TL;DR
1. Your patient can seize 8-24 hours in, usually they have neurologic symptoms and tachycardia before hand
2. Tachycardia may be masked by coingestions and symptoms may be very delayed
3. Do not discharge a patient without discussing observation time with a toxicologist or poison center
4. Do not dismiss tachycardia and anxiety as situational in a bupropion overdose
Spiller 1994- Review of instant release product overdoses
Shepherd 2004- Seizures in primarily sustained release products
1. Most seizures had prodromal neuropsychiatric symptoms
Starr 2009- Seizure in XL products.
1. Tachycardia, tremor, agitation most associated with seizures
2. Seizure occured as late as 24 hours and 25% occurred after 8 hours
Offerman 2020- Primarily sustained/extended release products
1. Tachycardia duration, and extent (>120) predicted seizure. (Hypotnesion and neuropsych symptoms also predict)
2. Late seizure occurred only in those with symptoms on presentation
3. Those who had cardiac arrest had prehospital seizure= bad sign
Rianprakaisang 2021- ToxIC review of risk factors for seizures
1. QTc and HR>140 predict seizures

Get the future of podcasts.