open access

Vol 71, No 2 (2020)
MARITIME MEDICINE Case report
Published online: 2020-06-27
Submitted: 2020-05-13
Accepted: 2020-06-12
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Fatal accident involving a welder employed by a shipping container company, associated with the use of tramadol and antidepressant agents

Pere Sanz-Gallen, Narciso Amigó de Bonet, María Luisa Canals, Gabriel Martí-Amengual
DOI: 10.5603/IMH.2020.0020
·
Pubmed: 32604453
·
International Maritime Health 2020;71(2):109-113.

open access

Vol 71, No 2 (2020)
MARITIME MEDICINE Case report
Published online: 2020-06-27
Submitted: 2020-05-13
Accepted: 2020-06-12

Abstract

The widespread use of opioids for the treatment of moderate or severe acute and chronic pain has become a public health problem due to the physical and psychological dependence and tolerance they produce. The increasingly higher doses that patients require may reach toxic levels or lead to accidents, including fatalities.

We present the case of a welder who, while working for a shipping container company, fell from height without a safety harness and subsequently died as a result of a traumatic brain injury. Post-mortem examination revealed a cardiac blood tramadol concentration of 2.83 mg/L, which is 3–4 times higher than the maximum therapeutic dose. The combined use of synthetic opioids and antidepressants may heighten the adverse neurological and psychiatric effects.

A review of the literature, identified studies, including previous reports of fatalities, supported our causal hypothesis of a serotonin syndrome. This syndrome can lead to a loss of cognitive and sensory capacity, interfere with decision-making ability, and produce mental confusion and dizziness, among other symptoms. In order to prevent harm to themselves and others, all persons who are currently taking these kinds of drugs should avoid dangerous tasks at work and must be advised by a physician regarding the type of activities that are safe for them to perform.

Abstract

The widespread use of opioids for the treatment of moderate or severe acute and chronic pain has become a public health problem due to the physical and psychological dependence and tolerance they produce. The increasingly higher doses that patients require may reach toxic levels or lead to accidents, including fatalities.

We present the case of a welder who, while working for a shipping container company, fell from height without a safety harness and subsequently died as a result of a traumatic brain injury. Post-mortem examination revealed a cardiac blood tramadol concentration of 2.83 mg/L, which is 3–4 times higher than the maximum therapeutic dose. The combined use of synthetic opioids and antidepressants may heighten the adverse neurological and psychiatric effects.

A review of the literature, identified studies, including previous reports of fatalities, supported our causal hypothesis of a serotonin syndrome. This syndrome can lead to a loss of cognitive and sensory capacity, interfere with decision-making ability, and produce mental confusion and dizziness, among other symptoms. In order to prevent harm to themselves and others, all persons who are currently taking these kinds of drugs should avoid dangerous tasks at work and must be advised by a physician regarding the type of activities that are safe for them to perform.

Get Citation

Keywords

fatal outcomes, occupational accidents, poisoning, opioid abuse, antidepressant agents, drug-related side effects, adverse reactions

About this article
Title

Fatal accident involving a welder employed by a shipping container company, associated with the use of tramadol and antidepressant agents

Journal

International Maritime Health

Issue

Vol 71, No 2 (2020)

Pages

109-113

Published online

2020-06-27

DOI

10.5603/IMH.2020.0020

Pubmed

32604453

Bibliographic record

International Maritime Health 2020;71(2):109-113.

Keywords

fatal outcomes
occupational accidents
poisoning
opioid abuse
antidepressant agents
drug-related side effects
adverse reactions

Authors

Pere Sanz-Gallen
Narciso Amigó de Bonet
María Luisa Canals
Gabriel Martí-Amengual

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