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.

References:

  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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