Tramadol overdose in total knee arthroplasty: A case report

Table 1 Test results and parameters

Test	Result
Blood urea	72 mg/dL
Serum creatinine	3.8 mg/dL
eGFR	36 mL/minute/1.73 m2
HbA1c	7.2
CBC, LFT, coagulation, echo, doppler	Within normal limits
Urinalysis (protein, sugar)	Normal
Vital signs	BP: 122/68 mmHg, HR: 72 bpm, RR: 15, SpO2: 92%
ABG	pH: 7.25 (mild respiratory acidosis)
CT & MRI brain	Cortical atrophy, lacunar infarcts
CT pulmonary angiography	No embolism or pneumonitis
Echocardiogram	Normal
Doppler (lower limbs)	No DVT
Tramadol level	1.8 mg/L (elevated; normal: 0.1-0.8 mg/L)

eGFR: Estimated glomerular filtration rate; HbA1c: Glycated hemoglobin; CBC: Complete blood count; LFT: Liver function tests; BP: Blood pressure; HR: Heart rate; RR: Respiratory rate; SpO₂: Oxygen saturation; ABG: Arterial blood gas; CT: Computer tomography; MRI: Magnetic resonance imaging; DVT: Deep vein thrombosis.

Table 2 Intensive care unit interventions and parameters

Intervention	Details
Intubation & ventilation	SIMV mode, PEEP 6, FiO2 60%, VT: 550
Opioid reversal	Buprenorphine patch removed, naloxone on standby
Diuresis	IV frusemide 40 mg BID
Recovery	GCS improved to 15/15 within 48 hours
Extubation & mobilization	POD 6
Pain management post-recovery	Paracetamol 1 g Q8H, pregabalin 75 mg QHS
Discharge	POD 10, stable vitals, no respiratory distress

SIMV: Synchronized intermittent mandatory ventilation; PEEP: Positive end-expiratory pressure; FiO₂: Fraction of inspired oxygen; VT: Tidal volume; IV: Intravenous; BID: Twice daily; GCS: Glasgow Coma Scale; POD: Postoperative day; Q8H: Every 8 hours; QHS: Every bedtime.