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Association of Tramadol Overdose, Brugada Phenotype on ECG, and PDE-8B Mutation causing a Life-Threatening Arrhythmia

DOI: 10.5083/ejcm20424884.190 , Cite or Link Using DOI
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Kartik Pandurang Jadhav, Dr Hari Kishan Boorugu, Krushna Chandra Mishra, Matta Venkatanaga Suresh, Kartik Munta, Pankaj V. Jariwala

ABSTRACT ‘Brugada phenotype’ on electrocardiogram (ECG) secondary to hyperkalemia is a known entity. However, ‘Brugada phenotype’ has rarely been documented secondary to tramadol usage and rhabdomyolysis. We present the case of a 25-years-old male doctor who was brought to the emergency room in a state of unconsciousness. His blood investigations showed acute kidney injury with elevated creatinine and urea. The former roommate found five used tramadol ampules, a bottle of normal saline, and intravenous (IV) sets in his room which gives the possibility of self- medication. The ‘Brugada phenotype’ appeared on ECG following ‘Tramadol overdosage’ and ‘Exertional Rhabdomyolysis’. This ECG phenotype might very well be confused with ST-segment elevation myocardial infarction on ECG. After a dose of naloxone 1 mg IV, his ECG showed resolution of ST elevation in V1-V2 and he was managed medically along with daily haemodialysis. Brugada phenotype on ECG is a precursor for life-threatening arrhythmias.