Ketamine intoxication: Rapid overview of emergency management

To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links).

Clinical presentation

Impaired consciousness is the most common presentation; ketamine intoxication may cause a range of central neurologic symptoms, most often depressed mental status, but also possibly mild agitation and hallucinations; mild tachycardia and hypertension often occur

Massive overdose can cause respiratory depression or apnea

Laryngospasm and heavy salivation may occur infrequently during intravenous use, even with standard doses; laryngospasm is rare and occurs most often in infants

Vertical or rotatory nystagmus may occur

Diagnostic testing

Diagnosis of ketamine intoxication is based on history and clinical evidence; definitive laboratory testing is typically not available and not routinely indicated

Obtain fingerstick glucose, acetaminophen and salicylate concentrations, electrocardiogram, and pregnancy test in women of childbearing age

Management

Secure airway, breathing, and circulation as necessary

Laryngospasm and respiratory depression

Generally resolve with noninvasive support (eg, bag-mask ventilation; supplemental oxygen); endotracheal intubation is rarely required

Salivation that compromises respirations or interferes with a necessary procedure

Treat with glycopyrrolate (5 mcg/kg, maximum single dose 0.2 mg, may be repeated once every two to three minutes, maximum total dose 0.8 mg) or atropine (0.01 to 0.02 mg/kg, minimum dose 0.1 mg, may be repeated every five minutes, maximum dose 1.2 mg)

Psychomotor agitation

Treat with benzodiazepines (eg, intravenous doses of diazepam 0.1 mg/kg or in adults 5 to 10 mg, or lorazepam 0.05 mg/kg or in adults 1 to 2 mg) until the desired level of sedation is achieved
Butyrophenones (eg, haloperidol, droperidol) and other antipsychotic agents should not be used to treat agitation

Disposition

Once symptoms have resolved, patients with uncomplicated ketamine toxicity may be discharged after a suitable period of observation (approximately six hours) during which they remain asymptomatic

Graphic 69157 Version 15.0

خرید پکیج

Ketamine intoxication: Rapid overview of emergency management