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Arterial Blood Gas Analysis of Patients with Tramadol-induced Seizure; a Cross Sectional Study

Bita Dadpour, Anahita Alizadeh, Maryam Vahabzadeh, Seyed Reza Mousavi, Mohammad Moshiri, Zahra Ataee, Babak Mostafazadeh
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Abstract

Introduction: Tramadol is an active analgesic drug that is commonly used to treat moderate to severe pain. The present study aimed to assess the arterial blood gas (ABG) analysis of patients with tramadol-induced seizure (TIS).

Methods: This prospective cross-sectional study was performed on 50 TIS cases that were referred to emergency department within a maximum of one hour after their last episode of seizure. The results of ABG analysis on admission were collected and their association with dosage and time interval between ingestion and admission was assessed.

Results: 50 cases with the mean age of 35.10 ± 9.62 years were studied (80.0% male). The mean dosage of ingestion was 1122.00 ± 613.88 (400 to 3000) mg and the mean time interval between ingestion and admission was 7.16 ± 2.18 hours. ABG analysis on admission showed that 49 (98.0%) patients had pH < 7.35 and PaCO2 > 45 mmHg (respiratory acidosis). There was a significant association between ingestion to admission time interval and both PaCO2 (r = -0.330, p = 0.019), and PaO2 (r = 0.303, p = 0.032). The dose of ingestion was negatively associated with respiratory rate (r = -0.556, p = 0.001), arterial pH (r = -0.676, p = 0.001), and PaO2 (r = -0.514, p = 0.001), but was positively associated with PaCO2 (r = 0.461, p = 0.001). Higher doses of tramadol led to more severe hypercapnia and need for intubation (OR = 1.12, 95% CI: 0.88 – 1.26; p = 0.045). 5 (10.0%) cases needed mechanical ventilation. All patients improved after supportive care with no in-hospital death.

Conclusion: Based on the findings, 98% of TIS cases had respiratory acidosis. Higher doses of ingested drug and longer time interval between ingestion and admission were associated with severity of ABG disturbances.


Keywords

Tramadol; blood gas analysis; seizures; acidosis, respiratory; hypercapnia

References

Sweileh WM, Shraim NY, Zyoud SH, Al-Jabi SW. Worldwide research productivity on tramadol: a bibliometric analysis. SpringerPlus. 2016;5(1):1108.

Subedi M, Bajaj S, Kumar MS, Yc M. An overview of tramadol and its usage in pain management and future perspective. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie. 2019;111:443-51.

Frink MC, Hennies H, Englberger W, Haurand M, Wilffert B. Influence of tramadol on neurotransmitter systems of the rat brain. Arzneimittel-Forschung. 1996;46(11):1029-36.

Desmeules JA, Piguet V, Collart L, Dayer P. Contribution of monoaminergic modulation to the analgesic effect of tramadol. British journal of clinical pharmacology. 1996;41(1):7-12.

Shadnia S, Soltaninejad K, Heydari K, Sasanian G, Abdollahi M. Tramadol intoxication: a review of 114 cases. Human & experimental toxicology. 2008;27(3):201-5.

Taghaddosinejad F, Mehrpour O, Afshari R, Seghatoleslami A, Abdollahi M, Dart RC. Factors related to seizure in tramadol poisoning and its blood concentration. Journal of medical toxicology. 2011;7(3):183.

Rehni AK, Singh I, Kumar M. Tramadol‐Induced Seizurogenic Effect: A Possible Role of Opioid‐Dependent γ‐Aminobutyric Acid Inhibitory Pathway. Basic & clinical pharmacology & toxicology. 2008;103(3):262-6.

Boostani R, Derakhshan S. Tramadol induced seizure: A 3-year study. Caspian journal of internal medicine. 2012;3(3):484.

Kroenke K, Krebs E, Bair M. General hospital psychiatry. Gen Hosp Psychiatry. 2009;31(3):206-19.

Sansone RA, Sansone LA. Tramadol: seizures, serotonin syndrome, and coadministered antidepressants. Psychiatry (Edgmont). 2009;6(4):17.

Mattia C, Mazzaferro S, Coluzzi F, Luzi M. Respiratory depression following iatrogenic tramadol overuse in a patient with chronic renal failure. The Journal of headache and pain. 2004;5(2):137.

Morrow RL, Dormuth CR, Paterson M, Mamdani MM, Gomes T, Juurlink DN. Tramadol and the risk of seizure: nested case-control study of US patients with employer-sponsored health benefits. BMJ open. 2019;9(3):e026705.

Ismail MA, Mahmoud SF, Khedr MA, Mohammed MK. Assessment of Cases of Acute Tramadol Toxicity as Regards Clinical, Laboratory and Management Procedures in Some University Hospitals in Cairo. Egyptian Journal of Hospital Medicine. 2018;72(1).

Rahimi HR, Soltaninejad K, Shadnia S. Acute tramadol poisoning and its clinical and laboratory findings. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2014;19(9):855.




DOI: https://doi.org/10.22037/aaem.v8i1.538

DOI (PDF): https://doi.org/10.22037/aaem.v8i1.538.g707

DOI (HTML): https://doi.org/10.22037/aaem.v8i1.538.g778