Hidden Trauma in Tramadol Intoxication

A 24-year-old man was brought to the ED with lethargy and confusion. His relatives found him lying flat in his room near a strip of tramadol tablets with 10 empty blisters, which meant he ingested 1,000 mg of the drug. They revealed that he had been taking tramadol illegally for five months. The patient received supportive care and cardiac monitoring. The next day, the patient became alert and complained of pain and discomfort in his upper teeth. He did not remember the seizure, but admitted tramadol abuse. His teeth seemed to be normal but were tender on pressure without evident buccal mucosa ecchymosis or laceration. The patient was discharged with advice for dentistry follow-up. A panoramic radiograph sought by the dentistry consultation demonstrated an upper incisor tooth fracture. (Figure 1.)   Seizures have been reported with tramadol even at recommended doses. (Ann Pharmacother 2005;39[6]:1039.) Tramadol poisoning may not be life-threatening, but it may complicate the intoxicated patients if accompanied by seizures. (J Pak Med Assoc 2009;59[3]:178; Eur Rev Med Pharmacol Sci 2012;16[Suppl 1]:34.) Farajidana et al. found the prevalence of trauma in tramadol ingestions was 24.6 percent, mostly in the face (9.5%). It didn’t detail the type of injuries, however. (Eur Rev Med Pharmacol Sci 2012;16[Suppl 1]:34.)   Patients with tramadol-induced seizures are significantly more susceptible to facial and dental injuries, which may remain undetected. It is important for EPs ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research