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Alprazolam/tramadol Various toxicities: case report

A 43-year-old woman developed hypotension, alteration of consciousness, tetraplegia, respiratory failure, cervical myelitis, stress-induced cardiomyopathy and refractory cardiogenic-shock following alprazolam and tramadol intoxication [dosages, routes, indications, time to reactions onsets and outcomes not stated]. The woman was admitted to an ICU with hypotension, alteration of consciousness and C4-level tetraplegia in the context of alprazolam and tramadol intoxication with concurrent alcohol intoxication. She was found to be in an unconscious state along with her neck in prolonged hyperflexion at 90° for a minimum of 12-hours. Due to respiratory failure, oro-tracheal intubation was performed. A spinal MRI revealed cervical myelitis, major para-vertebral and muscular oedema facing the lesion. The echocardiography suggested stress-induced cardiomyopathy with development of a refractory cardiogenic-shock which required veno-arterial- extracorporeal membrane oxygenation. The woman recovered with a normal cardiac function and consciousness, but the C4-tetraplegia persisted and she remained mechanical ventilation dependent because of central diaphragm paralysis. CSF analysis showed mild hyperproteinorachy without leucocytes, auto anti-body, IgG intrathecal synthesis, or viral genome detection. Cerebral MRI was normal. Despite corticosteroid bolus, her neurological condition did not improve, and she died from ventilator-associated pneumonia one month later. Masi P, et al. Spinal-cardiac crosstalk. Intensive Care Medicine 46: 1614-1615, No. 8, Aug 2020. Available from: URL: http://doi.org/10.1007/ s00134-019-05915-4

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Reactions 12 Sep 2020 No. 1821