(953) Intravenous Lipid Emulsion for Cardiogenic Shock due to Bupropion Toxicity

Introduction: Bupropion toxicity leading to cardiogenic shock is relatively rare but is a recognized and serious complication. Intravenous lipid emulsion (ILE) therapy can be considered to sequester lipophilic drugs like bupropion and mitigate their effects. Existing evidence is limited to a few case reports regarding the use of ILE in cardiogenic shock due to bupropion toxicity.

Description: We present the case of a 27-year-old female with a medical history of bipolar disorder who was brought to the emergency room following ingestion of 30 extended-release bupropion tablets of 150 mg strength. Shortly after admission, she developed hypotension, requiring pressor support, and was intubated for airway protection. A chest X-ray revealed bilateral pulmonary edema, and a transthoracic echocardiogram (TTE) showed an ejection fraction of 20-25% with diffuse hypokinesia. Telemetry indicated non-sustained ventricular tachycardia. Initial management included inotropic support and mechanical ventilation. Due to a lack of improvement, she was started on lipid emulsion therapy. By day 2, her blood pressure began to improve. She was extubated on day 3 of lipid emulsion therapy, and a repeat TTE showed an ejection fraction of 40-45%. The patient continued to improve, and a follow-up cardiac MRI after discharge showed an ejection fraction of 60%.

Discussion: This case highlights the potential benefits of ILE in bupropion toxicity. While ILE therapy is considered an off-label use for this indication, it should be considered after conventional treatments have failed. The rapid improvement in hemodynamic stability and cardiac function observed in this patient suggests that ILE may play a valuable role in the management of severe bupropion toxicity leading to cardiogenic shock. Further studies are needed to establish standardized guidelines for the use of ILE in this context and to better understand its efficacy and safety profile.