Table 4.
Case reports of bupropion intoxication resembling brain death (7)
| Source | Age*/sex | Dose | Duration of loss of brainstem reflexes | Neurologic exam | Failed brain death prerequisites | Neuroimaging | EEG | Drug concentration: [Bupropion] reference 50–100 ng/mL; [Hydroxybupropion] reference 600–2000 ng/mL |
Outcome |
|---|---|---|---|---|---|---|---|---|---|
| [35] | 29/F | Unk | ~ 24 h | Fixed and dilated pupils. Absent corneal, oculocephalic, gag, and plantar reflex. DTR present and diminished. No spontaneous movement. No response to stimulation | Neuroimaging | Normal CT x2 | Burst Suppression; diffuse slowing | [Bupropion] 1441 ng/mL; [hydroxybupropion] 3342 ng/mL | Recovery to baseline health |
| [36] | 13/F | Unk | ~ 24 h | “Flaccid paralysis and absent brainstem reflexes” | Neuroimaging |
Normal CT Normal MRI |
Slowing; focal seizures; full recovery | [Bupropion] 4321 ng/mL; [Hydroxybupropion] 1903.8 ng/mL | Recovery to baseline health |
| [37] | 13/F | 21 g | 24 h | Fixed and dilated pupils. Absent corneal, oculocephalic, cough, and gag reflex. No response to stimuli. | Neuroimaging |
Normal CT x3 –arrival –24-h –40-h CT at 48 h: diffuse edema |
6-h: Burst suppression; 18-h: generalized slowing with faster frequencies; 24-h: generalized slowing; 48-h: electrical silence |
NR | Died; CT after cardiac arrest displayed edema, EEG silent |
| [38] | 32/M | 27 g | ~ 24 h | Fixed and dilated pupils. Absent corneal, oculocephalic, and gag reflex | NR | NR | NR | [Bupropion] 5898.8 ng/mL; [Hydroxybupropion] 3521.8 ng/mL | “Discharged without appreciable motor or cognitive deficits” |
|
[5] [6] |
47/F | Unk | 24–36 h | Pupils fixed and dilated. “She lacked all brainstem reflexes” | Neuroimaging | Normal CT | Burst suppression | NR | Tracheostomy; full neurologic recovery |
| [39] | 18/F | 27 g | 24–120 h | Fixed and dilated pupils. Absent corneal and oculocephalic reflex. No DTR. Flaccid limbs. Periodic myoclonic jerks | Myoclonic jerks | NR | Burst suppression | NR | Recovery to baseline health |
| [40] | 24/M | 19.5 g | NR | Fixed and dilated pupils. Absent corneal, vestibulo-ocular, and gag reflex | Neuroimaging | Normal CT | Interictal epileptiform discharges | NR | “Mental status returned to normal” |
*Age in years; CT computerized tomography, DTR deep tendon reflexes, EEG electroencephalogram, F female, M male, MRI magnetic resonance imaging, NR not reported, Unk unknown