The Outcome of Unintentional Pediatric Bupropion Ingestions: A NPDS Database Review

Unintentional bupropion pediatric exposures uncommonly report severe clinical effects such as seizures. We sought to determine the clinical effects and case outcomes for unintentional bupropion ingestions in children age <= 6 years. The National Poison Data System was queried for unintentional, acute, single substance bupropion ingestions in children age <= 6 years for the time period January 1, 2000 to February 27, 2007 for cases followed to a known outcome. If exposure amount was reported, a mg/kg dose was determined; when weight was absent, it was interpolated from the available data set. An adverse neurological effect (ANE) was defined as seizure (single, multi/discrete, and status) or coma. For analysis, the outcomes of no effect and mild outcome were grouped, and the outcomes of moderate outcome, major outcome, and death were grouped. A subset of case notes were reviewed for accuracy. Seven thousand one hundred eighteen cases met the inclusion criteria, with 1,154 cases excluded because of multiple substances and coding errors, resulting in 5,964 cases. A total of 4,557 cases (76.4%) were managed at or sent to a HCF. The most common clinical effects reported were nausea/vomiting (4.3%), tachycardia (3.9%), agitated/irritable (3.1%), drowsiness/lethargy (2.4%), and seizure (1.4%). There were no deaths. Overall, there was a 3.3% rate of moderate/major outcomes. A mg/kg dose was calculable in 76.1% of cases; the average amount for the no effect/minor cases and moderate/major effect was 13.8 +/- 18.8 and 38.8 +/- 44.0 mg/kg, respectively (p<0.0001). Average time until development of seizures was 4.2 +/- 3.2 h with a maximum of 14 h. Few children develop toxicity from unintentional reported bupropion ingestions, with about 1.5% of patients developing an ANE.