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

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          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

          Blood Purif
          Blood Purification
          S. Karger AG
          July 2020
          04 February 2020
          : 49
          : 4
          : 509-512
          aDepartment of Anaesthesia and Intensive Care Unit, I.R.C.C.S. San Matteo Hospital and University of Pavia, Pavia, Italy
          bInternational Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
          cUnit of Nephrology Dialysis and Transplantation, IRCCS Policlinico San Matteo, Pavia, Italy
          dDepartment of Internal Medicine, Nephrology, Dialysis and Transplantation Clinics, Genoa University and IRCCS Ospedale Policlinico San Martino, Genova, Italy
          eDepartment of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy
          fDepartment of Nephrology, University of Padova, Padova, Italy
          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
          505845 Blood Purif 2020;49:509–512
          © 2020 S. Karger AG, Basel

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          Page count
          Figures: 1, Tables: 1, Pages: 4
          Case Report


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