OBJECTIVES: Severe complications of tramadol overdose have been reported; however, few large-scale studies have investigated this issue. Therefore, this study aimed to explore the presentation and complications of tramadol overdose in patients admitted to an intoxication referral center in northwestern Iran.METHODS: Patients with tramadol overdose admitted to Sina Teaching Hospital in Tabriz, Iran during 2013-2017 were included. For each patient, the following data were collected: demographics, previous drug or medication overdose, whether the patient was in the process of quitting drug use, ingested dose of tramadol and co-ingestants, Glasgow Coma Scale (GCS) score, clinical symptoms at the time of admission, and admission characteristics. Serotonin toxicity was diagnosed in patients who fit the Hunter criteria. Multiple logistic regression was performed to identify variables associated with the incidence of severe complications of tramadol overdose.RESULTS: In total, 512 cases of tramadol overdose were evaluated, of which 359 patients were included, with a median age of 41 years (range, 16-69) and a median tramadol dose of 1,500 mg (range, 500-4,000). The most frequent complications associated with tramadol overdose were hypertension (38.4%), tachycardia (24.8%), and seizure (14.5%). No serotonin toxicity was detected in patients. Having a GCS score <15, having taken a tramadol dose of >1,000 mg, being in the process of quitting drug use, being 30-49 years old, and male sex were significantly related to the incidence of severe complications of tramadol overdose.CONCLUSIONS: Although seizure was prevalent among Iranian patients with tramadol poisoning, serotonin toxicity and cardiogenic shock were rare findings.

No appropriate therapeutic method has been defined for AF. At present, the common way of treating AF following cardiac surgery is mainly based on prophylaxis in medical books and references.

Aim: The prevalence of alcohol poisoning is increasing in Iran but there is not enough information regarding the relationship between the prevalence of alcohol abuse and demographic variables. We aimed to obtain data regarding the epidemiological aspect of alcohol abuse and its treatment methods and the fate of alcohol-poisoned patients. Materials and Methods:This retrospective study was conducted on alcohol-poisoned patients who were referred to the Emergency Department of Sina Hospital from October 2011 to April 2012. Gender, age, marital status, social habit, type of alcohol consumed, time of alcohol consumption, chief complication, and type of treatment, and finally the outcomes of patients were recorded.Results: There were 30 alcohol-poisoned patients during this period, including 29 males and only one female with a mean age of 37.6 years. Clinically, 66.6%, 56.7%, 56.6%, and 23.3% of the patients suffered from metabolic acidosis, consciousness and visual disturbances, and respiratory distress, respectively. In this study, 73.3% of the hospitalized patients underwent dialysis, 6.7% of the patients received ethanol or charcoal, 13.3% of the patients received ethanol and folic acid or other treatments, and 6.7% of the patients underwent intubation. Complete recovery was observed in 70% of the treated patients, while 16.7% of the patients experienced partial recovery and 13.3% of the patients died. Conclusion:This study shows that in case of alcohol overdose or toxic level, we must take into account methanol and related side-effects, particularly in the patients who consume home-made alcohol. (Eurasian J Emerg Med 2015; 14: 131-3)

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