{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:35:17Z","timestamp":1789662917085,"version":"4.0.1"},"reference-count":15,"publisher":"Croatian Society for Medical Biochemistry and Laboratory Medicine","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biochem. med. (Online)"],"published-print":{"date-parts":[[2020,2,15]]},"abstract":"<jats:p>Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the\nexact mechanism is not known.\nCase description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a\nprofound hypoglycaemia (1.9 mmol\/L). Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient\nhad several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital.\nDespite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia.\nFurther investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation\nrevealed the presence of tramadol and its metabolites in lethal concentrations. Also acetaminophen, ibuprofen and lormetazepam were\npresent. Ethanol screening was negative (&lt; 0.1 g\/L) and no sulfonylurea were detected. The patient developed multiple organ failure, but eventually\nrecovered.\nWhat happened: The hypoglycaemia was caused by inappropriate stimulation of insulin secretion in a patient intoxicated with tramadol. The\nsudden hypokalaemia was caused by a massive intracellular shift of potassium in response to the hyperinsulinemia, triggered by the intravenous\nadministration of glucose.\nMain lesson: To our knowledge, we are the first to document a significant rise in endogenous insulin production in a hypoglycaemic patient presenting\nwith tramadol intoxication. Our observation suggests that hyperinsulinemia could be the cause of the hypoglycaemia associated with tramadol\nuse.<\/jats:p>","DOI":"10.11613\/bm.2020.010802","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T17:24:57Z","timestamp":1576257897000},"page":"143-148","source":"Crossref","is-referenced-by-count":10,"title":["An unconscious man with profound drug-induced hypoglycaemia"],"prefix":"10.11613","volume":"30","author":[{"given":"Toon","family":"Schiemsky","sequence":"first","affiliation":[{"name":"Laboratory Medicine, University Hospitals Leuven; Department of cardiovascular Medicine, University of Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Croes","sequence":"additional","affiliation":[{"name":"Laboratory medicine, AZ Groeninge Hospital, Kortrijk, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Vermeersch","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, University Hospitals Leuven; Department of cardiovascular Medicine, University of Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Pauwels","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, University Hospitals Leuven; Department of cardiovascular Medicine, University of Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koen","family":"Desmet","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, University Hospitals Leuven; Department of cardiovascular Medicine, University of Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris","family":"Penders","sequence":"additional","affiliation":[{"name":"Laboratory medicine, Ziekenhuis Oost-Limburg, Genk, 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