High yield highlight- Managing a Bupropion overdose

Ready for a high-octane dose of knowledge? 🔥🧠 Ryan's got you covered with this electrifying mini-episode on managing a bupropion overdose! 💊💥  Beware - there are plenty of pitfalls you'll want to avoid. Check out the full episode and other mini-episodes for even more tips and tricks! 🎧👀

1. Bupropion is the #1 antidepressant cause of major (life threatening) reported to U.S. Poison Centers
2. It is difficult to manage due to
3. Potential for delayed seizures
4. Unique cardiogenic shock in overdose
5. Potential wide complex arrhythmia refractory to Sodium Bicarbonate 
6. Potential interference with brain death testing
7. Treatment
8. Decontamination
9. Aggressive whole bowel irrigation or charcoal may be indicated if large ingestion
10. Supportive care
11. Intubation if airway compromised
12. Benzodiazepine for agitation
13. Benzodiazepines and GABA-ergic AED's for status epileptics
14. Tachycardia, tremor, and agitation are risk factor for seizures
15. Tachycardia may be masked by alpha 2 agonist co ingestions
16. Seizures may occur 24 hour out
17. Sodium bicarbonate for wide QRS (it may be refractory)
18. Inodilators and vasopressors for cardiogenic shock
19. ECMO for refractory shock or arrhythmia
20. Awareness that severe bupropion toxicity can mimic brain death
21. send analytical confirmation of bupropion if possible to rule out confounding
22. Enhanced elimination
23. limited options due to protein binding, not routine
24. Focused antidote
25. Consider IV fat emulsion if the patient is peri arrest
26. Observation times
27. Talk to a toxicolleague about observation times, decontamination, and use of invasive therapies to avoid falling into a trap

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