Daubin Cédric, Quentin Charlotte, Goullé Jean-Pierre, Guillotin Damien, Lehoux Philippe, Lepage Olivier, Charbonneau Pierre
Department of Medical Intensive Care, Caen University Hospital, Caen Cedex, France.
Clin Toxicol (Phila). 2007 Dec;45(8):961-4. doi: 10.1080/15563650701438847.
Tramadol use is largely considered safe. However, several lethal cases of tramadol intoxication were reported, suggesting an underestimated toxicity. We report for a tramadol overdose case in combination with other central nervous system depressants, leading to refractory shock requiring extracorporeal life support.
A 33-year-old man was admitted in our intensive care unit for drug intoxication with coma, seizures, and hypotension without signs of heart failure. A few hours later, he developed a ventricular tachycardia, followed by a brief cardiac arrest in asystole with refractory shock requiring an extracorporeal life support, vasopressors, and hemofiltration. With this aggressive support, his overall status gradually improved. Repeated echocardiography showed an improvement in the cardiac function. The patient was weaned off extracorporeal life support on day eight and discharged on day 12. On admission, a urine analysis, using gas chromatography-mass spectrometry, showed high peaks of tramadol and desmethyltramadol with the presence of hydroxyzine, gabapentine, and clonazepam. The tramadol blood concentration measured by the high-performance liquid chromatography method-diode array detector was 23.9 mg/L, much higher than many previously reported fatal overdoses. No other drugs with potential cardiac toxicity, such as beta-blockers, calcium antagonists, antiarrythmic, antidepressants, meprobamate, or other xenobiotics were detected.
This case illustrates that tramadol overdose may cause refractory shock and asystole when taken in combination with CNS depressants, and reminds all physicians to be vigilant with regard to the potential toxic effects of tramadol.
曲马多的使用在很大程度上被认为是安全的。然而，有几例曲马多中毒致死的病例被报道，这表明其毒性被低估了。我们报告了一例曲马多过量用药病例，该病例与其他中枢神经系统抑制剂合用，导致难治性休克，需要体外生命支持。
一名33岁男性因药物中毒被收入我们的重症监护病房，伴有昏迷、癫痫发作和低血压，无心力衰竭迹象。数小时后，他出现室性心动过速，随后短暂心脏停搏，处于心脏停搏状态，伴有难治性休克，需要体外生命支持、血管升压药和血液滤过。在这种积极的支持下，他的整体状况逐渐改善。多次超声心动图显示心脏功能有所改善。患者在第8天停用体外生命支持，并于第12天出院。入院时，采用气相色谱-质谱联用的尿液分析显示曲马多和去甲基曲马多有高浓度峰值，同时存在羟嗪、加巴喷丁和氯硝西泮。采用高效液相色谱法-二极管阵列检测器测定的曲马多血药浓度为23.9mg/L，远高于许多先前报道的致命过量用药情况。未检测到其他具有潜在心脏毒性的药物，如β受体阻滞剂、钙拮抗剂、抗心律失常药、抗抑郁药、甲丙氨酯或其他外源性物质。
该病例表明，曲马多过量用药与中枢神经系统抑制剂合用时可能导致难治性休克和心脏停搏，并提醒所有医生警惕曲马多的潜在毒性作用。
