Creatinine Increase in a Young Girl Due to Tramadol Poisoning

Document Type : Case Study

Authors

Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Tramadol is an opioid with two differential mechanisms, including binding to the mu-opioid receptor and acting as a serotonin-norepinephrine reuptake inhibitor. Tramadol side effects are seizure and rhabdomyolysis. In this regard, the present report introduced a girl suffering from acute kidney injury and creatinine increase as a result of tramadol poisoning.
Case Report: A girl was admitted to an intensive care unit with a diagnosis of tramadol overdose. Her symptoms included loss of conciseness and respiratory depression. She was intubated. Her urine toxicology test was positive for tramadol, and urea and creatinine levels were reported as 126 and 9.5 mg/dl, respectively. She underwent daily dialysis for 2 h; however, no decrease was observed in urea and creatinine levels. Daily dialysis increased to 3.5 h, and after 11 days, her creatinine and urea levels decreased to 3 and 20 mg/dl, respectively. The patient did not have any history of neurological diseases, and her brain computed tomography scan showed leukodystrophy. On the 12th day of hospitalization, the patient was separated from the ventilator and transferred to the ward. She was discharged after a week and recommended to continued psychiatric treatments.
Conclusion: Tramadol belongs to opioids and is usually sold without prescription. Seizure, rhabdomyolysis, kidney failure, and brain complications due to long hypoxia are the reported side effects, which are increasing in recent years. Therefore, higher control of tramadol legal and illegal distribution is required.

Keywords


  1. Clarot F, Proust B, Vaz E, Goulle JP. Tramadol-benzodiazepines and buprenorphine-benzodiazepines: two potentially fatal cocktails? J Clin Forensic Med. 2003; 10(2):125-6.
  2. Tobias JD. Seizures after overdose of tramadol. South Med J. 1997; 90(8):826-7.
  3. Beakley BD, Kaye AM, Kaye AD. Tramadol, pharmacology, side effects and serotonin syndrome, a review. Pain Physician. 2015; 18(4):395-400.
  4. Cantrell FL, Mallett P, Aldridge L, Verilhac K2, McIntyre IM. A tapentadol related fatality case report with postmortem concentrations. Forensic Sci Int. 2016; 266:el-3.
  5. Barbosa J, Faria J, Leal S, Afonso LP, Lobo J, Queirós O, et al. Acute administration of tramadol and tapentadol at effective analgesic and maximum tolerated doses causes hepato-and nephrotoxic effects in Wister rats. Toxicology. 2017; 389:118-29.
  6. Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012; 2(1):1-38.
  7. Levin A, Warnock DG, Mehta RL, Kellum JA, Shah SV, Molitoris BA, et al. Improving outcomes from acute kidney injury: report of an Initiative. Am J Kidney Dis. 2007; 50(1):1-4.
  8. Palevsky PM, Liu KD, Brophy PD, Chawla
    LS, Parikh CR, Thakar CV, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013; 61(5):649-72.
  9. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States,
    2016. JAMA. 2016; 315(15):1624-45.
  10. ConZip (tramadol). Prescribing information. Brid-gewater, NJ: Vertical Pharmaceuticals; 2018.
  11. Mallappallil M, Sabu J, Friedman E, Salifu M. What do we know about opioids and the kidney? Int J Mol Sci. 2017; 18(1):223.
  12. Afshari R, Ghooshkhanehee H. Tramadol overdose induced seizure, dramatic rise of CPK and acute renal failure. J Pak Med Assoc. 2009; 59(3):178.
  13. Alinejad S, Ghaemi K, Abdollahi M, Mehrpour O. Nephrotoxicity of methadone: a systematic review. Springerplus. 2016; 5(1):2087.
  14. Singh VP, Singh N, Jaggi AS. A review on renal toxicity profile of common abusive drugs. Korean J Physiol Pharmacol. 2013; 17(4):347-57.
  15. Mercadante S, Arcuri E. Opioids and renal function. J Pain. 2004; 5(1):2-19.
  16. Ali OK, Ahmed A, Mawlood A. Effects of tramadol on histopathological and biochemical parameters in male rabbits. Am J Biol Life Sci. 2015; 3(3):85-90.
  17. El-Gaafarawi II. Biochemical toxicity induced by tramadol administration in male rats. Egypt J Hosp Med. 2006; 23:353-62.
  18. Lee M, Joshi R. Tramadol: a rare cause of acute interstitial nephritis. J Hospital Med. 2015; 29:592.
  19. Essam Hafez M, Sahar Issa Y, Safaa Abdel Rahman M. Parenchymatous toxicity of tramadol: histopathological and biochemical study. J Alcohol Drug Depend. 2015; 3(5):225.
  20. Kongara K, Chambers P, Johnson CB. Glomerular filtration rate after tramadol, parecoxib and pindolol following anaesthesia and analgesia in comparison with morphine in dogs. Vet Anaesth Analg. 2009; 36(1):86-94.