Ketamine is a structural analog of phencyclidine (PCP). It is an anesthetic mostly used on animals but also sometimes used in surgical procedures in children and to treat pain in humans. It works in a rather fascinating way, different than most other widely used analgesics which turn off the pain receptors. ketamine on the other hand seems to disconnect the brain from the body and makes the subject oblivious to any physical pain. Also named “dissociative anesthesia”, it sends the subject into a trance-like state. Ketamine has been around for about 50 years and is widely abused as a recreational drug. Commonly known as special K, Kit Kat, Dorothy, or cat valium by the users. It comes in the form of white crystalline powder when sold as a recreational drug and a clear liquid when sold as a medicine and sometimes tablets although uncommon.
Effects on the body
In small doses, it is shown to have anti-depressive effects although the effect wears off in about 3 to 4 hours. When injected intravenously, it can effectively be used as an anesthetic in minor surgical procedures. When used as a recreational drug mostly taken in by snorting, it gives a feeling of relaxation at first, and the subject goes into a state of euphoria, an utter bliss, completely unaware of his surroundings and his physical condition. Sometimes the abusers hurt themselves but cannot tell if something is wrong due to the hallucinating state along with the physical anesthesia. At even higher doses, the abuser can go into a dissociative state that is sometimes described as an “out of body experience”, in technical terms known as the k-hole effect.
Apart from the hallucinogenic effect of ketamine, it has other side effects on the body as well which can eventually prove fatal. Ketamine can cause a complete loss of mobility and even a paralytic state which can lead to respiratory failure which may become the cause of death in the subject. The k-hole effect can leave a serious depressive effect on the brain because of this near-death experience. The individual may experience a feeling of hopelessness and helplessness with anxiety and paranoia.
Because the individuals can develop a high tolerance to the drug they eventually have to take larger amounts of the drug. Chronic use of the drug can have serious debilitating effects on the organs kidneys, liver, heart valves. Damage to the nose can anosmia or loss of smell. It can cause high blood pressure and respiratory problems, and occasionally cognitive impairment with memory loss.
Management of ketamine toxicity
If the patient presents with any of the signs of toxicity first run lab tests:
• Serum PCP, acetaminophen, MDMA, salicylates, to evaluate for co-ingesting
• ECG to check for arrhythmias
• Urine myoglobin to see for rhabdomyolysis
• CBC, RFTs, LFTs, and fingerstick blood glucose to check for hypoglycemia
We stabilize the patient with IV fluids and keep the patient’s vitals in check. No drug has been approved to treat ketamine overdose. If the drug was ingested activated charcoal can be used for gastric lavage. To alleviate the psychomimetic effects and agitation give benzodiazepines such as lorazepam 4 mg IV. Alpha 2 agonists can be used for cardiovascular effects.