Brief Report: A Case of Tramadol Overdose: Extracorporeal Life Support and Hemoperfusion as Life-Saving Treatment

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Abstract

We describe the case of a 49-year-old woman with a Tramadol intoxication associated with multiorgan failure. Veno-arterial femoro-femoral extracorporeal life support (VA-ECLS) and hemoperfusion (HP) were used as rescue treatments. The emergency medical service found a woman at home unconscious. Once in the hospital, she was intubated and catecholamines support was immediately started for a severe shock. Brain CT was normal, whereas EEG revealed a metabolic encephalopathy pattern. Toxic levels of Tramadol and Quetiapine were detected. VA-ECLS was implanted due to persistent multiorgan failure, and HP with a charcoal cartridge was set to increase the Tramadol clearance. To quantify the charcoal cartridge’s removal efficiency of Tramadol, Tramadol concentration was measured before and after the cartridge and before and after the treatment in the patient’s blood. The charcoal cartridge showed good extraction ratio during the treatment and no significant rebound effect. VA-ECLS and HP allowed the patient to be weaned from vasoconstrictors and the resolution of the organ failures. These treatments might be lifesaving in the Tramadol intoxication.

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Author and article information

Journal

Journal ID (publisher-id): BPU

Journal ID (nlm-ta): Blood Purif

Journal ID (doi): 10.1159/issn.0253-5068

Title: Blood Purification

Publisher: S. Karger AG

ISSN (Print): 0253-5068

ISSN (Electronic): 1421-9735

Publication date Subscription-year: 2020

Publication date (Print): July 2020

Publication date (Electronic): 04 February 2020

Volume: 49

Issue: 4

Pages: 509-512

Affiliations

[_a] _aDepartment of Anaesthesia and Intensive Care Unit, I.R.C.C.S. San Matteo Hospital and University of Pavia, Pavia, Italy

[_b] _bInternational Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy

[_c] _cUnit of Nephrology Dialysis and Transplantation, IRCCS Policlinico San Matteo, Pavia, Italy

[_d] _dDepartment of Internal Medicine, Nephrology, Dialysis and Transplantation Clinics, Genoa University and IRCCS Ospedale Policlinico San Martino, Genova, Italy

[_e] _eDepartment of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy

[_f] _fDepartment of Nephrology, University of Padova, Padova, Italy

[_g] _gDepartment of Nephrology Dialysis and Transplant-AUSSL 8 regione Veneto -San Bortolo Hospital, Vicenza, Italy

Author notes

*Fiorenza Ferrari, MD, MSc, Department of Anaesthesia and Intensive Care Unit, International Renal Research Institute of Vicenza (IRRIV), University San Matteo Hospital, I.R.C.C.S. San Matteo Hospital, Viale Golgi, 19, Lombardia, IT–2700 Pavia (Italy), E-Mail fioreferrari28@gmail.com

Article

Publisher ID: 505845 Other ID: Blood Purif 2020;49:509–512

DOI: 10.1159/000505845

PubMed ID: 32018266

SO-VID: a61b266c-987e-4ef2-8176-283d20496ae2

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 28 November 2019

Date accepted : 09 January 2020

Page count

Figures: 1, Tables: 1, Pages: 4

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