Steve Offerman1, Michael Levine2, Jasmin Gosen3, Stephen H Thomas4,5. 1. Medical Toxicology Consultation Service, Kaiser Permanente Northern California, Sacramento, CA, USA. 2. Department of Emergency Medicine, Division of Medical Toxicology, University of Southern California, 1200 North State Street. Room 1011, Los Angeles, CA, 90033, USA. mdlevine@usc.edu. 3. California North State University College of Medicine, Elk Grove, CA, USA. 4. Department of Emergency Medicine, Hamad General Hospital & Weill Cornell Medical College in Qatar, Doha, Qatar. 5. Queen Mary College, University of London, E1 4NS, London, UK.
Abstract
BACKGROUND: Bupropion is a unique class of antidepressant. In overdose, it is associated with tachycardia, altered mental status, and a dose-dependent risk of seizures, which can be delayed. Despite being a common medication, there is a paucity of data comparing toxicity in younger versus older children with bupropion exposures. The primary purpose of this study is to examine bupropion toxicity in pediatric patients and assess for toxicity differences between younger and older (teenaged) groups. METHODS: This single-center, observational cohort study reviewed pediatric patients presenting to a toxicology service between 2011 and 2018. The primary outcome measures evaluated were the presence of any seizure, delayed seizure (defined as occurring at least 6 hours after hospital arrival), and a composite endpoint of seizure, hypotension, or need for endotracheal intubation. Patients were subdivided into two groups-those 12 years and under, compared with those 13-17 years. RESULTS: A total of 80 unique pediatric cases were identified. Overall, the median (IQR) age was 14 (2.4-16) years. Patients under 13 years accounted for 31 (39%) of cases, whereas the remaining 49 cases were adolescents. Compared with the adolescents, the younger patients were less likely to be female (41.9% vs. 71.4%; p = 0.009) and more likely to have an unintentional ingestion (100% vs. 10.2%; p < 0.001). The younger group was more likely to present to health care earlier after the ingestion (median 61 (IQR 39-103) min vs. 139 (67-399) min; p = 0.002). The older group was more likely to be tachycardic (73.5% vs. 19.4%; p < 0.001), have sustained tachycardia (71.4% vs. 29% p < 0.001), and more likely to have altered mental status on arrival (38.8% vs. 6.5%; p < 0.001). Seizures were also much more likely in the older group (40.8% vs. 3.2%; p < 0.001). Adolescents were much more likely than younger children to reach the pre-defined composite endpoint (42.9% vs. 6.5%; p < 0.001), but this was largely driven by the seizures. CONCLUSION: Bupropion ingestions are relatively common among pediatric patients. However, adolescents are much more likely to present with more severe toxicity. Seizures are uncommon among younger children with exploratory ingestions.
BACKGROUND:Bupropion is a unique class of antidepressant. In overdose, it is associated with tachycardia, altered mental status, and a dose-dependent risk of seizures, which can be delayed. Despite being a common medication, there is a paucity of data comparing toxicity in younger versus older children with bupropion exposures. The primary purpose of this study is to examine bupropiontoxicity in pediatric patients and assess for toxicity differences between younger and older (teenaged) groups. METHODS: This single-center, observational cohort study reviewed pediatric patients presenting to a toxicology service between 2011 and 2018. The primary outcome measures evaluated were the presence of any seizure, delayed seizure (defined as occurring at least 6 hours after hospital arrival), and a composite endpoint of seizure, hypotension, or need for endotracheal intubation. Patients were subdivided into two groups-those 12 years and under, compared with those 13-17 years. RESULTS: A total of 80 unique pediatric cases were identified. Overall, the median (IQR) age was 14 (2.4-16) years. Patients under 13 years accounted for 31 (39%) of cases, whereas the remaining 49 cases were adolescents. Compared with the adolescents, the younger patients were less likely to be female (41.9% vs. 71.4%; p = 0.009) and more likely to have an unintentional ingestion (100% vs. 10.2%; p < 0.001). The younger group was more likely to present to health care earlier after the ingestion (median 61 (IQR 39-103) min vs. 139 (67-399) min; p = 0.002). The older group was more likely to be tachycardic (73.5% vs. 19.4%; p < 0.001), have sustained tachycardia (71.4% vs. 29% p < 0.001), and more likely to have altered mental status on arrival (38.8% vs. 6.5%; p < 0.001). Seizures were also much more likely in the older group (40.8% vs. 3.2%; p < 0.001). Adolescents were much more likely than younger children to reach the pre-defined composite endpoint (42.9% vs. 6.5%; p < 0.001), but this was largely driven by the seizures. CONCLUSION:Bupropion ingestions are relatively common among pediatric patients. However, adolescents are much more likely to present with more severe toxicity. Seizures are uncommon among younger children with exploratory ingestions.
Authors: Maurizio Fava; A John Rush; Michael E Thase; Anita Clayton; Stephen M Stahl; James F Pradko; J Andrew Johnston Journal: Prim Care Companion J Clin Psychiatry Date: 2005