Severe Tramadol Overdoses in Children: A Case Series Admitted to Paediatric Intensive Care Unit

Anne Millet,Fabienne Bordet,Etienne Javouhey,Corentin Tanne

doi:10.4172/2161-0495.1000317

Abstract

Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. We reviewed 7 paediatric cases of patients hospitalized in the Intensive Care Unit. We reported unusual hypertonia and chest rigidity leading to ventilator difficulties. None of the children were suspected to be ultra-rapid metabolizers, and one case led to death. Overdoses can lead to death and must maintain practitioners on alert because of the increasing use of tramadol in the paediatric population. The handling of the bottles should be explained to families and Naloxone could be efficient when opioids signs.

Highlights

Tramadol (±)cis-2-[(dimethylamino) methyl]-1-(3-methoxyphenyl)- cyclohexanol hydrochloride) is a common painkiller used for the management of mild to moderately severe acute pain
We report 7 paediatric cases of Tramadol poisoning for patients admitted in our Paediatric Intensive Care Unit (PICU)
Tramadol overdose can present opioid-like intoxication symptoms, serotoninergic syndrome and/or seizures

Summary

Introduction

Tramadol (±)cis-2-[(dimethylamino) methyl]-1-(3-methoxyphenyl)- cyclohexanol hydrochloride) is a common painkiller used for the management of mild to moderately severe acute pain. It is a central analgesic that works through two mechanisms according to its two enantiomers, being effective on μ-opiate receptors agonists and on serotonin and norepinephrine reuptake inhibition [1,2]. This painkiller is metabolized in the liver through the P450 cytochrome, cytochrome P450 CYP2D6 being the main metabolizer conducting in the O-demethylation. In California, Tramadol is the fourth cause of drug poisoning in adults, and seizures are frequently reported [4]. Due to Odesmethyltramadol's affinity for the μ-opiate receptors, an overdose can cause systemic symptoms such as nausea, vomiting, and respiratory or neurologic depression [5]. Other clinical presentations include serotoninergic syndromes or tonico-clonic seizures [5,6,7]

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