Rivas-Coppola Marianna S, Patterson Amy L, Morgan Robin, Wheless James W
Division of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Neuroscience Institute, Memphis Tennessee.
Division of Pediatric Neurology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Neuroscience Institute, Memphis Tennessee.
Pediatr Neurol. 2015 Sep;53(3):257-61. doi: 10.1016/j.pediatrneurol.2015.05.018. Epub 2015 Jun 14.
Bupropion is a monocyclic antidepressant in the aminoketone class, structurally related to amphetamines. The Food and Drug Administration withdrew this product from the market in 1986 after seizures were reported in bulimic patients. It was later reintroduced in 1989 when the incidence of seizures was shown to be dose-related in the immediate release preparation. Massive bupropion ingestion has been associated with status epilepticus and cardiogenic shock in adults. Seizures have been reported in children, but not status epilepticus. This report highlights a patient who presented with status epilepticus and developed cardiopulmonary arrest after bupropion ingestion. False-positive amphetamine diagnosis from urine drug screen on presentation was reported.
We review the presentation, clinical course, diagnostic studies, and outcome of this patient. We then review the literature regarding bupropion overdose in children.
Symptoms of bupropion toxicity and risk for seizures are dose-dependent and fatalities have been reported. Our patient developed status epilepticus and cardiopulmonary arrest and then progressed to have a hypoxic ischemic encephalopathy and refractory symptomatic partial seizures.
Our report highlights the need to keep this medication away from children in order to prevent accidental overdose.
安非他酮是一种氨基酮类单环抗抑郁药，在结构上与苯丙胺有关。1986年，在有贪食症的患者中报告出现癫痫发作后，美国食品药品监督管理局将该产品撤出市场。后来在1989年重新推出，当时速释制剂中癫痫发作的发生率显示与剂量相关。大量摄入安非他酮与成人癫痫持续状态和心源性休克有关。已有儿童癫痫发作的报告，但未出现癫痫持续状态。本报告重点介绍了一名在摄入安非他酮后出现癫痫持续状态并发展为心肺骤停的患者。报告了就诊时尿液药物筛查中安非他明诊断呈假阳性的情况。
我们回顾了该患者的临床表现、临床病程、诊断研究及结果。然后我们回顾了有关儿童安非他酮过量的文献。
安非他酮中毒症状和癫痫发作风险与剂量有关，且已有死亡报告。我们的患者出现了癫痫持续状态和心肺骤停，随后发展为缺氧缺血性脑病和难治性症状性部分性癫痫发作。
我们的报告强调需要让儿童远离这种药物，以防止意外过量服用。
