Inadvertent ketamine overdose in children: Clinical manifestations and outcome

doi:10.1016/S0196-0644(99)80051-1

Annals of Emergency Medicine

Volume 34, Issue 4, Part 1, October 1999, Pages 492-497

https://doi.org/10.1016/S0196-0644(99)80051-1 Get rights and content

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.

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Inadvertent ketamine overdose in children: Clinical manifestations and outcome1

Ann Emerg Med

Ann Emerg Med

Intravenous ketamine for pediatric sedation in the emergency department: Safety and efficacy with 156 cases

Acad Emerg Med

Ketamine HCl

1996 Annual Report of the American Association of Poison Control Centers toxic exposure surveillance system

Am J Emerg Med