Tramadol: Hallucinations and psychosis, and overdose leading to status epilepticus: case report

A 15-year-old boy developed hallucinations and confusional psychosis during treatment with tramadol for osteoid osteoma pain, and convulsive status epilepticus after he took a tramadol overdose [times to onset not stated].

The boy's pain became unresponsive to NSAIDs, and he started receiving tramadol. He took oral tramadol 25mg, and subsequently developed complex auditory hallucinations, which cumulated in confusional psychosis. His symptoms spontaneously resolved within 24 hours, and his mother stopped tramadol administration. Two weeks after his first tramadol dose, he took tramadol 500mg [route and indication not stated] and developed generalised tonic clonic convulsive seizures, without regaining consciousness between episodes.

The boy received glucose and thiamine at an emergency centre, followed by diazepam and phenytoin without improvement. He was transferred to a neurology institute, was intubated and began receiving thiopental sodium with control of epileptic activity. Arterial blood gas analysis revealed a PaO ₂ of 150mm Hg and a PaCO₂ of 38mm Hg. An EEG showed burst-suppression pattern of 3-5 seconds with irregular right frontal spike wave complexes during thiopental administration, and electrical silence after the thiopental dosage was decreased. His EEG remained isoelectric for 3 days. Magnesium valproate was then started, and thiopental was stopped. He gradually regained consciousness and was discharged with minor sequelae 30 days later. Neurological findings had normalised 3 months later.

References

1. Marquez-Romero JM, Zermeno-Pohls F, Soto-Cabrera E.Convulsive status epilepticus associated with a tramadol overdose. Neurologia 25: 583-585, Dec 2010. Available from: URL: http://dx.doi.org/10.1016/j.nrl.2009.07.001. - Mexico.