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Tramadol, a synthetic opioid derivative of codeine, is an extensively prescribed analgesic as it is considered a safe and effective drug. However, tramadol poisoning is increasingly reported and becoming a serious health problem worldwide, including Egypt. Despite this, the likelihood of tramadol-induced hepatorenal complications is infrequently studied. This prospective study was conducted over a six-month (JanuaryJune-2015) to describe socio-demographic and drug exposure patterns beside assessment of hepato-renal functions (AST = aspartate amino transferase, ALT = alanine amino transferase, ALP = alkaline phosphatase, TBL = total bilirubin, BUN = blood urea nitrogen, and CRE = creatinine) among tramadol poisoned patients who were admitted to Benha Poison Control Unit, Qalyubia, Egypt. Ninety-five patients in tramadol-intoxicated group (TI-GP) and twenty-five volunteers in the healthy-control group (HC-GP) fulfilled the inclusion criteria. For poisoning severity, clinical picture of the patients were categorized into group-I (G-I; mild), group-II (G-II; moderate), and group-III (G-III; severe). Most patients experienced minor clinical manifestations and listed in G-I. In TI-GP, the majority of cases were males (73; 76.84%) in the third decade of life with a mean age of 28.06±0.85-year, unmarried (45; 47.37%), urban residents (68; 71.58%) with sufficient financial resources (72; 75.79%), highly educated (61; 64.21%), and unemployed (39; 41.05%), whereas, the drug exposure data featured predominance of home incidence (77; 81.05%), oral route only (95; 100%), accidental manner (82; 86.32%) with abusive history (71; 74.74%), a mean ingested dose of 1258.68±57.71-mg, and a mean lag time of 6.57±0.56-hour. The mean ingested dose and lag time estimates of G-III demonstrated significant increases as compared to TI-GP, G-I, and G-II. All hepato-renal biomarkers of TI-GP, some in G-I (ALP, TBL, and CRE), G-II, and G-III showed significant elevations compared to HC-GP. Additionally, all biomarker levels (except TBL; insignificant) of G-I as well as some variables of G-II (AST, ALP, BUN, and CRE) and G-III (ALT, ALP, TBL, and CRE) were significantly decreased and increased, respectively, when compared with TI-GP. Whereas, all biomarker levels of G-II (except TBL; insignificant) and G-III demonstrated significant rises as matching G-I and dissimilar statistical results when compared with each other (significant rise of AST in G-II and ALT in GIII). All biomarkers showed positive correlation with the alleged ingested doses and lag times. Tramadol’s wide popularity, high consumption prevalence, and poisoning incidences, particularly among young Egyptian adults, is potentially growing socially hazardous phenomenon that has detrimental effects on hepato-renal functions in a dose-and time-dependent manner and should be considered during patients’ monitoring in overdosed situations for early detection of subclinical or serious organs damage.

the egyptian journal of forensic sciences and applied toxicology/theegyptian journal of forensic sciences and applied toxicology

SOCIO-DEMOGRAPHIC PATTERN OF TRAMADOL INTOXICATED PATIENTS AND THE CORRELATION BETWEEN HEPATO-RENAL BIOMARKER LEVELS WITH THE INGESTED DOSES AND LAG TIMES: A PROSPECTIVE CONTROLLED STUDY AT BENHA POISON CONTROL UNIT, QALYUBIA, EGYPT