Serotonin Syndrome Induced by Tramadol Intoxication in an 8-Month-Old Infant

Severe Tramadol Overdoses in Children: A Case Series Admitted to Paediatric Intensive Care Unit

“…Frequently, patients present a central nervous system depression linked to the opioid effects of Tramadol, but real serotoninergic syndromes involving tachycardia, hyperthermia, hypertension, hyper reflexia and clonus have been described [6,15]. Srinivas et al confirmed respiratory depression and seizures as an effect of Tramadol central action [16].…”

“…Only very few cases of acute Tramadol poisoning in infants have been reported [11], which can be daily treatment overdoses [8], accidental [6,9,10] or parental poisoning/Munchausen syndrome by proxy [5].…”

“…Due to Odesmethyltramadol's affinity for the μ-opiate receptors, an overdose can cause systemic symptoms such as nausea, vomiting, and respiratory or neurologic depression [5]. Other clinical presentations include serotoninergic syndromes or tonico-clonic seizures [5][6][7].…”

“…Intoxication is rare in the paediatric population and few cases are reported [3,5,6,[8][9][10][11]. We report 7 paediatric cases of Tramadol poisoning (voluntary or accidental) for patients admitted in our Paediatric Intensive Care Unit (PICU).…”

Tramadol - the Marmite™drug

“…Li et al [44] reported two children who suffered convulsions caused by continuous intravenous infusions of tramadol, whilst Grandvuillemin et al [45] reported two children with severe hypoglycaemia also thought to be related to tramadol. Marechal et al [46] described the case of an eight-month-old child who developed extreme agitation, fever and tachycardia (serotonin syndrome) after accidental ingestion of a single 200-mg tramadol tablet, and Perdreau et al [47] reported cardiogenic shock in a seven-yearold. Intoxication was confirmed by the finding of high serum levels of both tramadol and O-desmethyltramadol.…”