之前沒遇到過 TRAMADOL OVERDOSE 個案. 剛好看到FB上面的討論. 順便查詢做筆記.
第一篇
心跳過快 30.6%,
QRS 120 milliseconds or more in 7.5%,
corrected QT interval more than 440 milliseconds in 24.6%,
height of R wave more than 1 mm in lead aVR in 22.1%,
R/S ratio more than 0 in lead aVR in 23.5%,\
terminal 40-millisecond frontal plane QRS axis greater than 120° in 31.7%,
and complete or incomplete right bundle-branch block in 4.6% of the patients were detected.
There were no statistically significant differences between the patients who had not convulsed and those who had convulsed after admission regarding age, sex, vital signs, and ECG findings at presentation (all P values were >.05).
Electrocardiographic manifestations of tramadol toxicity with special reference to their ability for prediction of seizures
Abstract
Aim
The aims of this study are to determine the electrocardiographic (ECG) manifestations of the symptomatic patients with isolated tramadol toxicity and to predict seizures based on ECG parameters.
Methods
Medical charts of a total of 479 patients with isolated tramadol toxicity were retrospectively evaluated. Their clinical manifestations were recorded, and their ECG parameters including rate, PR interval, QRS duration, corrected QT interval, terminal 40-millisecond frontal plane QRS axis, and the height of R wave and R/S ratio in the lead aVR were measured. The data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney U test, Pearson χ2, Pearson correlation coefficient (r), and the Student t test.
Results
Electrocardiographic heart rate more than 100 beats per minute in 30.6%, QRS 120 milliseconds or more in 7.5%, corrected QT interval more than 440 milliseconds in 24.6%, height of R wave more than 1 mm in lead aVR in 22.1%, R/S ratio more than 0 in lead aVR in 23.5%, terminal 40-millisecond frontal plane QRS axis greater than 120° in 31.7%, and complete or incomplete right bundle-branch block in 4.6% of the patients were detected. There were no statistically significant differences between the patients who had not convulsed and those who had convulsed after admission regarding age, sex, vital signs, and ECG findings at presentation (all P values were >.05).
Conclusions
Tramadol toxicity shows ECG changes consistent with sodium channel blockade and potassium channel blockage effects. The risk of development of seizures cannot be predicted based on the changes of ECG parameters at presentation.
Introduction
Tramadol is a widely used, synthetic opioid analgesic [1], [2], [3]. It has a weak μ-receptor agonist activity that blocks the pain pathways as well as the inhibition of the reuptake of the biogenic amines especially serotonin and norepinephrine in central nervous system. The latter mechanism results in an increment in the pain threshold [4]. Tramadol toxicity can cause nausea and vomiting, hypertension, tachycardia, central nervous system depression, respiratory depression, agitation, and seizures [4], [5], [6]. Electrocardiographic (ECG) changes in opioid overdose are well described with propoxyphene [7], [8], [9], [10] and heroin [11], [12], [13], [14] including QRS prolongation, nonspecific ST segment and T-wave changes, first-degree atrioventricular block, atrial fibrillation, prolonged corrected QT (QTc) intervals, and ventricular dysrhythmias. Furthermore, a specific ECG pattern, the Brugada pattern, has previously been reported with isolated tramadol overdose [15]. However, except for the previously mentioned case of Brugada pattern in tramadol toxicity, the ECG findings of this toxicity have not yet been reported. This retrospective study aimed to determine the ECG manifestations of the symptomatic patients with isolated tramadol toxicity and the probability of prediction of seizures by the application of these manifestations.
