• Amir Hossein Behnoush, Nafiseh Alizadeh, Mahdi Emami, Elham Bazmi, Yousef Alimohamadi, and Behnam Behnoush.
• School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: amirhossein.behnoush@gmail.com.
• J Emerg Med. 2024 Feb 1; 66 (2): 154162154-162.

BackgroundAs the prevalence of tramadol toxicity is increasing, managing these patients with the aim of treatment and complete recovery has become a major challenge for health care professionals.ObjectiveThis study evaluated the short-term effects of IV lipid emulsion (ILE) administration in cases of tramadol poisoning.MethodsIn this double-blind, randomized controlled trial, 120 patients with pure tramadol poisoning and a Glasgow Coma (GCS) score ≤ 12 referred to a poisoning center in Tehran, Iran were selected and randomly assigned 1:1 to receive ILE 20% (intervention) or 0.9% saline (control) after admission and primary stabilization. The patient's vital signs, GCS score, hospitalization duration, and rate of seizure occurrence were recorded and compared between the two groups.ResultsMean (SD) age of participants was 25.3 (5.4) years and 84 (70%) were male. Mean (SD) ingested dose of tramadol was 3118 (244) mg, which was not different between the groups. Compared with controls, the ILE group had a higher level of consciousness after treatment (median [interquartile range] GCS score 12 [10-13] vs. 10 [8-12]; p = 0.03). In addition, length of hospitalization (median [interquartile range] (2 [1-3] days vs. 4 [4-6] days; p < 0.01) and rate of seizure occurrence were lower in the intervention group (16/60 vs. 30/60; p < 0.01).ConclusionsIn the setting of tramadol poisoning with a decreased level of consciousness and based on our study's findings, administration of ILE is suggested to help manage patients in hospital emergency departments. However, larger trials might be needed to confirm these findings before entering the guidelines.Copyright © 2023 Elsevier Inc. All rights reserved.

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