Coroner's Finding: EVANS Shaun Michael

22y · Male·Mixed Diflunisal and Buproprion (Zyban) toxicity

A 22-year-old man presented to Royal Adelaide Hospital's Emergency Department after taking approximately 110 Zyban (bupropion) tablets as a suicide attempt. Unknown to treating staff, he had also ingested a potentially lethal quantity of diflunisal (an anti-inflammatory). He died from mixed bupropion and diflunisal toxicity. Key clinical failures included: failure to use activated charcoal (rejected based on flawed second-hand advice from poison centre rather than direct consultation), delayed medical review (45 minutes), delayed decontamination by 1.5 hours, delayed intubation despite seizures and declining consciousness, and failure to recognise the multi-drug overdose despite positive paracetamol and salicylate blood tests. The patient's non-disclosure of diflunisal was a complicating factor, but inadequate questioning by staff contributed. While the combined toxicity was likely fatal regardless, optimal supportive care with early intubation and consideration of charcoal decontamination with airway protection were not provided.