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Death Secondary to Acute Tramadol Intoxication in a Child: An Autopsy Case Report
Taher Sakly1, Dorra Oualha1, Mariem Bel Hadj1
1Department of Forensic Medicine, Faculty of Medicine.
The American Journal of Forensic Medicine and Pathology
|July 16, 2026
Summary
A rare fatal pediatric tramadol intoxication occurred in a 4-year-old child after a prescribed dose. Postmortem toxicology confirmed a lethal tramadol concentration, highlighting risks of overdose and the need for careful prescribing and parental education.
Area of Science:
- Pediatric toxicology
- Forensic pathology
- Clinical pharmacology
Background:
- Tramadol is a widely used analgesic for postoperative pain.
- It is generally considered to have low abuse potential.
- Fatal pediatric tramadol intoxication is exceptionally rare.
Purpose of the Study:
- To report a rare case of fatal pediatric tramadol intoxication.
- To emphasize the role of forensic toxicology in unexplained deaths.
- To highlight medicolegal concerns in pediatric pain management.
Main Methods:
- Case report of a 4-year-old child found deceased post-circumcision.
- Forensic autopsy with histological examination.
- Postmortem plasma tramadol concentration analysis.
Main Results:
- Autopsy revealed pulmonary edema; no traumatic injuries.
- Plasma tramadol concentration was 2500 ng/mL (therapeutic range: 100-300 ng/mL).
- Excessive tramadol dose confirmed in the pharmaceutical container.
Conclusions:
- Cause of death attributed to acute tramadol intoxication, likely via respiratory depression.
- This case underscores the importance of forensic toxicology for nonspecific autopsy findings.
- Highlights medicolegal issues regarding prescription practices and parental education for analgesics.
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