7.
    Shepherd G, Velez LI, Keyes DC. Intentional bupropion overdoses. J Emerg Med. 2004;27:147–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Davoudian V. Bupropion overdose mimicking brain death. American College of Physicians Colorado, Chapter Annual Meeting, 2008. Colorado Springs: Broadmoor Hotel; 2008.Google Scholar
  9. 9.
    Borges MA, Botos HJ, Bastos RF, Godoy MF, Marchi NS. Emergency EEG: study of survival. Arq Neuropsiquiatr. 2010;68:174–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Niedermeyer E. The burst-suppression electroencephalogram. Am J Electroneurodiagnostic Technol. 2009;49:333–41.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Child NeurologyChildren’s National Health SystemWashingtonUSA

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