Parameter  Score
Manner of poisoning  
Therapeutic error 3
Addiction 2
Suicidal 1
Blood pressure  
Normal (110-135/65-85 mmHg) 3
Hypertension (>140/90 mmHg) 2
Hypotension (BP <90/60mmHg) 1
Respiratory rate 2
Normal (12-24breath/min)  
Bradypnea (< 12breath/min) or Tachypnea >24breath/min) 1
Cyanosis  
Absent 2
Present 1
CNS manifestations  
a)Seizure  
Absent 2
Present 1
b)Coma 2
Absent  
Present 1
Cardiovascular complications  
a)Shock  
Absent 2
Present 1
b)Cardiac arrest  
Absent 2
Present 1
Pulmonary complications  
a)Respiratory failure  
Absent 2
Present 1
b) Pulmonary edema  
Absent 2
Present 1
Ischemic changes  
Absent 2
Present(elevated or depressed ST segment, flat or inverted T wave, deep Q) 1
pH  
7.35-7.45 3
7.23-7.34 2
<7.23 1
HCO3┬»  
22-24mmol/l 3
15-21.9mmol/l 2
<15mmol/l 1
Serum K  
3.5-5meq/l 2
<3.5 meq/l or >5 meq/ l 1
Serum createnine  
0.6-1.4mg/dl 2
>1.4 mg/dl 1
Alanine Aminotransferase (ALT)  
5-56U/L 2
>56U/L 1
White blood cell count  
4,500 - 10,000mm3 2
>10000 mm3 1
Creatine kinase MB (CK-MB)  
Up to 24 U/L 2
>24 U/L 1
Total Maximum 40
Minimum 18
Table 7: predictive Score for progression of tramadol intoxication