Potential Impact of 3% Hypertonic Saline Infusion on Tra-madol Poisoning-Induced Electrocardiogram Changes; aRandomized Clinical Trial

Tramadol is a synthetic analgesic with weak mu-opioid receptor agonist activity. Tramadol over-dose is associated with adverse cardiac effects due to inhibiting cardiac Na+and K+channels. This study aimedto investigate the potential ameliorative role of 3% hypertonic saline on the electrocardiogram (ECG) changesin patients presenting with tramadol poisoning.

This was a single-center, controlled, randomized,single-blind clinical trial. Patients were randomized into the case (received hypertonic saline) and control (re-ceived placebo) groups. ECG was obtained twice in each group (upon arrival and following the intervention).Response to therapeutic interventions was evaluated using Wilcoxon Signed Ranks Test.

A total of76 patients were included. The mean age of patients was 24.88 ± 4.29 years, and 62 (81.6%) were male. Themean ingested dose of tramadol was 1673.68 ± 608.85 (range: 550-2750) mg. The number needed to treat andthe absolute risk reduction of 3% hypertonic saline in the treatment of wide QRS were 1 (95% CI: 1.00 – 1.00)and 100%, respectively. In the treatment of long QTc, these measures were 1.9 (95%CI: 1.2 – 4.5) and 53.85%(95%CI: 22.00 – 85.69), respectively.

Given that hypertonic saline infusion can significantly amelio-rate tramadol-mediated ECG changes, including QRS prolongation and QT lengthening, it can be regarded as apotential therapeutic strategy to prevent the development of life-threatening ventricular arrhythmias caused bytramadol toxicity.