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제목	Serotonin Syndrome Due to Tramadol Toxicity Manifesting as Severe Acute Kidney Injury Treated with Hemodialysis and Hemoperfusion: A Case Report
저자	Dosmer Oloan Simarmata
출판정보	2026; 2026(1):
키워드	Acute Kidney Injury, Hemodialysis, Hemoperfusion, Serotonin Syndrome, Tramadol Toxicity
초록	Case Study: Serotonin Syndrome is a life-threatening condition caused by excessive serotonergic activity in the central and peripheral nervous systems. Although commonly associated with antidepressants, tramadol, an opioid analgesic with serotonergic properties, has increasingly been recognized as an important trigger. Severe complications such as rhabdomyolysis and acute kidney injury (AKI) are rare but associated with high morbidity. A 28-year-old man presented with progressive dyspnea, brief convulsions, oliguria, and myalgia. The patient reported recreational use of tramadol 800 mg daily, escalating to 1800 mg on the day of admission, concurrent with ondansetron use. On admission, he exhibited autonomic instability, hypertension, pulmonary edema, repeated spontaneous generalized tonic-clonic seizures and hyperreflexia. Laboratory findings revealed severe metabolic acidosis, hyperkalemia, hyperuricemia, hyperphosphatemia, and markedly elevated serum creatinine. Urinalysis demonstrated dark urine with positive heme but minimal erythrocytes, suggesting myoglobinuria. Creatine kinase levels were elevated. Based on clinical manifestations and laboratory findings with fulfillment of the Hunter Serotonin Toxicity Criteria, the patient was diagnosed with Serotonin Syndrome complicated by rhabdomyolysis and AKI. The patient required mechanical ventilation, benzodiazepine sedation, and renal replacement therapy. Intermittent hemodialysis combined with hemoperfusion was initiated, leading to gradual clinical and renal recovery. The patient was discharged with normalized renal function. Tramadol enhances serotonergic activity through inhibition of serotonin reuptake and μ-opioid receptor stimulation. Excess serotonin causes neuromuscular hyperactivity and sustained muscle contraction, leading to rhabdomyolysis and subsequent AKI. Although tramadol is poorly eliminated by conventional hemodialysis, hemoperfusion effectively removes circulating toxins and inflammatory mediators. Serotonin Syndrome should be considered in patients with unexplained neurological manifestations and AKI following tramadol exposure. Early diagnosis, discontinuation of offending agents, and prompt supportive care, including combined hemodialysis and hemoperfusion, are essential rescue therapies that significantly decrease morbidity and mortality.
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