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Pires KD, Bloom J, Golob S, Sahagún BE, Greco AA, Chebolu E, Yang J, Ting P, Postelnicu R, Soetanto V, Joseph L, Bangalore S, Hall SF, Biary R, Hoffman RS, Park DS, Alviar CL, Harari R, Smith SW, Su MK. Successful Treatment of Confirmed Severe Bupropion Cardiotoxicity With Veno-Arterial Extracorporeal Membrane Oxygenation Initiation Prior to Cardiac Arrest. Cureus 2024; 16:e53768. [PMID: 38465186 PMCID: PMC10922220 DOI: 10.7759/cureus.53768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Bupropion is a substituted cathinone (β-keto amphetamine) norepinephrine/dopamine reuptake inhibitor andnoncompetitive nicotinic acetylcholine receptor antagonist that is frequently used to treat major depressive disorder. Bupropion overdose can cause neurotoxicity and cardiotoxicity, the latter of which is thought to be secondary to gap junction inhibition and ion channel blockade. We report a patient with a confirmed bupropion ingestion causing severe cardiotoxicity, for whom prophylactic veno-arterial extracorporeal membrane oxygenation (ECMO) was successfully implemented. The patient was placed on the ECMO circuit several hours before he experienced multiple episodes of hemodynamically unstable ventricular tachycardia, which were treated with multiple rounds of electrical defibrillation and terminated after administration of lidocaine. Despite a neurological examination notable for fixed and dilated pupils after ECMO cannulation, the patient completely recovered without neurological deficits. Multiple bupropion and hydroxybupropion concentrations were obtained and appear to correlate with electrocardiogram interval widening and toxicity.
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Affiliation(s)
- Kyle D Pires
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - Joshua Bloom
- Division of Medical Toxicology, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
| | - Stephanie Golob
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Barbara E Sahagún
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
| | - Allison A Greco
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Esha Chebolu
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
| | - Jenny Yang
- Department of Medicine, New York University Grossman School of Medicine, New York, USA
| | - Peter Ting
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Radu Postelnicu
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Vanessa Soetanto
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Leian Joseph
- Division of Pulmonary, Critical Care, & Sleep Medicine, New York University Grossman School of Medicine, New York, USA
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Sylvie F Hall
- Cardiac Intensive Care Unit and Department of Pharmacy, Bellevue Hospital Center, New York, USA
| | - Rana Biary
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - David S Park
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Carlos L Alviar
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Rafael Harari
- The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, USA
| | - Silas W Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
- New York City Poison Center, New York City Department of Health and Mental Hygiene, New York, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, USA
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Chebolu E, Schwandt ML, Ramchandani VA, Stangl BL, George DT, Horneffer Y, Vinson T, Vogt EL, Manor BA, Diazgranados N, Goldman D. Common Factors Underlying Diverse Responses in Alcohol Use Disorder. Psychiatr Res Clin Pract 2021; 3:76-87. [PMID: 34746678 PMCID: PMC8552111 DOI: 10.1176/appi.prcp.20200028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 01/23/2023] Open
Abstract
Objective Interindividual variation in responses to alcohol is substantial, posing challenges for medical management and for understanding the biological underpinnings of alcohol use disorders (AUD). It is important to understand whether diverse alcohol responses such as sedation, which is predictive of risk and partly heritable, occur concurrently or independently from responses such as blackouts and withdrawal. We hypothesized that latent factors accounting for sources of variance in diverse alcohol response phenotypes could be identified in a large, deeply phenotyped sample of patients with AUD. Methods We factor analyzed 17 alcohol response related items from the Alcohol Dependence Scale (ADS) in 938 individuals diagnosed with AUD via structured clinical interviews. Demographic, genetic, and clinical characteristics were tested as predictors of the latent factors by multiple indicators, multiple causes analysis. Results The final factor solution included three alcohol response factors: Physical Symptoms, Perceptual Disturbances, and Neurobiological Effects. Both gender and genetic ancestry were identified as variables influencing alcohol response. Major depressive disorder positively predicted physical symptoms and aggression negatively predicted physical symptoms. Barratt's Impulsivity Scale total score predicted the Physical and Perceptual domains. Family history, average drinks per drinking day, and negative urgency (an impulsivity measure) predicted all three domains. Conclusions Diverse items from the ADS concurrently load onto three correlated alcohol response factors rather than loading independently. Genetic ancestry and clinical characteristics predicted the severity of items that define the alcohol response factors even after accounting for degree of alcohol consumption. Co‐occurring phenotypes point towards an underlying shared physiology of diverse alcohol responses. Three common factors relevant for diverse alcohol responses are identified: Physical Symptoms, Perceptual Disturbances, and Neurobiological Effects Alcohol response items from the Alcohol Dependence Scale concurrently load onto these three factors rather than loading independently The three factors are correlated; patients presenting to clinical settings with a problem such as blackout are likely to experience several other problems either acutely or in the future
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Affiliation(s)
- Esha Chebolu
- Office of the Clinical Director Laboratory of Neurogenetics NIAAA Bethesda MD
| | | | | | | | | | | | | | - Emily L Vogt
- University of Michigan Medical School Ann Arbor MI
| | | | | | - David Goldman
- Office of the Clinical Director Laboratory of Neurogenetics NIAAA Bethesda MD
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Bajwa NA, Mazurek K, Chebolu E, Pourafkari L. Argyria: a cause of pseudocyanosis. QJM 2021; 114:341. [PMID: 33401304 DOI: 10.1093/qjmed/hcaa347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N A Bajwa
- Catholic Health System, University at Buffalo, Buffalo, New York, USA
| | - K Mazurek
- University at Buffalo, Buffalo, New York, USA
| | - E Chebolu
- University at Buffalo, Buffalo, New York, USA
| | - L Pourafkari
- Catholic Health System, Sisters of Charity Hospital, University at Buffalo, Buffalo, NY 14214, USA
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Alali S, Hsu J, Akbar A, Welch R, Gibbs J, Pollack C, Fanikos J, Chebolu E, Nguyen J, Fermann G, Jivanjee M, Williams J, Imhoff B, Rising K, Isaacs R, Zhongyang T, Mahan C, Le T, Rosenblatt L, Gueye I, Peacock WF. Abstracts for the 38 th annual emergencies in medicine conference. J Emerg Trauma Shock 2021. [PMCID: PMC8054809 DOI: 10.4103/jets.jets_175_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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