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      Hypoglycemia in a Child with Tramadol Poisoning

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          Abstract

          Tramadol is a central acting analgesic of the opioid group used for moderate to severe pain. Tramadol overdose can be accidental or intentional and is more common in adolescent and adult males. We report the case of a 4-year-old boy presenting with hypoglycemia following tramadol poisoning with loss of consciousness and convulsion; he was managed conservatively and made remarkable improvement without any sequelae.

          Translated abstract

          ملخص البحث : يستخدم عقار (Tramadol) دواءً مسكنا لعلاج الآلام الشديدة. وتعتبر الجرعة المفرطة من هذا العقار أما مقصودة أو بطريق الخطأ، وتكثر لدى المراهقين والبالغين. يعرض الباحثون حالة لطفل في الرابعة من العمر يعاني من هبوط في سكر الدم بعد تناوله جرعة مفرطة من هذا الدواء مما أدى إلى فقدان وعي الطفل وإصابته بتشنجات. وقد تم علاجه بدون مضاعفات.

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          Most cited references 10

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          Tramadol intoxication: a review of 114 cases.

          Tramadol as a centrally acting analgesic is extensively used in the management of moderate to severe pain. It slightly affects opioid receptors and inhibits the reuptake of norepinephrin and serotonin in the CNS. There are reports about toxicity and abuse of tramadol. The objective of the present study was to evaluate epidemiology of intentional tramadol intoxications. All poisoning cases that admitted to Loghman-Hakim Hospital Poison Center from April to May 2007 were studied. A total of 114 cases (82 men and 32 women) of intentional tramadol intoxications with the median age of 23.66 +/- 6.87 years (range 16-54 years) were identified. Other illicit drugs were found to be used in combination with tramadol in some of the cases, which among them benzodiazepines were the most common. Tramadol overdose has been one of the most frequent causes of drug poisoning in the country in the recent years, especially in male young adults with history of substance abuse and mental disorders. Nausea, vomiting, Central Nervous System (CNS) depression, tachycardia, and seizure are the most common findings in this kind of poisoning. Cardiopulmonary arrest was found as the cause of death in cases who had ingested more than 5000 mg tramadol.
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            Factors related to seizure in tramadol poisoning and its blood concentration.

            This study examines the relation between seizure and plasma tramadol concentration in patients with tramadol poisoning, as a novel centrally acting analgesic used for the treatment of mild to severe pain. All patients admitted with a history of tramadol overdose accompanied by unconsciousness or seizures referred to Baharloo Hospital Poison Center, Tehran, Iran from March 2008 to March 2009 were included. Demographic information, clinical findings, and blood tramadol concentrations were studied. There were 401 patients with a history of tramadol overdose; 121 (30.2%) with a history of seizure and 14 (3.5%) with a history of unconsciousness were included. Most of overdoses involved men (83%). The mean age was 22.9 years (range, 14-50 years). Intentional overdose was the most common mode of poisoning (51.9%). The mean dose ingested was 1,511 mg (SD, 1,353; range, 200-7,000). Mean back-extrapolated tramadol blood concentrations were 3,843 ng/mL (3,715; 269-20,049). Back-extrapolated blood concentrations were correlated with dose (r = 0.313; P < 0.001) as well as blood concentration levels (r = 0.801; P < 0.001). Seizure was significantly correlated to higher reported dose (P < 0.001) and tramadol only to overdose (P < 0.001). However, it was neither related to higher tramadol blood concentrations, nor related to time elapsed, age, sex, history of addiction, and observed Glasgow Coma Scale of patients. Most patients experienced just one seizure (76%). The tramadol-induced seizure is dose dependent. Although higher doses of tramadol was related to higher blood concentration, blood tramadol concentrations was not associated with seizure.
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              Plasma glucose-lowering effect of tramadol in streptozotocin-induced diabetic rats.

              The effect of tramadol on the plasma glucose level of streptozotocin (STZ)-induced diabetic rats was investigated. A dose-dependent lowering of plasma glucose was seen in the fasting STZ-induced diabetic rats 30 min after intravenous injection of tramadol. This effect of tramadol was abolished by pretreatment with naloxone or naloxonazine at doses sufficient to block opioid mu-receptors. However, response to tramadol was not changed in STZ-induced diabetic rats receiving p-chlorophenylalanine at a dose sufficient to deplete endogenous 5-hydroxytrptamine (5-HT). Therefore, mediation of 5-HT in this action of tramadol is ruled out. In isolated soleus muscle, tramadol enhanced the uptake of radioactive glucose in a concentration-dependent manner. The stimulatory effects of tramadol on glycogen synthesis were also seen in hepatocytes isolated from STZ-induced diabetic rats. The blockade of these actions by naloxone and naloxonazine indicated the mediation of opioid mu-receptors. The mRNA and protein levels of the subtype 4 form of glucose transporter in soleus muscle were increased after repeated treatments for 4 days with tramadol in STZ-induced diabetic rats. Moreover, similar repeated treatments with tramadol reversed the elevated mRNA and protein levels of phosphoenolpyruvate carboxykinase in the liver of STZ-induced diabetic rats. These results suggest that activation of opioid mu-receptors by tramadol can increase the utilization of glucose and/or decrease hepatic gluconeogenesis to lower plasma glucose in diabetic rats lacking insulin.
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                Author and article information

                Journal
                Saudi J Med Med Sci
                Saudi J Med Med Sci
                SJMMS
                Saudi Journal of Medicine & Medical Sciences
                Medknow Publications & Media Pvt Ltd (India )
                1658-631X
                2321-4856
                Jan-Apr 2016
                02 December 2015
                : 4
                : 1
                : 35-37
                Affiliations
                [1 ]Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
                [2 ]Department of Nursing, Aminu Kano Teaching Hospital, Kano, Nigeria
                Author notes
                Correspondence: Dr. Ibrahim Aliyu, Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria. E-mail: ibrahimaliyu2006@ 123456yahoo.com
                Article
                SJMMS-4-35
                10.4103/1658-631X.170892
                6298260
                Copyright: © 2016 Saudi Journal of Medicine and Medical Sciences

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Categories
                Case Report

                tramadol, overdose, hypoglycemia, analgesic

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