2.Tramadol intoxication and its toxicological effect.
Hua-xin WANG ; Ling WANG ; Da-wei GUAN ; Ming-biao WANG
Journal of Forensic Medicine 2008;24(4):293-296
Tramadol is a centrally acting analgesic with a dual mode of action. Its analgesic efficacy is attributed to its partial affinity for the mu-opiate receptor and its inhibition of norepinephrine and serotonin reuptake. Acting in a synergistic manner and being more efficacious, tramadol is used worldwide for the treatment of moderate to severe acute or chronic pain. Abuse and dependence of tramadol as well as tramadol-related deaths have been increasingly reported, either ingested alone or taken in combination with other potentially interacting drugs. The possible toxic effect of tramadol was reviewed from aspects of its analgesic mechanisms, adverse effect, dependence, and abuse.
Analgesics, Opioid/poisoning*
;
Forensic Toxicology
;
Humans
;
Substance-Related Disorders/prevention & control*
;
Tramadol/poisoning*
3.The expression of GABA(A) receptor alpha1 and GABA(B) receptor 1 in medulla oblongata solitary nucleus and ambiguous nucleus in the cases of tramadol intoxication.
Shu ZHANG ; Da-Wei GUAN ; Ling WANG ; Hua-Xin WANG ; Guo-Hua ZHANG ; Rui ZHAO ; Yan-Yan FAN
Journal of Forensic Medicine 2011;27(6):401-404
OBJECTIVE:
To observe the expression of GABA(A) receptor alpha1 (GABA(A)alpha1) and GABA(B) receptor 1 (GABA(B)1) in human medulla oblongata solitary nucleus and ambiguous nucleus due to tramadol-induced death.
METHODS:
GABA(A)alpha1 and GABA(B)1 were detected by immunohistochemical SP method in tramadol-induced death group and control group. All results were evaluated by images analysis system.
RESULTS:
Low expression of GABA(A)alpha1 and GABA(B)1 were detected in solitary nucleus and ambiguous nucleus in the control brain tissue. In cases of tramadol-induced death, the expression of GABA(A)alpha1 and GABA(B)1 significantly increased.
CONCLUSION
The mechanism of tramadol intoxication death could be caused by respiratory depression induced by over-expression of GABA(A)alpha1 and GABA(B)1 in medulla oblongata solitary nucleus and ambiguous nucleus.
Adult
;
Analgesics, Opioid/poisoning*
;
Autopsy
;
Case-Control Studies
;
Cause of Death
;
Female
;
Forensic Toxicology
;
Humans
;
Immunohistochemistry
;
Male
;
Medulla Oblongata/metabolism*
;
Receptors, GABA-A/metabolism*
;
Receptors, GABA-B/metabolism*
;
Respiration Disorders/etiology*
;
Solitary Nucleus/metabolism*
;
Staining and Labeling
;
Tramadol/poisoning*
4.Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran.
Khoshideh BABAK ; Arefi MOHAMMAD ; Ghorbani MAZAHER ; Akbarpour SAMANEH ; Taghizadeh FATEMEH
Epidemiology and Health 2017;39(1):e2017050-
OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis. METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test. RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%). CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.
Analgesics, Opioid
;
Checklist
;
Critical Care*
;
Cross-Sectional Studies
;
Drug-Related Side Effects and Adverse Reactions
;
Female
;
Humans
;
Intensive Care Units*
;
Iran*
;
Male
;
Methadone
;
Mortality
;
Opium
;
Poisoning*
;
Potassium
;
Renal Insufficiency
;
Rhabdomyolysis*
;
Sodium
;
Street Drugs
;
Urea
5.Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran
Khoshideh BABAK ; Arefi MOHAMMAD ; Ghorbani MAZAHER ; Akbarpour SAMANEH ; Taghizadeh FATEMEH
Epidemiology and Health 2017;39(1):2017050-
OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis.METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test.RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%).CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.
Analgesics, Opioid
;
Checklist
;
Critical Care
;
Cross-Sectional Studies
;
Drug-Related Side Effects and Adverse Reactions
;
Female
;
Humans
;
Intensive Care Units
;
Iran
;
Male
;
Methadone
;
Mortality
;
Opium
;
Poisoning
;
Potassium
;
Renal Insufficiency
;
Rhabdomyolysis
;
Sodium
;
Street Drugs
;
Urea