1Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2Department of Clinical Toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
3Medical Toxicology and Drug abuse research group, Birjand University of Medical Sciences, Birjand, Iran
4Department of Poisoning Emergency, Noor Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran
*Address for correspondence: Department of Clinical toxicology and Forensic Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Ghaffari Avenue, Birjand, Iran P.O.Box:97-175-379 E-mail: omehrpour@bums.ac.iromid.mehrpour@yahoo.com.au Tel and Fax: + 985614440488
Seizures have been reported in patients receiving tramadol at the recommended dose or in poisoning. The aim of this study was to evaluate factors associated with seizure in tramadol poisoning.
All patients admitted in poisoning ward of Shoshtrai Hospital Poison Center, Shiraz, Iran from March 2008 to March 2009 with a history of tramadol poisoning accompanied by seizures were included. Different variables including demographic information, ingested dose, time elapsed ingestion and seizure, time elapsed ingestion and admission to Hospital, history of chronic tramadol abuse cigarette use, illegal abuse, number of seizure, personal history of seizure (under treatment with anti convulsion drugs), need to naloxonone, need to intensive care unit (ICU), coma grading, and mortality rate were recorded in a check list.
54 cases of tramadol intoxication with seizure admitted to our hospital during the study period. Mean age (SD) was 26.48 (7.74) (range, 17–45). The majority of cases were in the age group of 15–30 years (N=42, 77.8%). Time from ingestion to admission varied between 0.5–12 hours. Onset of seizure was between 0.5 -20 hours after tramadol ingestion. Most of seizure occurred 0.5 -2 hours after ingestion (%). Half of cases had one episode of seizure, followed by two seizure in 35% of cases (n=19). The route of poisoning in all of patients was oral.The range of ingested dose was from 200 to 11000 mg with an average (SD) of 3248 (2515) mg. most of seizure were occurred at dose of 200–2000 mg (n=25, 46.3%). Seizure was treated with diazepam alone in 85% of cases. Eleven patients (20.4%) required intensive care unit (ICU) during treatment. Mortality rate was 7.4%.There was a significant difference between male and female according to coma grading (p=0.05). The significant differences between number of seizure and ingested dose (p=0.005), ICU admission (p=0.01), and mortality (p=0.03) was observed. There was also a significant difference between mortality and ingested dose (p=0.02), and ICU admission (p=0.02).
Seizures and ingested tramadol dose are important factors associated with ICU admission and mortality.
Tramadol, Seizure, poisoning
