Kürten Cornelius, Tzvetkov Mladen, Ellenrieder Volker, Schwörer Harald
Dtsch Med Wochenschr. 2016 Sep;141(20):1480-1482. doi: 10.1055/s-0042-114217. Epub 2016 Oct 4.
We report about a 79 year old non-diabetic patient who was admitted to the emergency room with severe hypoglycemia (blood glucose level: 36 mg / dl and Glasgow Coma Scale Score: 3). After the infusion of G40 % her blood glucose level stabilised. The patient reported to have taken 50 mg of Tramadol during the night to treat her headache. No other differential diagnosis for hypoglycemia (i.e. diabetes, insulinoma, severe liver or kidney disease) could be established. Therefore, we suspected a tramadol induced hypoglycemia. The mechanisms and the risk factors for this potential side effect remain unclear. The patient showed no abnormality in metabolism (CYP2D6) or membrane transport (OCT1) of tramadol. No further treatment for hypoglycemic episodes was needed. The patient was discharged after the differential diagnosis and pharmacogenetic testing was completed. Hypoglycemia is a little known adverse effect after tramadol intake, which has only been published in few cases. Tramadol, a weak opioid analgesic classified as step 2 of the WHO cancer pain ladder, is used in moderate pain. Given the continuous rise in tramadol prescription due to better management of chronic pain, further investigation of this issue seems needed as well as an increased awareness amongst physicians.
我们报告了一名79岁的非糖尿病患者，该患者因严重低血糖（血糖水平：36mg/dl，格拉斯哥昏迷量表评分：3）被送往急诊室。输注40%葡萄糖后，她的血糖水平稳定下来。患者报告称夜间服用了50mg曲马多以治疗头痛。无法确定低血糖的其他鉴别诊断（即糖尿病、胰岛素瘤、严重肝脏或肾脏疾病）。因此，我们怀疑是曲马多诱发的低血糖。这种潜在副作用的机制和危险因素尚不清楚。患者曲马多的代谢（CYP2D6）或膜转运（OCT1）未显示异常。低血糖发作无需进一步治疗。完成鉴别诊断和药物遗传学检测后，患者出院。低血糖是服用曲马多后鲜为人知的不良反应，仅在少数病例中报道过。曲马多是一种弱阿片类镇痛药，被归类为世界卫生组织癌症疼痛阶梯的第2步，用于中度疼痛。鉴于由于慢性疼痛管理的改善，曲马多处方持续增加，似乎需要对这个问题进行进一步调查，并提高医生的认识。
