Tramadol Poisoning Research Articles

Investigation of clinical and paraclinical consequences of tramadol poisoning and related factors

Tramadol, is frequently misused and leading to an increase in cases of overdose and poisoning worldwide. This study aimed to investigate the clinical and paraclinical consequences of tramadol poisoning and related factors. This was a retrospective study performed on patients with acute tramadol poisoning who were referred to the Amir Al-Momenin Hospital Emergency Department, Zabol, during 2019-2020. Patients’ socio-demographic information and clinical and paraclinical manifestations were collected in a predesigned checklist. Overall, 71 subjects were included in this study. The mean dose of tramadol was 640.14 ± 521 mg. Seizures occurred in 17 subjects that were not dose-dependent. In patients who died or were in a coma, pH, bicarbonate (HCO3 ), and oxygen saturation (O2 sat) levels decreased, while PCO2 levels increased significantly (P < 0.05). The dose of tramadol used in the poisoning of this substance played no role in the course of the disease and the prognosis of patients, but low pH, HCO3 , O2 sat, and high CO2 pressure could be related to the outcome of these patients.

Tramadol intoxication in children: An emerging issue

Background: Prescribing tramadol in children raises safety concerns. In Europe, tramadol is still approved and licensed for use in children over 1-3 years of age, depending on the country. In this context, the authors report a case of a tramadol overdose in a 5-year-old-child with a medical history of homozygous sickle cell disease.Methods: Tramadol and M1 were quantified using liquid chromatography with a diode array detection method. CYP2D6 genotype was determined using a Next Generation Sequencing platform (MISeq, Illumina).Results: Tramadol and M1 were quantified in blood respectively at 5.48 and 1.32 µg/mL at admission, at 0.77 and 0.35 µg/mL 12 hours later, and at 0.32 and 0.18 µg/mL 20 hours later. The patient was predicted as a CYP2D6 normal metabolizer (*35/*29).Conclusion: One of the most important difficulties with the use of tramadol in children relates to its pharmacokinetic (PK) properties. Indeed, tramadol’s PK is characterized by a great variability related to: i) anatomical/physiological factors that impact the volume of distribution (Vd); ii) CYP2D6 genetic polymorphisms. Considering such an issue is particularly relevant to prevent poisoning. In the reported case, the plasma elimination half-life was estimated at 6.3 h, significantly more than those reported in 2-8 year-old children (about 3 h). This discrepancy does not seem related to genetic polymorphisms but rather to the Vd. Indeed, the patient was predicted to be a CYP2D6 normal metabolizer (*35/*29). The case presented here highlights the risk associated with the tramadol use in children and emphasizes the importance of considering PK variability among this population. Such variability necessitates greater caution in prescribing tramadol in children and highlights the importance of therapeutic education for families of children treated with this painkiller.

Pattern of Traumatic Injuries in Patients with Tramadol Poisoning: A Cross-Sectional Study in a Tertiary Care Hospital.

This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuries in patients admitted to the hospital. The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographic information, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, and occurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, including the Mann-Whitney U-test, Pearson's Chi-square test, and Student's t-test, were conducted to compare the patients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed using SPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant. The average patient's age was 24.66±5.64 years, with males comprising 84.3% of the sample. The mean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizures were observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma was reported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures, with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%). Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantly longer. Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the need to perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolonged hospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handling and transferring to hospitals.

Clinical and Laboratory Factors Related to Seizure and Serotonin Toxicity in Tramadol Intoxication: An Egyptian Study.

Tramadol is a centrally acting analgesic with a lower risk of addiction compared to opioids. Tramadol overdose is becoming a health crisis in Egypt and is associated with serious and severe adverse effects. This study aims to identify clinical and laboratory findings associated with tramadol-induced seizure and serotonin toxicity in adult Egyptian patients with tramadol overdose. This prospective study included adult patients admitted for tramadol overdose with or without symptoms of seizure or serotonin toxicity. Basic demographic information, clinical symptoms, laboratory measurements, and plasma tramadol concentrations were collected. A total of 71 patients (79% males) were included in the study. Seizure occurred in 38% of the subjects and was prevalent in male patients with metabolic acidosis or high tramadol concentrations. Serotonin toxicity occurred in 41% of the subjects and was prevalent in patients with hyperthermia, high pulse rate, and high tramadol levels. Seizure and serotonin toxicity are severe adverse effects of tramadol overdose that occur in high frequency among young Egyptians. High tramadol concentrations in plasma seem to play a key role in prevalence of seizure and serotonin syndrome in tramadol-intoxicated adult Egyptians.

Effects of Intravenous Lipid Emulsion Administration in Acute Tramadol Poisoning: A Randomized Controlled Trial

BackgroundAs the prevalence of tramadol toxicity is increasing, managing these patients with the aim of treatment and complete recovery has become a major challenge for health care professionals. ObjectiveThis study evaluated the short-term effects of IV lipid emulsion (ILE) administration in cases of tramadol poisoning. MethodsIn this double-blind, randomized controlled trial, 120 patients with pure tramadol poisoning and a Glasgow Coma (GCS) score ≤ 12 referred to a poisoning center in Tehran, Iran were selected and randomly assigned 1:1 to receive ILE 20% (intervention) or 0.9% saline (control) after admission and primary stabilization. The patient's vital signs, GCS score, hospitalization duration, and rate of seizure occurrence were recorded and compared between the two groups. ResultsMean (SD) age of participants was 25.3 (5.4) years and 84 (70%) were male. Mean (SD) ingested dose of tramadol was 3118 (244) mg, which was not different between the groups. Compared with controls, the ILE group had a higher level of consciousness after treatment (median [interquartile range] GCS score 12 [10–13] vs. 10 [8–12]; p = 0.03). In addition, length of hospitalization (median [interquartile range] (2 [1–3] days vs. 4 [4–6] days; p < 0.01) and rate of seizure occurrence were lower in the intervention group (16/60 vs. 30/60; p < 0.01). ConclusionsIn the setting of tramadol poisoning with a decreased level of consciousness and based on our study's findings, administration of ILE is suggested to help manage patients in hospital emergency departments. However, larger trials might be needed to confirm these findings before entering the guidelines.

Assessment of renal function indexes in methamphetamine or tramadol intoxication adults to the emergency departments: a systematic review and meta-analysis

BackgroundRenal dysfunction is one of the adverse effects observed in methamphetamine (MET) or tramadol abusers. In this study, we aimed to review articles involving intoxication with MET or tramadol to assess the occurrence of renal dysfunction.MethodsTwo researchers systematically searched PubMed, Scopus, Web of Sciences, and Google Scholar databases from 2000 to 2022. All articles that assessed renal function indexes including creatine, Blood Urea Nitrogen (BUN), and Creatine phosphokinase (CPK) in MET and tramadol intoxication at the time of admission in hospitals were included. We applied random effect model with Knapp-Hartung adjustment for meta-analysis using STATA.16 software and reported outcomes with pooled Weighted Mean (WM).ResultsPooled WM for BUN was 29.85 (95% CI, 21.25–38.46) in tramadol intoxication and 31.64(95% CI, 12.71–50.57) in MET intoxication. Pooled WM for creatinine in tramadol and MET intoxication was respectively 1.04 (95% CI, 0.84–1.25) and 1.35 (95% CI, 1.13–1.56). Also, pooled WM for CPK was 397.68(376.42-418.94) in tramadol and 909.87(549.98-1269.76) in MET intoxication. No significance was observed in publication bias and heterogeneity tests.ConclusionOur findings showed that tramadol or MET intoxication is associated with a considerably increased risk of renal dysfunction that may result in organ failure.

Tramadol poisoning and its management and complications: a scoping review.

The primary objective of this scoping review was to determine the poisoning consequences of TR and its associated symptom management techniques, as well as its effect on opioid and non-opioid receptors, metabolism, and complications on various organ systems. Typically, acute overdose of TR is not considered life threatening, and most fatalities are attributed to polysubstance overdose. TR can cause drowsiness, headaches, seizures, respiratory depression, low heart rate, coma, and even death. Additionally, the prolonged use of TR can lead to addiction, with withdrawal resulting in both common and atypical symptoms. Therefore, it is recommended that patients with TR poisoning receive close monitoring of their cardiovascular system, along with a comprehensive management plan for their levels of consciousness and respiratory function.

GC-IR technique a rapid tool for detection of Tramadol in Forensic Confiscated Drugs and Biological Fluids

Tramadol is placed under Drug Controlled Substance Act, in India since 2018, owing to its extensive abuse as a narcotic substance recently. Subsequently, there is increased illegal trafficking across our nation for the drug tramadol. Forensic Science Laboratory, Delhi receives confiscated drugs and toxicological samples for chemical analysis to evaluate their precise composition enabling regulations from law enforcement agencies. Although considered a safe drug for its anti-inflammatory properties when used under medical guidance nevertheless, unintentional fatal tramadol intoxication due to its action on opioid receptors has been reported in several autopsy cases. Contraband tramadol is presently being examined using Gas Chromatography-Mass Spectrometer (GC-MS) and Fourier-transform infrared spectroscopy (FTIR) instrumental techniques in routine forensic examination. In the proposed study, an advanced sensitive technique Gas Chromatography Infrared spectroscopy (GC-IR) was explored as an alternative tool for rapid identification and confirmation. Standard Tramadol was used for method establishment and the method was subsequently applied to seized drug samples and Biological Fluids (blood, and urine samples). Findings of the study indicate that this method can be successfully applied to seized drugs and biological toxicological samples in the forensic examination for the drug Tramadol which was successfully detected by GC-IR. This new rapid analytical method will prove beneficial for the forensic community during routine examination of forensic samples with confirmation.

Tramadol and Coffee Synergy Triggered Oxidative Stress, Altered Cerebellar Histomorphology and Behaviour in Rats

Tramadol intoxication with other substances has recently raised neurological concerns especially among youths in the society. The effects of tramadol and coffee on the cerebellum of Wistar rats were studied. Thirty adult Wistar rats (average weight of 180 g) were randomly assigned into six groups (n=6) as follows: Control, coffee (72.46 mg/kg), coffee (108.69 mg/kg), tramadol (2.86 mg/kg), tramadol (5.71 mg/kg) and coffee (72.46 mg/kg) + tramadol (2.86 mg/kg). The administrations were orally, and done once daily for twenty-eight consecutive days. On day 29, spontane-ous alternation in the T-maze was carried out, and the rats anaesthetized with ketamine hydrochloride (50 mg/kg intraperitoneally). Their blood were assayed for antioxidant, while the 10 % buffered formalin perfused brains were routinely processed with haematoxylin and eosin technique. Behavioural study showed significantly (p&lt;0.05) increased spontaneous alternation in coffee (108.69 mg/kg), tramadol (5.71 mg/kg), and coffee (72.46 mg/kg) + tramadol (2.86 mg/kg) groups compared to the control. Catalase, superoxide dismutase and reduced glutathione levels were not different (p&gt;0.05), while the malondialdehyde level was significantly (p&lt;0.05) higher in the coffee (72.46 mg/kg) + tramadol (2.86 mg/kg) group compared to the control. Histological observations showed cerebellar cytoarchitectural alterations, including atrophy of the Purkinje cells in the coffee (108.69 mg/kg), tramadol (5.71 mg/kg), and coffee (72.46 mg/kg) + tramadol (2.86 mg/kg) groups compared to the control. In conclusion, co-administration of tramadol and coffee triggered free radicals, damaged the cerebellar tissues and caused a more deleterious effect on memory function than individual doses.

Evaluation of neurological symptoms of acute tramadol poisoning and its relationship with laboratory findings

Introduction: Tramadol is a unique opioid and the most prescribed opioid worldwide. Tramadol-related overdose and death have been increased in several countries. Due to the high level of tramadol use, misuse, and overdose in Iran, and considering the cost and time spent doing laboratory tests for all patients, this study aimed to investigate the possible relationship between changes in laboratory findings of patients poisoned by tramadol and their neurological manifestations to evaluate the need for these tests. Methods: This was a cross-sectional descriptive study of patients with acute tramadol poisoning who were referred to the Emergency department of Sina hospital, Tabriz, Iran from March 2020 to March 2021. Lab tests taken from the patient in the emergency department were recorded. Meanwhile, the patients’ neurological symptoms were noted. And demographic information of patients was collected in a predesigned checklist and was analyzed by IBM® SPSS® 20.0 release software. Results: A total of 95 patients including 76.8% male and 23.2% female with an average age of 28.26±10.57 were admitted to the emergency department. The most common symptoms of neurological impairment experienced by patients were seizure (32.6%) and decreased level of consciousness (38.8%). There was no relationship between the neurological symptoms of tramadol poisoning with neither arterial blood gas characteristics nor hematological factors (P&gt;0.05). Conclusion: The neurological manifestations of tramadol poisoning were not related to arterial blood gas characteristics such as PH, PCO2, PO2, and HCO3−. Also, there was no relationship between hematological factors including white blood cell (WBC), red cell distribution width (RDW), platelets (Plt), sodium (Na), potassium (K) and blood sugar (BS), and neurological symptoms caused by acute tramadol poisoning. Therefore, requesting these tests during tramadol poisoning should be reconsidered.

Zinc oxide calcium silicate composite attenuates acute tramadol toxicity in mice

BackgroundSeizures are considered to be the most common symptom encountered in emergency- rushed tramadol-poisoned patients; accounting for 8% of the drug-induced seizure cases. Although, diazepam clears these seizures, the risk of central respiratory depression cannot be overlooked. Henceforth, three adsorbing composites were examined in a tramadol acute intoxication mouse model.MethodsCalcium Silicate (Wollastonite) either non-doped or wet doped with iron oxide (3%Fe2O3) or zinc oxide (30% ZnO) were prepared. The composites’ adsorption capacity for tramadol was determined in vitro. Tramadol intoxication was induced in Swiss albino mice by a parenteral dose of 120 mg/kg. Proposed treatments were administered within 1 min at 5 increasing doses, i.p. The next 30 min, seizures were monitored as an intoxication symptom. Plasma tramadol concentration was recorded after two hours of administration.ResultsThe 3% Fe2O3-containing composite (CSFe3), was found to be composed of mainly wollastonite with very little alpha–hematite. On the other hand, hardystonite and wellimite were developed in the 30%ZnO-containing composite (CSZn3). Micro-round and irregular nano-sized microstructures were established (The particle size of CS was 56 nm, CSFe3 was 49 nm, and CSZn3 was 42 nm). The CSZn3 adsorption capacity reached 1497 mg of tramadol for each gram. Tramadol concentration was reduced in plasma and seizures were inhibited after its administration to mice at three doses.ConclusionThe calcium silicate composite doped with ZnO presented a good resolution of tramadol-induced seizures accompanied by detoxification of blood, indicating its potential for application in such cases. Further studies are required.

A comparative study of postmortem distribution and postmortem diffusion of tramadol in rabbits

In recent years, the cases of tramadol intoxication have become more frequent in many countries. However, most of the previous studies have been based on cases of tramadol intoxication, and the detailed information on the differences between postmortem distribution and diffusion of tramadol remains unclear. To investigate this issue systematically, we established a postmortem distribution model and two postmortem diffusion models. Then, gas chromatography-mass spectrometry (GC/MS) was used to measure the concentrations of tramadol in various biological specimens of fluids and tissues. In postmortem distribution, the results showed an uneven distribution of tramadol in various biological specimens, and the concentrations of tramadol in urine were significantly higher than those in other fluids. In postmortem diffusion, the results showed a dosage-dependent increase of tramadol concentration in most specimens; at all time points from 0.25 to 6 h after postmortem administration, the concentrations of tramadol in fluids were not significantly different from those in tissues, and the concentrations of tramadol in urine were lower than those in both tissues and other fluids in most time points. We recommend a quantitative examination of the specimens of both fluids and tissues to provide more evidence for the forensic identification, and the realization that there is a correlation between the concentrations of fluids and tissues is important for determining antemortem and postmortem administration of tramadol. This information can serve as ancillary data in inferring the contribution of a drug to death in cases of suspected tramadol poisoning.

Repeated episodes of seizures in an infant following accidental administration of tramadol suppository: a case report

Tramadol has become a popular analgesic in last few years. Number of studies has reported tramadol poisoning in children. Here, we report a case of tramadol poisoning in a one and half month old infant who presented with repeated seizures and apnea following accidental administration of tramadol suppository. IMC J Med Sci. 2023; 17(1): 010. DOI: https://doi.org/10.55010/imcjms.17.010 *Correspondence: Israt Zahan Ima, Department of Pediatrics, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), 1/A Ibrahim Sarani, Segunbagicha, Dhaka, Bangladesh. Email: imaisratzahan@gmail.com

Molecular Network-Based Identification of Tramadol Metabolites in a Fatal Tramadol Poisoning.

Identification of xenobiotics and their phase I/II metabolites in poisoned patients remains challenging. Systematic approaches using bioinformatic tools are needed to detect all compounds as exhaustively as possible. Here, we aimed to assess an analytical workflow using liquid chromatography coupled to high-resolution mass spectrometry with data processing based on a molecular network to identify tramadol metabolites in urine and plasma in poisoned patients. The generated molecular network from liquid chromatography coupled to high-resolution tandem mass spectrometry data acquired in both positive and negative ion modes allowed for the identification of 25 tramadol metabolites in urine and plasma, including four methylated metabolites that have not been previously reported in humans or in vitro models. While positive ion mode is reliable for generating a network of tramadol metabolites displaying a dimethylamino radical in their structure, negative ion mode was useful to cluster phase II metabolites. In conclusion, the combined use of molecular networks in positive and negative ion modes is a suitable and robust tool to identify a broad range of metabolites in poisoned patients, as shown in a fatal tramadol-poisoned patient.

Short‐term mortality following tramadol poisonings in Denmark

Tramadol is a commonly used opioid with a potential of addiction and abuse. Using Danish nationwide registers, we aimed to (1) characterise opioid poisonings; (2) assess the 30‐day mortality following morphine, oxycodone, and mixed poisonings compared to tramadol poisonings; and (3) assess the development in tramadol poisonings during a 12‐year period.Poisonings were identified from 2006 to 2017. A Cox proportional hazards regression model was used to estimate adjusted hazard ratios (aHRs) along with 95% confidence intervals (CIs) for 30‐day mortality following morphine, oxycodone or mixed poisonings compared to tramadol poisonings.We identified 7718 opioid poisonings among 6365 patients. The patients with a tramadol poisoning were younger and had less comorbidities than the patients with a morphine, oxycodone or mixed poisoning. Within 30 days, a total of 205 patients died. The 30‐day mortality risk was higher following morphine (aHR 3.2, 95% CI 2.0–5.1), oxycodone (aHR 2.1, 95% CI 1.2–3.6) and mixed poisonings (aHR 1.6, 95% CI 1.0–2.7) compared to tramadol poisonings. The annual number of tramadol poisonings increased from 233 in 2006 to 501 in 2013 and declined to 348 in 2017.In conclusion, despite a lower mortality risk compared to other opioid poisonings, physicians should consider the poisoning and abuse risks when prescribing tramadol.

Spectrum of Poisoning and Outcome among Children in a Tertiary Hospital, North-East Nigeria: A 20 Years Restrospective Review, 2000-2019

Introduction: Acute poisoning in children is cause of hospitalization and death worldwide. It is a Paediatrics emergency with significant economic cost. There are epidemiological differences in acute poisonings in children evaluated in Emergency departments across different countries and regions of the world. The aim of this study was to determine the causes of poisoning in children in our health facility during the period 2000-2019. Methodology: Case notes of children 6 months to 18 years managed for acute poisoning from January 2000 to December 2019 at Paediatrics unit, Federal Teaching Hospital Gombe (FTHG), were analysed. The International classification of Disease ICD 10 was used. Ethical Clearance was obtained. Results: 26,716 children were admitted with 76 cases of Acute poisoning giving a prevalence rate of 2.8/1000 children. 56.6% (43) were males. 63.2% (48) of children were years of age. 69.7% (53) were urban dwellers and 59.2% (45) from low socioeconomic class. 52.6% (40) of poisoning occurred in rainy season. 97.3% (74) of children had unintentional poisoning. Organophosphates 22.3% (17) and kerosine 22.3% (17) were the most common substances ingested. Snake-bite and corrosive ingestion occurred in 13.1% and 11.8% of children respectively. Ingestion was the route in 84.2% of cases. 75.0% (57) of poisoning occurred at home. ACP occurred in children aged 1 - 5 years (p-value = 0.025); More in Children from low socioeconomic status (p-value = 0.001) and urban settings (p-value = 0.001). There was no statistically significant relation between type of poisoning and gender p = 0.839, season p = 0.608, religion p = 0.504 and ethnic background p = 0.342. 4.2% (3) children died each from organophosphate, snake bite and tramadol poisoning. Conclusion: Kerosine and organophosphate were the leading cause of accidental childhood poisoning.

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

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.

Tramadol Poisoning: A Systematic Review of Studies in Iran

Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran. Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation. Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for &gt;24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level. Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults.

Tramadol intoxication in infants: experience at a tertiary care hospital in Dhaka, Bangladesh

Background: Tramadol is a widely used opioid analgesic for different types of pain. Very few cases of acute tramadol intoxication in infants have been reported where respiratory and central nervous system depression are frequent. The aim of this study was to evaluate the clinical manifestation, treatment and outcome of tramadol intoxication in infants.&#x0D; Methods: This was a retrospective observational study of hospitalized infants in the Department of Neonatology and Paediatrics in BIRDEM General Hospital, Dhaka, Bangladesh from February 2014 to November 2019. Ten infants with history of administration of tramadol suppository were included in this study. Data regarding clinical features, cause of the “incident dose and route of administration” of tramadol, effects of naloxone and outcomes were recorded and analyzed.&#x0D; Results: Of 10 infants, 6 were male and 4 were female. The mean age was 5.1±3.0 months and the mean weight was 6.1±1.8 kg. The mean time of onset of symptoms after drug administration was 2.6±1.0 hours with a mean dose of 17.9±6.4 mg/kg body weight. The main clinical features were decreased level of consciousness (100%), seizure (80%), meiosis (80%) and apnoea (50%). In each 50% (5) of cases, tramadol was given erroneously instead of glycerine and paracetamol suppository. Among them 2 (20%) infants received tramadol suppository as an over-the-counter (OTC) drug. All infants were treated with naloxone without any side effect. In addition, three infants needed mechanical ventilation. The average duration of hospital stay was 89.3±47.4 hours. Nine infants were discharged and one (10%) died.&#x0D; Conclusions: Our study suggested that tramadol intoxication among infants is predominantly accidental. Early identification and prompt initiation of treatment are essential. The creation of public awareness about the safe storage of drugs at home and avoidance of OTC drugs can prevent tramadol intoxication in children.&#x0D; BIRDEM Med J 2021; 11(3): 197-201

Evaluation of the Frequency of Stimulant and Opioid Abuse in the Poisoned Cases Referred To Hospitals in Ardabil, Iran

Introduction:Poisoning with acute opioids and stimulant is the most common causes of emergency visits, and its early detection and treatment is of utmost importance. The present study aimed to evaluate the frequency of opioid and stimulant use in poisoned cases.Materials and Methods: This cross-sectional descriptive study was conducted on 255 cases with acute opioids and stimulant poisoning.Results: Out of all patients, 7(2.7%) patients died due to severe complications. Moreover, 72.2% of patients were male, and the majority of cases (86.87%) were urban residents. The leading cause of poisoning was suicide (65.1%), and 34.9% of patients had accidental poisoning. The mean age of patients was 36.26 years. Tramadol, methadone, and opium with 29.4%, 23.9%, and 23.5% were the most used opioids for poisoning, respectively.Conclusion:As evidenced by the obtained results, tramadol poisoning is the most common poisoning in patients referring to hospital emergence. Nevertheless, tramadol use and availability need to be prevented and controlled; moreover, the awareness of health system providers should be raised about the care of these patients.