An Overdose that Happens Hours Later

​A 15-year-old girl was brought to the emergency department by EMS after a seizure witnessed by her mother. She admitted that she had ingested "a handful of pills" in a suicide attempt five hours earlier. The mother said her daughter had a history of cutting but no prior suicide attempts.Her past medical history was significant for depression, for which she took bupropion XL, and she reported past alcohol and marijuana use. Her initial vital signs were a temperature of 97.9°F, a pulse of 162 bpm, a blood pressure of 127/65 mm Hg, a respiratory rate of 14 bpm, and a pulse ox of 100% on room air. Her exam was significant for altered mental status, and she appeared post-ictal.The patient had no focal neurologic deficits. Her heart rate was tachycardic, and she had no muscle rigidity, hyperreflexia, or myoclonus. Her ECG demonstrated a sinus tachycardia with a normal QRS but a QTc of 509 ms. She had another seizure while in the ED, and was given 1 mg lorazepam IV. The seizure then stopped.She continued to have seizures despite frequent administration of lorazepam, and after her third episode, she was sedated with propofol and intubated. The patient was given multiple amps of bicarb, which had minimal effect on the QTc. The patient was transferred to the PICU.The Mechanism of BupropionBupropion is a monocyclic antidepressant structurally similar to amphetamines. It is a selective inhibitor of dopamine, serotonin, and norepinephrine reuptake. Bupropion also exerts anti...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs