Effects of naloxone and diazepam on blood glucose levels in tramadol overdose using generalized estimating equation (GEE) model; (an experimental study)

Samaneh Nakhaee,Alireza Amirabadizadeh,Omid Mehrpour,Ebrahim Miri-Moghaddam,Khadijeh Farrokhfall,Masoumeh Askari,Mohsen Foadoddini

doi:10.1186/s12902-021-00847-x

Samaneh Nakhaee, Alireza Amirabadizadeh + Show 5 more

Open Access

https://doi.org/10.1186/s12902-021-00847-x

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Abstract

BackgroundTramadol is a synthetic opioid and poisoning is increasing around the world day by day. Various treatments are applied for tramadol poisoning. Due to the unknown effects of tramadol poisoning and some of its treatments on blood glucose levels, this study was conducted to investigate the overdose of tramadol and its common treatments (naloxone, diazepam), and their combination on blood glucose levels in male rats.MethodsThis study was conducted in 45 male Wistar rats. The animals were randomly divided into five groups of 9. They received a 75 mg/kg dose of tramadol alone with naloxone, diazepam, and a combination of both of these two drugs. On the last day, animals’ tail vein blood glucose levels (BGL) were measured using a glucometer at different times, including before the tramadol injection (baseline) and 1 hour, 3 hours, and 6 hours after wards. The rats were anesthetized and sacrificed 24 h after the last injection. Blood samples were then taken, and the serum obtained was used to verify the fasting glucose concentration. Data were analyzed using SPSS software at a significance level of 0.05 using a one-way analysis of variance (ANOVA) and a generalized estimating equation (GEE).ResultsAccording to the GEE model results, the diazepam-tramadol and naloxone-diazepam-tramadol groups showed blood glucose levels five units higher than the tramadol group (p < 0.05). The diazepam-tramadol group had significantly higher blood glucose levels than the naloxone-tramadol group (p < 0.05). The mean blood glucose levels before the intervention, 3 hours and 6 hours after the injection of tramadol did not differ between the groups, but the blood glucose levels 1 hour after the injection of tramadol in the group of naloxone-tramadol were significantly lower than in the control group (p < 0.05). Blood glucose levels did not differ between the groups 24 h after injection of tramadol.ConclusionThe results of the present study showed tramadol overdose does not affect blood glucose levels. The diazepam-tramadol combination and the diazepam-naloxone-tramadol combination caused an increase in blood glucose levels.

Highlights

Tramadol is a synthetic opioid and poisoning is increasing around the world day by day
The diazepam-tramadol combination and the diazepam-naloxone-tramadol combination caused an increase in blood glucose levels
One death occurred in the naloxone-diazepam-tramadol group during the study

Summary

Introduction

Tramadol is a synthetic opioid and poisoning is increasing around the world day by day. Tramadol is widely used throughout the world This has led to an increase in the number of cases of poisoning, side effects and deaths [1]. Seizure is more common in tramadol poisoning than with other opioids. Tramadol overdose-induced blood glucose changes is another potential side effect that has received insufficient attention. These changes may be among the predisposing factors for seizures in patients presenting with tramadol overdose [8]. Serial blood glucose monitoring has been instructed to detect and manage hypoglycemia and hyperglycemia in tramadol overdose [8]. All studies on tramadol use in diabetes documented hypoglycemia [1]

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