Acute Delirium after Injectable Tramadol

Abstract

Introduction: Delirium and confusional states are among the most common mental disorders encountered in patients with acute medical illness, particularly among those who are older. We report a case of tramadol induced acute delirium in a patient admitted in the emergency ward which was managed by stoppage of the offending drug. Case report: A 62 year old male presented to the emergency ward with complaints of acute abdominal pain and ultrasonography revealed cholithiasis. All other investigations were unremarkable and the patients was put on conservative management including tramadol for pain relief. Few hours later, the patient developed confusion, violent behavior, and started talking irrelevantly, which subsided after he was sedated with lorazepam. Next morning, after receiving another dose of injectable tramadol, the patient again developed delirium with similar symptoms as the night before. After thorough psychiatric consultation he was diagnosed with tramadol induced delirium. As a result, tramadol was discontinued and the patient recovered completely. Conclusion: Tramadol, a commonly used analgesic in emergency and surgical settings, can lead to delirium. It is important for emergency physicians to have a high index of suspicion so that they can promptly identify the offending drug and take corrective measures.