Bupropion overdose as a clinically significant confounder of the neurological examination

Abstract

Background Bupropion is a selective dopamine and norepinephrine reuptake inhibitor utilized in the treatment of multiple neuropsychiatric conditions. It has been implicated as a brain death mimic due to its association with a comatose examination. Case Report A 31-year-old man with depression and anxiety ingested bupropion as part of a multi-drug overdose in a suicide attempt. During his hospital course, he suffered two cardiopulmonary arrests approximately 24 hours after ingestion. Neurological examination was excessively poor relative to imaging studies and was notable for absent brainstem reflexes. He was treated with targeted temperature management and lipid emulsion therapy with rapid improvement. He was eventually discharged after making a complete neurological recovery. Conclusion Bupropion is a unique clinical confounder and may be associated with a disproportionately poor neurological examination in the setting of intoxication. Many factors should be considered in the approach to evaluation, treatment, and prognostication of these patients.

Keywords

• bupropion
• coma
• overdose
• prognosis
• neurologic examination
• brain death