SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

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UNUSUAL TRAMADOL CONCENTRATIONS IN AN ACCIDENTAL DEATH INVOLVING
POLY DRUG USE
Ginger Baker, M.S., * Janice Yazzie, B.S., and Sarah Kerrigan, Ph.D.
New Mexico Department of Health, Scientific Laboratory Division, Toxicology Bureau, PO Box 4700,
Albuquerque, NM 87196·4700
Tramadol is a synthetic opioid-receptor agonist that is used clinically as an analgesic in daily doses of 100
to 400 mg. Therapeutic concentrations in blood are reported in the range 0.1 to 0.8 mg/L. Overdoses of 500
mg and higher may cause agitation, hypertension, tachycardia and seizures whereas doses greater than 800
mg may result in coma and respiratory depression. We report a case involving unusually high postmortem
tramadol (Ultram) concentrations in a 35 year-old male with a past medical history of bipolar illness,
anxiety, depression and substance abuse.
Tramadol concentrations were determined using solid phase extraction (Polychrom Clin II) and gas
chromatography/mass spectrometry (GCIMS) using full scan analysis with mepivicaine as the internal
standard. An R2 value in the linear range (0.2 4.0 mglL) was 1.000 for tramadol. The Intraassay CV
was 6.4 % using laboratory fortified independent spikes.
Initial toxicology findings of illicit drugs in femoral blood identified cocaine and benzoylecogonine at
concentrations of 0.04 mg/L and 0.91 mg/L, respectively. Therapeutic prescription medications found in
femoral blood included paroxetine, trazadone, tramadoland the active metabolite, O·desmethyltramadol.
Quantitative analysis oftramadol revealed extraordinarily high concentrations of the parent drug. Tramadol
concentrations in femoral blood, heart blood and vitreous fluid were 74 mg/L, 83 mg/L and 18 mg/L,
respectively. O-desmethyltramadol concentrations in femoral blood, heart blood and vitreous fluid were 4
mg/L,5mg/L and Img/L, respectively. Issues that need to be considered when interpreting toxicological
findings associated with multiple drug use will be discussed.
Keywords: tramadol, overdose, postmortem
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