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Inadvertent ketamine overdose in children: clinical manifestations and outcome
S M Green1, R Clark, M A Hostetler
1Departments of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA.
Insights
Inadvertent ketamine overdose in children in the emergency department (ED) led to prolonged sedation and occasional respiratory depression, but no long-term adverse outcomes were observed, suggesting a wide safety margin.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Toxicology
- Pharmacology
Background:
- Ketamine is a widely used anesthetic and analgesic.
- Inadvertent medication errors can occur in emergency settings.
- Understanding the safety profile of ketamine overdose is crucial for patient management.
Purpose of the Study:
- To characterize the clinical effects and outcomes of accidental ketamine overdose in pediatric patients presenting to the emergency department.
- To identify the causes and patterns of ketamine dosing errors.
Main Methods:
- A retrospective review of 9 pediatric cases of inadvertent ketamine overdose reported to the Institute for Safe Medication Practices.
- Analysis of clinical manifestations, routes of administration, dosages, and patient outcomes.
Main Results:
- Nine children received ketamine doses 5 to 100 times the intended amount via intramuscular or intravenous routes.
- All patients experienced prolonged sedation (3-24 hours); 4 had transient respiratory depression requiring intervention in 2.
- No adverse outcomes or neurological deficits were observed at discharge or follow-up.
Conclusions:
- Inadvertent ketamine overdose in healthy children in the ED appears to have a wide margin of safety, primarily causing prolonged sedation.
- While serious adverse events were not observed in this small sample, caution is warranted.
- Further investigation is needed to fully understand the risks associated with ketamine overdose.
Study Objective:
We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department.
Methods:
We investigated cases of inadvertent ketamine overdose in children seen in the ED solicited through electronic mail subscription lists or reported to the Institute for Safe Medication Practices. The clinical manifestations, outcome, and reported cause for each case are described.
Results:
We identified 9 cases of inadvertent ketamine overdose in children treated in the ED. Patients received either 5(n=3), 10(n=5), or 100(n=1) times the intended dose, either by the intramuscular (n=5) or intravenous (n=4) route. All 9 experienced prolonged sedation (3 to 24 hours). Four experienced brief respiratory depression shortly after administration, and assisted ventilation was performed in 2. Two children without respiratory difficulty or hypoxemia were intubated by their physicians as a precaution. In 5 children, the dosing error was not discovered until late in the sedation, often when the child was not waking at the expected time. No adverse outcomes were noted, and all children were normal neurologically on discharge and longer-term follow-up if available.
Conclusion:
No adverse outcomes were noted in 9 healthy children treated in the ED who inadvertently received 5 to 100 times the intended dose of ketamine. Toxicity manifested as prolonged sedation in all 9 and brief respiratory depression in 4. The margin of safety in ketamine overdose may be wide, although less common and more serious outcomes cannot be excluded by this small, self-reported sample.