Death Secondary to Acute Tramadol Intoxication in a Child: An Autopsy Case Report

Tramadol is a centrally acting analgesic that is widely prescribed for the management of postoperative pain, and it is often considered to have low abuse potential. Fatal pediatric mono-intoxication is an exceptionally rare occurrence. The following report details the case of a 4-year-old child with no significant medical history, who was found dead in his bed 24 hours after undergoing circumcision. According to the family, the mother administered a single dose of 90 drops of Tramal (~400 mg) in accordance with the prescribed postoperative medication plan. A forensic autopsy was conducted, which revealed a eutrophic child with no traumatic injuries and pulmonary edema as the only significant finding, confirmed histologically. Postmortem toxicological analysis demonstrated a plasma tramadol concentration of 2500 ng/mL, which exceeds the therapeutic range (100-300 ng/mL) and is above the concentration often cited as fatal (>2000 ng/mL) in toxicological references. A thorough examination of the pharmaceutical container confirmed the presence of an excessive dose of the drug. The cause of death was attributed to acute tramadol intoxication, most likely due to respiratory depression. This case underscores the critical role of forensic toxicology when autopsy findings are nonspecific and highlights significant medicolegal concerns regarding prescription practices and parental education.