@article{ref1,
title="A suicidal poisoning due to tramadol. A metabolic approach to death investigation",
journal="Journal of forensic and legal medicine",
year="2013",
author="Barbera, Nunziata and Fisichella, Marco and Bosco, Andrea and Indorato, Francesca and Spadaro, Giorgio and Romano, Guido",
volume="20",
number="5",
pages="555-558",
abstract="Tramadol is a synthetic opioid, widely used for post-surgical and chronic pain. Lethal overdose due only to tramadol is not common; more often the poisoning is due to tramadol in combination with other substances. Reported is a suicidal case of lethal tramadol poisoning in a 48-year-old woman. Tramadol and its metabolites O-desmethyltramadol (M1), N-desmethyltramadol (M2), N,N-didesmethyltramadol (M3), N,O-didesmethyltramadol (M5) were detected by GC/MS in biological fluids (femoral blood, bile, urine, gastric content) and viscera (brain, lung, liver and kidney). The tramadol concentration in femoral blood was 61.83 mcg/ml which is approximately 30 times higher than that believed to be lethal. According with other Authors, a preferential formation of M1 over M2 (M1/M2 ratio >1) is indicative of acute death, while M1/M2 ratio <1 suggests that death occurred after a longer time lapse from ingestion.<p /> <p>Language: en</p>",
language="en",
issn="1752-928X",
doi="10.1016/j.jflm.2013.03.006",
url="http://dx.doi.org/10.1016/j.jflm.2013.03.006"
}