An 86-year-old female was found unconscious the day after taking a prescribed tablet containing a combination of tramadol and acetaminophen. At admission to the hospital, marked hypoglycemia (blood glucose: 4 mg/dL) was confirmed, but serum insulin and C-peptide were within the normal range, which suggested that neither endogenous hyperinsulinemia nor exogenous insulin administration was responsible for the hypoglycemia. Despite resuscitation efforts, the woman subsequently died. At autopsy, there was renal disorder, but any pathological abnormalities that could have caused hypoglycemia were not observed. Blood tramadol and acetaminophen were in the therapeutic range. We speculate that the cause of fatal hypoglycemia was tramadol intake at the therapeutic dose. Older age and renal insufficiency are factors that could have potentially caused the fatal hypoglycemia in this case despite tramadol having been taken at a therapeutic dose. This is the first case report of fatal hypoglycemia following ingestion of a therapeutic dose of tramadol.

一名 86 岁的女性在服用含有曲马多和对乙酰氨基酚的处方药片后第二天昏迷不醒。入院时证实明显低血糖（血糖：4 mg/dL），但血清胰岛素和C肽均在正常范围内，提示内源性高胰岛素血症和外源性胰岛素给药均不是低血糖的原因。尽管进行了复苏努力，该妇女随后还是死亡。尸检时有肾脏疾病，但未观察到任何可能导致低血糖的病理异常。血液曲马多和对乙酰氨基酚在治疗范围内。我们推测致命性低血糖的原因是服用治疗剂量的曲马多。尽管曲马多已经以治疗剂量服用，但在这种情况下，年龄较大和肾功能不全是可能导致致命性低血糖的因素。这是摄入治疗剂量的曲马多后发生致命性低血糖的首例病例报告。