Massive Iatrogenic Pediatric Ketamine Overdose With Serial Levels and Minimal Morbidity

Abstract

Ketamine is a dissociative anesthetic commonly used for procedural sedation owing to its perceived favorable safety profile. Despite its frequent use, overdoses of ketamine are rarely reported, and no cases with serum levels of ketamine or its metabolite have previously been reported. We report a case of an iatrogenic pediatric ketamine 20 mg/kg intramuscular overdose with serial ketamine and norketamine levels that resulted in minimal toxicity.

Overdoses and deaths related to the use of ketamine and its analogues: a systematic review

“…Among all the overdose cases, ketamine was the predominant substance (246 cases = 79%), followed by 2-Oxo-PCE (56 cases = 18%), MXE (6 cases = 2%) and PCP (4 cases = 1%). Over-sedation of children was described in three publications (53,54,56), where three cases received five times the intended dose of ketamine, seven cases received ten times the intended dose and, remarkably, one case received 100 times the intended dose. In all cases, the over-sedation was closely monitored and it produced no sequelae.…”

“…The 72 cases described by Gill and Stajíc (2000) and the case described by Peyton et al (1988) concern deaths during surgery, where ketamine was used as an anaesthetic (47,50). The overdose cases in the clinical setting were caused by mistakes in the administration of the drug and left no sequelae (53)(54)(55)(56)58). No cases of overdose or death related to the use of ketamine as an antidepressant in a therapeutic setting were found.…”

“…An excessive and dangerous dose, i.e. an overdose, seems to be effectively managed with the administration of benzodiazepines and time (53,54,56). However, considering the popularity in mixing drugs for recreational purposes, it is essential to keep in mind that a patient experiencing a ketamine overdose might have used other drugs concomitantly.…”