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Journal of Medical Toxicology

, Volume 12, Issue 3, pp 301–304 | Cite as

Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation

  • C. William HeiseEmail author
  • Aaron B. Skolnik
  • Robert A. Raschke
  • Huw Owen-Reece
  • Kimberlie A. Graeme
Toxicology Observation

Abstract

Bupropion inhibits the uptake of dopamine and norepinephrine. Clinical effects in overdose include seizure, status epilepticus, tachycardia, arrhythmias, and cardiogenic shock. We report two cases of severe bupropion toxicity resulting in refractory cardiogenic shock, cardiac arrest, and repeated seizures treated successfully. Patients with cardiovascular failure related to poisoning may particularly benefit from extracorporeal membrane oxygenation (ECMO). These are the first cases of bupropion toxicity treated with veno-arterial EMCO (VA-ECMO) in which bupropion toxicity is supported by confirmatory testing. Both cases demonstrate the effectiveness of VA-ECMO in poisoned patients with severe cardiogenic shock or cardiopulmonary failure.

Keywords

ECMO Cardiogenic shock Overdose Bupropion Extracorporeal membrane oxygenation Status epilepticus 

Notes

Compliance with Ethical Standards

Conflicts of Interest

All authors have no conflicts of interest nor financial stake to disclose.

Informed Consent

Consent for publication of these cases was obtained and provided to the journal in accordance with JMT policy.

Sources of Funding

None

References

  1. 1.
    Arias HR, Santamaría A, Ali SF. Pharmacological and neurotoxicological actions mediated by bupropion and diethylpropion. Int Rev Neurobiol. 2009;88:223–55.CrossRefPubMedGoogle Scholar
  2. 2.
    Ascher JA, Cole JO, Colin JN, Feighner JP, Ferris RM, Fibiger HC, Golden RN, Martin P, Potter WZ, Richelson E. Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995.Google Scholar
  3. 3.
    Fava M, Rush AJ, Thase ME, Clayton A, Stahl SM, Pradko JF, 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(3):106.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd annual report. Clin Toxicol. 2015;53(10):962–1147.CrossRefGoogle Scholar
  5. 5.
    Curry SC, Kashani JS, LoVecchio F, Holubek W. Intraventricular conduction delay after bupropion overdose. J Emerg Med. 2005;29(3):299–305.CrossRefPubMedGoogle Scholar
  6. 6.
    Caillier B, Pilote S, Castonguay A, Patoine D, Ménard‐Desrosiers V, Vigneault P, et al. QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile. Fundam Clin Pharmacol. 2012;26(5):599–608.CrossRefPubMedGoogle Scholar
  7. 7.
    Shenoi AN, Gertz SJ, Mikkilineni S, Kalyanaraman M. Refractory hypotension from massive bupropion overdose successfully treated with extracorporeal membrane oxygenation. Pediatr Emerg Care. 2011;27(1):43–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Johnson NJ, Gaieski DF, Allen SR, Perrone J, DeRoos F. A review of emergency cardiopulmonary bypass for severe poisoning by cardiotoxic drugs. Jo Med Toxicol. 2013;9(1):54–60.CrossRefGoogle Scholar
  9. 9.
    Kolcz J, Pietrzyk J, Januszewska K, Procelewska M, Mroczek T, Malec E. Extracorporeal life support in severe propranolol and verapamil intoxication. J Intensive Care Med. 2007;22(6):381–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Durward A, Guerguerian AM, Lefebvre M, Shemie SD. Massive diltiazem overdose treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2003;4(3):372–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA. 2009;302(17):1888–95.CrossRefPubMedGoogle Scholar
  12. 12.
    Masson R, Colas V, Parienti JJ, Lehoux P, Massetti M, Charbonneau P, et al. A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication. Resuscitation. 2012;83(11):1413–7.CrossRefPubMedGoogle Scholar
  13. 13.
    St-Onge M, Fan E, Mégarbane B, Hancock-Howard R, Coyte PC. Venoarterial extracorporeal membrane oxygenation for patients in shock or cardiac arrest secondary to cardiotoxicant poisoning: a cost-effectiveness analysis. J Crit Care. 2015;30(2):437–e7.CrossRefPubMedGoogle Scholar
  14. 14.
    De Lange DW, Sikma MA, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol. 2013;51(5):385–93.CrossRefGoogle Scholar
  15. 15.
    Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905–14.CrossRefPubMedGoogle Scholar
  16. 16.
    Hoffman A, Pinto E, Gilhar D. Effect of pretreatment with anticonvulsants on theophylline-induced seizures in the rat. J Crit Care. 1993;8(4):198–202.CrossRefPubMedGoogle Scholar
  17. 17.
    Mousavi S, Levcovich B, Mojtahedzadeh M. A systematic review on pharmacokinetic changes in critically ill patients: role of extracorporeal membrane oxygenation. Daru: Journal of Faculty of Pharmacy, Tehran University of Medical Sciences. 2011;19(5):312.Google Scholar
  18. 18.
    Elliott ES, Buck ML. Phenobarbital dosing and pharmacokinetics in a neonate receiving extracorporeal membrane oxygenation. Ann Pharmacother. 1999;33(4):419–22.CrossRefPubMedGoogle Scholar
  19. 19.
    Sirianni AJ, Osterhoudt KC, Calello DP, Muller AA, Waterhouse MR, Goodkin MB, et al. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med. 2008;51(4):412–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Lee HM, Archer JR, Dargan PI, Wood DM. What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Clin Toxicol. 2015;53(3):145–50.CrossRefGoogle Scholar
  21. 21.
    Laizure SC, DeVane CL. Stability of bupropion and its major metabolites in human plasma. Ther Drug Monit. 1985;7(4):447–50.CrossRefPubMedGoogle Scholar

Copyright information

© American College of Medical Toxicology 2016

Authors and Affiliations

  • C. William Heise
    • 1
    • 2
    Email author
  • Aaron B. Skolnik
    • 2
  • Robert A. Raschke
    • 3
  • Huw Owen-Reece
    • 3
  • Kimberlie A. Graeme
    • 2
  1. 1.Center for Toxicology and Pharmacology Education and ResearchUniversity of Arizona College of Medicine PhoenixPhoenixUSA
  2. 2.Department of Medical ToxicologyBanner University Medical Center PhoenixPhoenixUSA
  3. 3.Department of Medicine, Section of Critical CareBanner University Medical Center PhoenixPhoenixUSA

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