title: Refractory hypotension from massive bupropion overdose successfully treated with extracorporeal membrane oxygenation.
abstract: An 11-month-old male infant presented with history of bupropion ingestion (750 mg/kg). He developed seizures, respiratory failure, and severe hypotension with metabolic acidosis refractory to inotropic support. The patient received mechanical ventilation, intralipids, phenytoin, inotropic support (dopamine, norepinephrine, and epinephrine), and extracorporeal membrane oxygenation (ECMO). Inotropes were weaned upon initiation of ECMO and discontinued 66 hours after ingestion. Total ECMO duration was 71 hours. The patient was extubated on hospital day 8 and has not had any neurological sequelae upon 12-month follow-up examinations. We report for the first time successful use of ECMO after ingestion of a potentially fatal dose of bupropion.
authors.affiliation: Department of Pediatrics, Children's Hospital of New Jersey, Newark, NJ 07112, USA.
authors.forename: Asha N
authors.initials: AN
authors.lastname: Shenoi
authors.forename: Shira J
authors.initials: SJ
authors.lastname: Gertz
authors.forename: Sushmita
authors.initials: S
authors.lastname: Mikkilineni
authors.forename: Meena
authors.initials: M
authors.lastname: Kalyanaraman
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000506:poisoning; D001794:Blood Pressure / Q000187:drug effects; D016642:Bupropion / Q000506:poisoning*; D062787:Drug Overdose / Q000150:complications / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D007223:Infant; D008297:Male
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion