Multiply organ dysfunction syndrome due to tramadol intoxication alone

Tramadol is a synthetic, centrally acting analgesic for the treatment of moderate to severe pain. It is widely used because of its efficacy and safety. A normal-dose tramadol has less adverse effects than other opioids. Multiply organ dysfunction syndrome due to tramadol intoxication is rare.We present a case of 19-year-old male patient who had multiply organ dysfunction syndrome due to oral tramadol alone. With a history of tramadol abuse for 6 months, the patient was found unconsciousness in bed 8 hours before hospitalization. A toxicologic analysis showed a tramadol blood concentration of 9.5 mg/L without toxic levels of other drugs. The patient developed deep coma, acute respiratory distress syndrome, hepatic and renal dysfunction,and shock in the first 24 hours after admission. With mechanical ventilation, hemoperfusion, and other supportive therapies, his overall status gradually improved and he was discharged 23 days later.