Evaluation of the pattern of clinical signs of tramadol poisoning and its relationship with serum tramadol concentration and its metabolites

Abstract

Introduction: Tramadol is one of the opioid drugs that is unfortunately misused in Iran. One of the most common side effects of tramadol is seizures. Quick and easy diagnosis of tramadol poisoning can help speed up treatment and care of the patient. The aim of this study was to investigate the possible association between serum levels of tramadol and its metabolites with the patient's clinical symptoms and to investigate the possibility of its diagnosis on toxic exhalation.

Materials and Methods: This study consists of two parts, the first part is a retrospective study on the demographics of patients with tramadol poisoning in the last 5 years and the second part is a prospective and cross-sectional study in which all patients who due to consumption or Tramadol abuse was referred to the emergency department of Sina Medical Center and included in the study. Blood samples were taken from patients and exhalation samples were taken if conscious. Capillary Electrophoresis (CE) was used to assess the blood level of the drug. In this study, tramadol was diagnosed and the possibility of diagnosing intoxication with combined narcotics in exhaled samples of poisoned patients was attempted.

Results: In the first part of the study (retrospective), out of 359 patients, 52 patients (14.5%) had seizures. In the second part of the study (prospective), tramadol was measured in the serum of poisoned people by electrophoresis. Capillary, in the best extraction conditions, the minimum detection limit was 0.7 μg / l (PPM 0.007). Tramadol and its metabolites were also identified in the exhaled samples of patients. 6 patients (13.3%) had seizures, 4 patients (8.9%) were admitted to the critical care ward. 38 patients (84.4%) developed respiratory depression and 4 patients (8.9%) underwent urotracheal intubation. Serum levels of tramadol or dose and length of hospital stay are significantly correlated.

Discussion & Conclusion: This study showed that this method has an acceptable function in determining tramadol in plasma samples and with increasing serum levels of tramadol, the probability of seizures increases and the most common clinical symptom is respiratory depression. Also in this study, tramadol and its metabolite were identified in the exhalation sample.