Letter to the Editor

Seizure Associated with Butanediol Ingestion

James Cisek
Medical College of Virginia
Richmond, VA

Int J Med Toxicol 2001; 4(1): 12

A 39-year-old male with a history of depression was well managed on bupropion 200 mg bid. He occasionally had insomnia and was active in several Internet "chat groups," where he learned about butanediol. He purchased a 1-liter container of 1,4-butanediol (BD) directly from a chemical supply company and began ingesting approximately 10-ml aliquots each night to enhance sleep. On the seventh night, he had a single, witnessed 3-minute tonic episode associated with an altered mental status and incontinence of stool. The seizure resolved spontaneously. When seen in the emergency department immediately afterward, he was asymptomatic with a normal neurological examination. The complete blood count, electrolytes, calcium, and drug screens were negative. An electroencephalogram performed in the Emergency Department was negative. He remains seizure free 18 months post-ingestion. Both the patient and his wife denied an overdose of buproprion.


Butanediol (pine needle oil) is a commonly used industrial chemical that can be easily purchased by the public. BD is converted by alcohol dehydrogenase tog–hydroxybutyraldehyde, which is then converted to g-hydroxybutyrate (GHB) by aldehyde dehydrongease (1-2). This patient is the first reported case of a BD associated seizure. Seizures are a rare manifestation of GHB intoxication (3). Perhaps the BD contributed to the seizure in addition to GHB (4). Seizures are a recognized adverse effect of buproprion administration (5,6). It is possible that the BD interacted with the buproprion in this case.


  1. Snead OC, Furner R, Liu C. In vivo conversion of gamma-aminobutyric acid and 1,4 butanediol to gamma-hydroxybutyric acid in rat brain. Studies using stable isotopes. Biochem Pharmacol 1989;38:4375-4380.
  2. Snead OC, Liu CC, Bearden LJ. Studies on the relationship of gamma-hydroxybutyric acid to gamma-aminobutyric acid. Evidence that GABA is not the sole source of GHB in rat brain. Biochem Pharmacol 1982;31:3917-3923.
  3. Chin RL, Sporer KA, Cullison B, et al. Clinical Course of gamma-Hydroxybutyrate in Overdose. Ann Emer Med 1998;31:716-722.
  4. Poldrugo F, Snead O. 1,4 Butanediol, gamma-hydroxybutyric acid and ethanol: relationships and interactions. Neuropharmacology 1984;23:109-113.
  5. Davidson J. Seizures and buproprion: A review. J Clin Psychiatry 1989;50:256-261.
  6. Fleet JVW, Manberg PJ, Miller LL, Harto-Truax N, Sato T, Fleck RJ, Stern WC, Cato AE. Overview of clinically significant adverse reactions to buproprion. J Clin Psychiatry 1983;44:191-196.

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