Ketamine Overdose

Fallen · Oct 8, 2012

I have a character who has been given a series of ketamine injections over a peiod of five days. The wrong dosage is given on the fifth, and my MC starts to have breathing troubles, lapse into unconsiousness. I've had a look around, but can't find anything that covers the medication a EMT would use to neutralise the efects of the ketamine.

I was wondering if anyone had any idea what would be used, or any sources I could look into?

The MC takes medication for OCD, and with the Ketamine, he's also been given an opiate. He's otherwise very healthy.

Thanks for any help!!!

asroc · Oct 8, 2012

There is no medication to neutralize ketamine, at least not in EMS. Can't say for sure about the ED, but I don't think so. The character's treatment would be mostly supportive. So he'd be intubated with supplemental oxygen, get an IV and be closely monitored during the ride to the hospital, but there's not much else an EMT can do, other than deal with complications as they arise.

An opiate is going to increase the anesthetic effect of the ketamine, but I'm not sure if the OCD meds would be a problem.

GeorgeK · Oct 8, 2012

asroc said:
An opiate is going to increase the anesthetic effect of the ketamine, but I'm not sure if the OCD meds would be a problem.

It depends upon what the meds are, but as a general rule when you are to the point of being near anesthesia then anything that's psychoactive or neuroleptic can tip you from light sedation to apnea.

Fallen · Oct 8, 2012

asroc said:
There is no medication to neutralize ketamine, at least not in EMS. Can't say for sure about the ED, but I don't think so. The character's treatment would be mostly supportive. So he'd be intubated with supplemental oxygen, get an IV and be closely monitored during the ride to the hospital, but there's not much else an EMT can do, other than deal with complications as they arise.

An opiate is going to increase the anesthetic effect of the ketamine, but I'm not sure if the OCD meds would be a problem.

Would they need anything to increase his blood pressure? Or is it like you've just said, Oxygen, IV, observation?

And, thank you! This really helps

GeorgeK said:
It depends upon what the meds are, but as a general rule when you are to the point of being near anesthesia then anything that's psychoactive or neuroleptic can tip you from light sedation to apnea.

The character takes Paroxetine for his OCD. I know that has its sedative effect, but he hasn't been taking his OCD meds since the Ketamine and opiates (it's not a doctor giving him these injections etc). If he's been taking Paroxetine since he was 17 (I know 18 is the preffered age, but it's a medical necessity), would it still be in his blood stream (he's twenty-nine now so has been taking them for a long time). Would it make a difference to his treament?

And thank you, too. Big BIG help

veinglory · Oct 8, 2012

He's basically going to be in a coma, and so my guess would be the support is similar to coma patients with other etiologies.

Anninyn · Oct 8, 2012

A friend of my husband once OD'd on ketamine - not like this, but in a club situation. She was given a pill the dealer said was E, but it was ketamine, and well, it turned out she was hypersensitive.

She had to be hospitalised, nearly died, and was unconscious for a couple of days. Afterwards she was very unwell indeed.

Now, this was mid-90's, so things may have changed since then, but the treatment was, as previous posters have said, simply supportive - keeping her body running till she'd shed it from her system.

asroc · Oct 8, 2012

Fallen said:
Would they need anything to increase his blood pressure? Or is it like you've just said, Oxygen, IV, observation?

And, thank you! This really helps

You're welcome!

The saline infused through the IV should keep the BP up. Ketamine itself tends to keep the vital functions fairly stable or even increase BP and heart rate, too.

GeorgeK · Oct 8, 2012

Fallen said:
would it still be in his blood stream

Duration of taking it is more important for getting up to a therapeutic dose than getting off it. Within a week of discontinuation blood levels will be at negligible levels, although some of the side effects might last longer. It's very variable because those meds alter how the cells function. Once the drug is out of the system there is some variablility in how fast the cells revert to their new baseline.

Anninyn said:
A friend of my husband once OD'd on ketamine - not like this, but in a club situation. She was given a pill the dealer said was E, but it was ketamine, and well, it turned out she was hypersensitive.

Or she was given something that was a cocktail of things that happened to include ketamine. Drug dealers are not known for pharmacologic purity. That's why drug screens are batteries of tests taht include all the most common things. They aren't all inclusive.

Anninyn · Oct 8, 2012

GeorgeK said:
Or she was given something that was a cocktail of things that happened to include ketamine. Drug dealers are not known for pharmacologic purity. That's why drug screens are batteries of tests taht include all the most common things. They aren't all inclusive.

Quite likely. Either way, she was hypersensitive and got very, very ill. Ketamine can be very nasty.

Fallen · Oct 8, 2012

Thanks so much, everyone, the information is really, really helpful.

Reps for your time and trouble.

ColoradoGuy · Oct 9, 2012

I use ketamine quite a bit in my pediatric intensive care practice and have 30 years experience with it. It's a very useful drug in children for sedation and anesthesia, and sometimes for severe asthma. It has several well-known effects that you might find useful.

It always increases heart rate and often increases blood pressure. It makes the eyes quite red. It causes nystagmus (roving eyes). It causes an increase in respiratory secretions, sometimes dramatically so. These things are dose-dependant. The hallucinations are somewhat related to total dose, but they can happen at any dose. They are far less common in children than in adults, which is what really limits the use of ketamine in adults. I've seen the drug produce the equivalent of an acute psychotic episode in an adolescent that lasted for several days.

Regarding breathing, one of the advantages of ketamine compared to other anesthetics is that respiratory drive is well maintained -- people keep breathing even with quite massive doses.

There is no antidote to ketamine -- we just let it wear off. It is relatively short acting and its physiologic effects are gone in about an hour at most after an IV dose. That being said, many patients will feel a bit odd for an hour or two and can be emotionally labile and react strongly to suggestive stimuli. (I keep the lights and noise level down until they have completely emerged from the drug.)

To lessen the side effects we often combine ketamine with a drug to reduce the secretions (e.g. glycopyrrolate) and an anti-anxiety drug (e.g. midazolam). The latter markedly reduces (nearly eliminates them, actually, in children) the incidence of hallucinations at emergence from the drug.

Ketamine can be given IV, IM, intra-nasal, or oral. The onset of action of an IV dose is about 2 minutes, IM about twice that. The first sign that the drug is working is roving eyes (nystagmus). I always watch for that.

One thing you might find useful for your plot is that ketamine comes in 2 strengths -- 10 mg/mL and 100 mg/mL. I've seen several accidental overdoses from using the more concentrated solution and thinking it was the dilute one.

Usual dose IV is 1 mg/kg, IM 3-4 mg/kg

Let me know if you have specific questions I can answer

Fallen · Oct 9, 2012

ColoradoGuy said:
I use ketamine quite a bit in my pediatric intensive care practice and have 30 years experience with it. It's a very useful drug in children for sedation and anesthesia, and sometimes for severe asthma. It has several well-known effects that you might find useful.

It always increases heart rate and often increases blood pressure. It makes the eyes quite red. It causes nystagmus (roving eyes). It causes an increase in respiratory secretions, sometimes dramatically so. These things are dose-dependant. The hallucinations are somewhat related to total dose, but they can happen at any dose. They are far less common in children than in adults, which is what really limits the use of ketamine in adults. I've seen the drug produce the equivalent of an acute psychotic episode in an adolescent that lasted for several days.

Regarding breathing, one of the advantages of ketamine compared to other anesthetics is that respiratory drive is well maintained -- people keep breathing even with quite massive doses.

There is no antidote to ketamine -- we just let it wear off. It is relatively short acting and its physiologic effects are gone in about an hour at most after an IV dose. That being said, many patients will feel a bit odd for an hour or two and can be emotionally labile and react strongly to suggestive stimuli. (I keep the lights and noise level down until they have completely emerged from the drug.)

To lessen the side effects we often combine ketamine with a drug to reduce the secretions (e.g. glycopyrrolate) and an anti-anxiety drug (e.g. midazolam). The latter markedly reduces (nearly eliminates them, actually, in children) the incidence of hallucinations at emergence from the drug.

Ketamine can be given IV, IM, intra-nasal, or oral. The onset of action of an IV dose is about 2 minutes, IM about twice that. The first sign that the drug is working is roving eyes (nystagmus). I always watch for that.

One thing you might find useful for your plot is that ketamine comes in 2 strengths -- 10 mg/mL and 100 mg/mL. I've seen several accidental overdoses from using the more concentrated solution and thinking it was the dilute one.

Usual dose IV is 1 mg/kg, IM 3-4 mg/kg

Let me know if you have specific questions I can answer

CG, that's frickin brilliant -- thank you!!!

NikkiSloan · Oct 13, 2012

ColoradoGuy said:
I use ketamine quite a bit in my pediatric intensive care practice and have 30 years experience with it. It's a very useful drug in children for sedation and anesthesia, and sometimes for severe asthma. It has several well-known effects that you might find useful.

It always increases heart rate and often increases blood pressure. It makes the eyes quite red. It causes nystagmus (roving eyes). It causes an increase in respiratory secretions, sometimes dramatically so. These things are dose-dependant. The hallucinations are somewhat related to total dose, but they can happen at any dose. They are far less common in children than in adults, which is what really limits the use of ketamine in adults. I've seen the drug produce the equivalent of an acute psychotic episode in an adolescent that lasted for several days.

Regarding breathing, one of the advantages of ketamine compared to other anesthetics is that respiratory drive is well maintained -- people keep breathing even with quite massive doses.

There is no antidote to ketamine -- we just let it wear off. It is relatively short acting and its physiologic effects are gone in about an hour at most after an IV dose. That being said, many patients will feel a bit odd for an hour or two and can be emotionally labile and react strongly to suggestive stimuli. (I keep the lights and noise level down until they have completely emerged from the drug.)

To lessen the side effects we often combine ketamine with a drug to reduce the secretions (e.g. glycopyrrolate) and an anti-anxiety drug (e.g. midazolam). The latter markedly reduces (nearly eliminates them, actually, in children) the incidence of hallucinations at emergence from the drug.

Ketamine can be given IV, IM, intra-nasal, or oral. The onset of action of an IV dose is about 2 minutes, IM about twice that. The first sign that the drug is working is roving eyes (nystagmus). I always watch for that.

One thing you might find useful for your plot is that ketamine comes in 2 strengths -- 10 mg/mL and 100 mg/mL. I've seen several accidental overdoses from using the more concentrated solution and thinking it was the dilute one.

Usual dose IV is 1 mg/kg, IM 3-4 mg/kg

Let me know if you have specific questions I can answer

What would be the effect of a combination of ketamine (street quality) and digitalis on an adult (40-something) woman of small stature?

Ketamine Overdose

Fallen

Stood at the coalface

asroc

Alex

GeorgeK

ever seeking

Fallen

Stood at the coalface

veinglory

volitare nequeo

Anninyn

Stealing your twiglets.

asroc

Alex

GeorgeK

ever seeking

Anninyn

Stealing your twiglets.

Fallen

Stood at the coalface

ColoradoGuy

I've seen worse.

Fallen

Stood at the coalface

NikkiSloan