Tramadol Overdose Induced CPK Rise, Haemodynamic and Electocardiographic Changes and Seizure

Introduction: Overdose with tramadol, an opioid with unique structure, shows a variety of complications (1). This study aimed to evaluate the clinical findings related to this overdose and determine if evaluated CPK in these cases are related to seizure. Methods: All cases admitted with suspected tramadol overdose from 1st September 2006 to 31st August 2007 were included prospectively. The patients with known previous seizure, cardiac or kidney problems were excluded. Results: Tramadol overdose accounted for 151 cases (1.2% of all cases). A male predominance (63%) was found. Mean (SD) age was 22.6 (7.4) years. Four cases were referred to the nephrology department, one case referred to ICU. The most common ECG finding was sinus tachycardia. Heart rate was 94 ( plus or minus 24) bpm on admission. PR interval was 151 ( plus or minus 26) msec, QRS duration was 83 ( plus or minus 18) msec, and QTc was 428 ( plus or minus 38) msec. When patients were discharged, these indices were heart rate 78 ( plus or minus 15), PR 147 ( plus or minus 28), QRS 81 ( plus or minus 13) QTc 321 ( plus or minus 27). A ratio was derived by dividing R wave to S wave in aVR Lead. It was positively associated with QTc on admission (r=0.457, P