Circulation

Cardiovascular complications are uncommon with tramadol poisoning. If hypotension is problematic, start intravenous fluid resuscitation. Severe hypotension requiring inotropic support can occur following massive ingestions—seek advice from a clinical toxicologist regarding management.

If the QT interval is prolonged, commence continuous ECG monitoring and assess serial 12-lead ECGs, and manage urgently according to Treatment for QT-interval prolongation and torsades de pointes.