• Koen De Decker, Jan Cordonnier, Werner Jacobs, Vera Coucke, Paul Schepens, and Philippe G Jorens.
• Department of Critical Care Medicine, University Hospital of Antwerp, Edegem, Belgium. koen.de.decker@uza.be
• Forensic Sci. Int. 2008 Feb 25;175(1):79-82.

AbstractPoisoning may also lead to both coma and multiple organ failure, also in youngsters without a known major medical history. As not all toxic agents are routinely screened when a poisoning is suspected, it is useful to consider less frequently encountered poisons in certain cases. We describe the occurrence of asystole and multiple organ failure which occurred in a young man after a suspected tramadol overdose. The tramadol concentration on admission in the ICU was indeed 8 microg/ml (mg/l), far above the therapeutic range. Subsequently, the patient developed severe acute liver failure, finally leading to death. Post-mortem toxicology did not reveal any other poison responsible for this unfavourable course as only very high serum and tissue tramadol and desmethyltramadol concentrations were found. Only a few fatal poisonings attributable to tramadol alone, as observed in our case, have been reported. An overview of these cases is presented.

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