Department of Emergency Medicine, Division of Medical Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA.
Medical College of Wisconsin, Milwaukee, WI, USA.
Clin Toxicol (Phila). 2024 May;62(5):296-302. doi: 10.1080/15563650.2024.2347514. Epub 2024 May 23.
Bupropion is a popular antidepressant due to its favorable side effect profile and indications for smoking cessation and weight loss. Due to the possibility of delayed onset seizure and other adverse outcomes after bupropion overdose, patients are often observed for periods of 12-24 hours following suspected ingestion. Tachycardia is a clinical predictor that holds promise in differentiating cases at risk for seizures from low-risk cases that do not require prolonged observation. This study assessed whether heart rate within the first eight hours of presentation can identify cases that do not require extended observation.
This is a retrospective cohort study of all supra-therapeutic bupropion cases from two hospital systems between 2010 and 2022.
Data from 216 charts were included. Seizures, hypotension, and dysrhythmias occurred in 19 percent ( = 41), 1.4 percent ( = 3), 0.9 percent ( = 2) respectively. One patient died. Delayed adverse effects were rare ( = 4); they occurred from 14 hours to 28 hours post-ingestion. Maximum heart rate in eight hours was associated with a risk of adverse outcomes. (odds ratio, 1.07; 95 percent confidence interval: 1.05 to 1.09; 0.001). An eight hour maximum heart rate threshold of 104 beats/minute had a negative predictive value of 100 percent (95 percent confidence interval: 96.7 percent to 100 percent) for the occurrence of delayed adverse effects. All patients with delayed effects had tachycardia within five hours of emergency department arrival.
Delayed adverse outcomes of seizures, hypotension, dysrhythmia, and death were uncommon in this cohort. Heart rate during the first eight hours of observation performs reliably as a screening test to identify patients at low risk for delayed adverse outcomes. This study is limited by its retrospective nature, the inability to ascertain time of ingestion for most cases and the lack of confirmatory laboratory testing.
This study supports the use of an eight hour observation period when there are no other clinical signs of toxicity to warrant admission and if no co-ingestion or administration of substances that mask tachycardia are present.
由于其良好的副作用谱和戒烟及减肥的适应证，安非他酮是一种流行的抗抑郁药。由于安非他酮过量后可能出现迟发性发作和其他不良后果，因此患者在疑似摄入后通常会观察 12-24 小时。心动过速是一种有前途的临床预测指标，可区分有发作风险的病例和不需要延长观察时间的低风险病例。本研究评估了在出现后的前 8 小时内心率是否可以识别不需要延长观察时间的病例。
这是一项回顾性队列研究，纳入了 2010 年至 2022 年两个医院系统中所有超治疗剂量安非他酮的病例。
共纳入 216 份病历。发作、低血压和心律失常的发生率分别为 19%（41 例）、1.4%（3 例）和 0.9%（2 例）。一名患者死亡。迟发性不良反应罕见（4 例），发生于摄入后 14 至 28 小时。8 小时内的最大心率与不良结局的风险相关。（比值比，1.07；95%置信区间：1.05 至 1.09； 0.001）。8 小时最大心率阈值为 104 次/分钟时，对于迟发性不良反应的发生，其阴性预测值为 100%（95%置信区间：96.7%至 100%）。所有迟发性不良反应患者在急诊科就诊后 5 小时内均有心动过速。
在本队列中，迟发性发作、低血压、心律失常和死亡等不良后果并不常见。观察期前 8 小时的心率可靠地作为一种筛查试验，可识别发生迟发性不良结局风险较低的患者。本研究存在其回顾性、大多数病例无法确定摄入时间以及缺乏确证性实验室检查的局限性。
本研究支持在没有其他毒性临床体征需要入院治疗且没有合并摄入或使用掩盖心动过速的物质的情况下，使用 8 小时观察期。
