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PHARM Podcast 161 Can ketamine kill you?

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Hi folks

on todays episode I discuss  whether ketamine can kill. There’s a myth going around that ketamine when given medically is so safe that its impossible to kill a patient. The myth goes that above a dissociative dose, any extra ketamine will cause only prolonged effect and no other adverse reactions. This is not true. Ketamine is a mild respiratory and cardiac depressant. The more you give, the more depressant effect.  It is certainly potentially lethal when given to alcohol intoxicated patients and extreme caution needs to be taken in this group.

On the podcast I discuss a recent death of an American police officer who was alcohol intoxicated during his birthday party, then became agitated and fellow officers called then an ambulance. It was decided he might be suffering from Excited Delirium syndrome and ketamine sedation was chosen as per protocol . There was a question raised if alcohol intoxication was risky with ketamine but this was discounted. Soon after sedation, he was placed into the ambulance but suffered a cardiac arrest en route. Despite resuscitation he died of hypoxic brain injury a few days later. The medical examiner report evidently found no obvious signs of Excited Delirium Syndrome nor any other drugs in his blood apart from alcohol and ketamine given. It was ruled accidental death by mixture of alcohol and ketamine. So be careful with your ketamine sedations!

Show notes:

Lee deputy died of brain injury after ketamine treatment for alcohol-induced delirium

An autopsy report from the medical examiner points to a deadly combination of alcohol and medically-administered Ketamine in the death of Deputy Willard Truckenmiller.

Lee County Deputy Dies Due to Alcohol and a Sedative Mix

Laryngospasm and hypoxia after intramuscular administration of ketamine to a patient in excited delirium

Serious adverse events during procedural sedation with ketamine. (note laryngospasm more common with IM ketamine)

2014 NAEMSP talk on prehospital ketamine for agitation ( note median IV and IM dosing ranges . 500mg dosing rarely needed)

Ketamine: an update on the first twenty-five years of clinical experience

Ketamine causes respiratory depression similar to opioids

Ketamine causes respiratory depression similar to opiates

Critical review of ketamine (pg6)

Use with caution in the chronic alcoholic and the acutely alcohol-intoxicated patient.

Opioid receptors-mediated respiratory effects and antinociception after S(+)-ketamine.

The involvement of the mu-opioid receptor in ketamine-induced respiratory depression and antinociception

Postmortem Blood Ketamine Distribution in Two Fatalities

PROLONGED APNOEA WITH KETAMINE

Prolonged apnoea, trismus and ketamine

Case report of failed DSI – apnoea after ketamine

KETAMINE ADVERSE AIRWAY EVENTS

PATIENT DEATH AFTER KETAMINE OVERDOSE SPURS CHANGES AT UVMMC

Podcast ( available here and on iTunes)

Right Click and Choose Save-as to Download the Podcast.

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