Management of Bupropion Toxicity With Intravenous Lipid Emulsion Therapy in a Pediatric Patient: A Case Report.

This case report involves a 2-year-old female with no past medical history who presented after ingestion of an unknown amount of 300 mg bupropion extended-release tablets. Shortly after ingestion, the mother mechanically induced vomiting, which recovered only small pieces of the tablets. The patient remained asymptomatic for a short period, then she began vomiting and had several tonic-clonic seizures, leading to emergency medical service (EMS) being called and ultimately, intubation for airway protection. On arrival at the pediatric intensive care unit (estimated 6 hours post ingestion), the patient was unresponsive with fixed and dilated pupils and no cough, gag, or respiratory effort. An electrocardiogram revealed that the patient had a first-degree heart block with a prolonged QTc interval. The patient remained unresponsive while off sedation with no effort to breathe over the ventilator. A bolus of intravenous lipid emulsion (ILE) 1.5 mL/kg followed by a continuous infusion of 0.5 mL/kg/min was administered (estimated 8 hours post ingestion). A few minutes following the start of the infusion, the patient began to spontaneously breathe over the ventilator. The patient was successfully extubated within 36 hours after ILE, and within 72 hours the patient had recovered to baseline and discharged home. This case displays successful use of ILE for bupropion toxicity in a young child. More studies are needed to fully understand the benefits and potential risks of the use of ILE in this population.