Acute Tramadol Poisoning; Evaluating the Risk Factors of Seizures and Finding a Correlation with Tramadol Blood Level

Document Type : Original Article


Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.


Background: tramadol-induced seizures (TIS) are reported to occur in 15%–35% of tramadol poisoned cases.
Aim: the present study aimed to evaluate the risk factors of TIS and to find out if there is a correlation between TIS and the ingested dose and the blood level of tramadol.
Patients and methods: this study included cases of both genders with acute tramadol poisoning admitted to Tanta University Poison Control Center from January 2019 to December 2019. Each case was subjected to history taking, clinical and laboratory evaluation including tramadol urine screen and tramadol blood level estimation at admission.
Results: Sixty-two cases were enrolled in the study. Their mean age was 28.3  9.6 years, 85.5% of them were males, addiction was the most common mood of poisoning. Seizure was recorded in 40.4% of the cases. There was a significant statistical difference between non- seizing and seizing groups regarding ingested tramadol dose and tramadol blood level. Furthermore, there was a strong significant positive correlation between both and occurrence of seizures. Receiver operating curve analysis revealed that both had an excellent discriminatory power in predicting seizure occurrence, but tramadol blood level had a better area under the curve.
Conclusion: Acute tramadol poisoning is associated with increased risk of developing seizures. The ingested tramadol dose and the tramadol blood level could be used as excellent predictors of seizures in cases of tramadol overdoses.