Abstract
INTRODUCTION: Tramadol is a synthetic opioid analgesic with two major metabolites O- desmethyltramadol (M1) and N-desmethyltramadol (M2), both metabolized by P450 CYP2D6 cytochrome. This molecule is generally considered to be devoid of serious side effects, however, it presents significant toxicity, particularly cardiac toxicity. Three cases of cardiac arrest due to the use of tramadol have been described in the literature but none led to death.CASE REPORT: We here report the case of a 27-year-old Caucasian woman, admit in an emergency unit for a fall on roller skates, who died from sudden cardiopulmonary arrest, refractory to resuscitation, shortly after a slow intravenous injection of tramadol. Any cause of death was find at the autopsy except the presence of tramadol at a therapeutic concentration.DISCUSSION: In general, when tramadol is involved in a death it is associated with the intake of other toxic substances and it is found in high concentration in blood. Here, tramadol and its metabolite M1 were found at concentrations expected for the clinical situation and mode of administration. At these concentrations, any serious or lethal adverse effects are usually observed. A higher than normal blood catecholamine level due to a state of severe stress may have potentiated the cardiac side effects of the molecule and thus lead to death through the cardio-toxic action of tramadol.CONCLUSION: To our knowledge, this is the first fatal case of cardiorespiratory arrest after slow injection of tramadol in a young subject, without comorbidity, in the context of an adapted use of this analgesic. The resuscitation carried out, although maximal and early, did not result in survival.