title: Cardiogenic shock due to acute tramadol intoxication.
abstract: Tramadol is a common analgesic, widely prescribed because of its efficiency and safety. We report the case of a 7-year-old child admitted in cardiac intensive care unit for cardiogenic shock due to tramadol intoxication. Without any past history, the child was admitted at emergency room for generalised convulsion, followed by respiratory distress. Cardiogenic shock was suspected after clinical examination and chest X-ray and confirmed by transthoracic echocardiography showing low left ventricular ejection fraction (<30 %) with pulmonary hypertension. No evidence of cardiac infarction or myocarditis was found. Tramadol intoxication was suspected because of empty tramadol tablets found near the child and later confirmed by toxicologic analysis showing high blood concentration of tramadol (>1 mg/L) and O-desmethyltramadol (>1.5 mg/L). Hemodynamic support by inotropic drug infusion and diuretics was necessary. Left ventricular function normalised after 2 days of treatment allowing drug infusion weaning. Cardiac magnetic resonance imaging performed 3 days after admission confirmed normal left ventricular ejection fraction and volumes without evidence of late gadolinium enhancement. Cardiogenic shock due to tramadol intoxication is rare but exists. Negative inotropic effect of high doses of tramadol has been suspected. Quick recovery is possible.
authors.affiliation: Service de Cardiologie Congénitale et Pédiatrique, Hôpital du Haut-Lévêque, CHU Bordeaux, Avenue de Magellan, 33604, Pessac, France, elop85@yahoo.fr.
authors.forename: Elodie
authors.initials: E
authors.lastname: Perdreau
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Mouton
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning*; D002648:Child; D062787:Drug Overdose / Q000150:complications*; D004452:Echocardiography; D006801:Humans; D008279:Magnetic Resonance Imaging; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014147:Tramadol / Q000506:poisoning*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced*
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol