Décès secondaire à une injection intraveineuse lente de Tramadol lors d’une prise en charge médicale : à propos d’un cas

International audienceIntroductionTramadol is a synthetic opioid analgesic with two major metabolites O-desmethyltramadol (M1) and N-desmethyltramadol (M2), both metabolized by P450 CYP2D6 cytochrome. This molecule is generally considered to be devoid of serious side effects; however, it presents significant toxicity, particularly cardiac toxicity. Three cases of cardiac arrest due to the use of tramadol have been described in the literature but none led to death.Case reportWe, here, report the case of a 27-year-old Caucasian woman, admit in an emergency unit for a fall on roller skates, who died from sudden cardiopulmonary arrest, refractory to resuscitation, shortly after a slow intravenous injection of tramadol. Any cause of death was found at the autopsy except the presence of tramadol at a therapeutic concentration.DiscussionIn general, when tramadol is involved in a death, it is associated with the intake of other toxic substances and it is found in high concentration in blood. Here, tramadol and its metabolite M1 were found at concentrations expected for the clinical situation and mode of administration. At these concentrations, any serious or lethal adverse effects are usually observed. A higher than normal blood catecholamine level due to a state of severe stress may have potentiated the cardiac side effects of the molecule and thus lead to death through the cardio-toxic action of tramadol.ConclusionTo our knowledge, this is the first fatal case of cardiorespiratory arrest after slow injection of tramadol in a young subject, without comorbidity, in the context of an adapted use of this analgesic. The resuscitation carried out, although maximal and early, did not result in survival.IntroductionLe tramadol est un antalgique opiacé synthétique de palier II, dont les principaux métabolites sont le O-desméthyltramadol (M1) et le N-desméthyltramadol (M2), métabolisés par le cytochrome P450 CYP2D6. Cette molécule est généralement considérée comme dépourvue d’effets secondaires graves ; néanmoins, elle présente une toxicité non négligeable, notamment cardiaque. Trois cas d’arrêts cardiaques imputables à l’usage du tramadol ont été décrits dans la littérature, mais aucun n’a conduit au décès du sujet.À propos du casCet article présente le cas d’une jeune femme caucasienne, de 27 ans, prise en charge pour une chute en rollers, décédée des suites d’un arrêt cardiorespiratoire brutal, réfractaire à toute réanimation, survenu peu après une injection intraveineuse lente de tramadol. Aucune cause de décès n’avait été mise en évidence à l’autopsie, hormis la présence sanguine de tramadol à une concentration thérapeutique.DiscussionEn général, lorsque le tramadol est impliqué dans un décès, il est associé à la prise d’autres substances toxiques et il est présent en grande quantité. Ici, le tramadol et son métabolite M1 étaient retrouvés à des concentrations attendues pour la situation clinique et le mode d’administration. À ces concentrations, aucun effet indésirable grave ou létal n’est habituellement observé. Un taux sanguin de catécholamines plus élevé que la normale, dû à un état de stress important, a pu potentialiser les effets secondaires cardiaques de la molécule et ainsi entraîner le décès par l’action cardiotoxique du tramadol.ConclusionC’est, à notre connaissance, le premier cas mortel d’arrêt cardiorespiratoire au décours immédiat d’une injection lente de tramadol, chez un sujet jeune, sans antécédents, dans le cadre d’une utilisation adaptée de cet antalgique. La réanimation menée, bien que maximale et précoce, n’a pu permettre la survie de la jeune femme

A Numerical study of compacted clay tensile strength by discrete element modelling: A bending test application

International audienceThe study of the clay tensile behaviour is one of the topics which requires a specific lighting especially when we give a closely attention to the pathology of the constructions built with or on the clays submitted to significant tensilestrenght. Therefore, failure or damage of clay can be related especially to tensile limit and not to shear limit overtaking. It is the case of compacted clay liners in wastes landfill cover or for embankments built on high compressible soils. In order to study the tensile compacted clay behaviour, a series of laboratory bending tests were carried out. On the basis of the test results, different numerical simulations using Discrete Element Method were engaged. Two numerical bending tests were carried out: a three points bending and a four points bending. A comparison between the two numerical protocols is given. Four analytical models (classical elasticity, bimodular elasticity, differential model and struts-tie method) are used in order to interpret bending tests results and are compared with the numerical simulations. At the same time, the validity of the assumptions relative to the four models was discussed. To outcome to these results, a study and an adjustment of numerical and micromechanical parameters were carried out. It was demonstrated that the Discrete Element Method has a strong correlation with laboratory tests and can contribute somewhat to the understanding and discussion on the validity degree of the kind of indirect tests and of their interpretation

LASERIX : premier bilan du fonctionnement de l'installation

The LASERIX facility provides coherent and short soft x-ray beams for scientific applications. The beams are generated through high intensity laser interaction with matter using two different schemes, plasma based soft x-ray lasers, and high order laser harmonic generation. We describe in this communication the present status of the facility. The experimental setup composed of a terawatt titanium-sapphire laser and of different IR/XUV conversion devices is briefly described. The LASERIX beamtime has been recently opened to external users. We present two typical experiments performed in that context with the facility. The first one is dedicated to the fundamental study of the plasma based soft x-ray laser, whereas the second uses the existing beam to study irradiation induced damages in DNA samples. The future evolution of the facility, including enhancement of the laser energy is finally presented

Mild processing techniques and development of functional marine protein and peptide ingredients

International audienc

LASERIX : premier bilan du fonctionnement de l'installation

The LASERIX facility provides coherent and short soft x-ray beams for scientific applications. The beams are generated through high intensity laser interaction with matter using two different schemes, plasma based soft x-ray lasers, and high order laser harmonic generation. We describe in this communication the present status of the facility. The experimental setup composed of a terawatt titanium-sapphire laser and of different IR/XUV conversion devices is briefly described. The LASERIX beamtime has been recently opened to external users. We present two typical experiments performed in that context with the facility. The first one is dedicated to the fundamental study of the plasma based soft x-ray laser, whereas the second uses the existing beam to study irradiation induced damages in DNA samples. The future evolution of the facility, including enhancement of the laser energy is finally presented