title: Refractory Cardiogenic Shock During Tramadol Poisoning: A Case Report.
abstract: Tramadol is a weak opioid analgesic indicated for the treatment of moderate to severe pain. Tramadol intoxication can be lethal, and this drug is frequently involved in voluntary overdose. Classically, tramadol intoxication is associated with neurological and respiratory side effects. In contrast, cardiac effects are poorly documented in the literature. We report a case of severe tramadol intoxication, with plasma concentration 20 times the toxic threshold, complicated by refractory cardiogenic shock, successfully treated by extra corporeal life support (ECLS) with a favorable cardiac outcome and ECLS weaning at day 10. Seizure, clonus, and nonreactive mydriasis were present during 4 days, and complete awakening was delayed to day 15. Poisoning caused by high doses of tramadol can lead to refractory cardiogenic shock, and ECLS can be considered as effective rescue therapy in this context.
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalo-Universitaire J. MINJOZ, Boulevard Fleming, 25030, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Belin
authors.affiliation: Pôle Pharmaceutique, Centre Hospitalo-Universitaire J. MINJOZ, 25030, Besançon, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Clairet
authors.affiliation: Service de Chirurgie Cardiaque, Centre Hospitalo-Universitaire J. MINJOZ, 25030, Besançon, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalo-Universitaire J. MINJOZ, Boulevard Fleming, 25030, Besançon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalo-Universitaire J. MINJOZ, Boulevard Fleming, 25030, Besançon, France. gpiton@chu-besancon.fr.
authors.forename: Gaël
authors.initials: G
authors.lastname: Piton
mesh_terms: D000701:Analgesics, Opioid / Q000097:blood / Q000506:poisoning*; D062787:Drug Overdose; D005112:Extracorporeal Circulation; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013406:Suicide, Attempted; D014147:Tramadol / Q000097:blood / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol
keywords: Cardiogenic shock; ECLS; Intoxication; Tramadol