title: A suicidal poisoning due to tramadol. A metabolic approach to death investigation.
abstract: Tramadol is a synthetic opioid, widely used for post-surgical and chronic pain. Lethal overdose due only to tramadol is not common; more often the poisoning is due to tramadol in combination with other substances. Reported is a suicidal case of lethal tramadol poisoning in a 48-year-old woman. Tramadol and its metabolites O-desmethyltramadol (M1), N-desmethyltramadol (M2), N,N-didesmethyltramadol (M3), N,O-didesmethyltramadol (M5) were detected by GC/MS in biological fluids (femoral blood, bile, urine, gastric content) and viscera (brain, lung, liver and kidney). The tramadol concentration in femoral blood was 61.83 mcg/ml which is approximately 30 times higher than that believed to be lethal. According with other Authors, a preferential formation of M1 over M2 (M1/M2 ratio >1) is indicative of acute death, while M1/M2 ratio <1 suggests that death occurred after a longer time lapse from ingestion.
authors.affiliation: Department G.F. Ingrassia, Laboratory of Forensic Toxicology, University of Catania, Italy.
authors.forename: Nunziata
authors.initials: N
authors.lastname: Barbera
authors.forename: Marco
authors.initials: M
authors.lastname: Fisichella
authors.forename: Andrea
authors.initials: A
authors.lastname: Bosco
authors.forename: Francesca
authors.initials: F
authors.lastname: Indorato
authors.forename: Giorgio
authors.initials: G
authors.lastname: Spadaro
authors.forename: Guido
authors.initials: G
authors.lastname: Romano
mesh_terms: D000701:Analgesics, Opioid / Q000032:analysis / Q000506:poisoning*; D001646:Bile / Q000737:chemistry; D005260:Female; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D008875:Middle Aged; D013405:Suicide; D014147:Tramadol / Q000031:analogs & derivatives / Q000032:analysis / Q000506:poisoning*
chemical_list: D000701:Analgesics, Opioid; C080580:O-demethyltramadol; D014147:Tramadol; C080579:N-demethyltramadol