After their last symptom resolves, patients who experience relief of symptoms after intoxication should undergo continuous monitoring for 1 to 2 hours. Patients who are asymptomatic at presentation but report recent use of ketamine should be observed for six hours. Genetics and various other factors rely on the impact of the drug, which is influenced by metabolic capacity and inherent sensitivity to the effects of the drug, method of administration (for example, oral more than intravenous), dosage, and several hours depending on the dosage, method of administration (for example, oral more than intravenous), metabolic capacity, and inherent sensitivity to the effects of the drug. Typically, the effects of ketamine intoxication typically endure between 15 minutes to several hours depending on the dosage, method of administration (for example, oral more than intravenous), metabolic capacity, and inherent sensitivity to the effects of the drug. Generally, only supportive care is required for patients with ketamine toxicity.
The patient admitted should be observed and monitored, especially if the patient develops severe complications or symptoms of hyperthermia. The temperature should also be monitored for other symptoms. The vital signs of the patient should be closely monitored, as respiratory support can be provided if the patient’s airway becomes compromised and intubation occurs. Although there have been reports of aspiration, Ketamine has been shown to be a better choice for sedation than other anesthetic agents, as it helps maintain a protective airway and causes bronchodilation. If the patient vomits, they should be positioned with their head facing down, leaning forward or lying on the left side to avoid compromising the airway. Monitoring the patient’s circulation, breathing, and airway is especially important when ketamine is taken in combination with other drugs, as it can potentially cause cardiopulmonary compromise.
If ketamine was ingested in large quantities, especially when used with other drugs, activated charcoal could be used for gastrointestinal decontamination. It is typically given at a dose of 1 g/kg with a maximum oral dose of 50 g. Activated charcoal should be avoided in patients with absent bowel sounds or unprotected airways. To obviate the need for gastric lavage, activated charcoal may be administered within a brief amount of time, sufficiently preventing the distribution of a large volume of ketamine, which tends to be ineffective in patients undergoing dialysis and hemoperfusion.
If the patient’s safety is secure and IV access is initiated, the healthcare team may provide physical restraints to manage hyperthermia due to inadequate cooling evaporative heat decrease. The patient’s room should be quiet and dim, and unnecessary stimulation should be avoided. Caution should be exercised when using prolonged haloperidol, as it may lower seizure thresholds and prolong QT intervals, potentially leading to torsades de pointes. However, adequate sedation can be achieved by administering 10 to 15 mg of haloperidol every 10 to 15 minutes. Haloperidol has been used to treat agitation and psychotic episodes, including those associated with hyperthermia, butyrophenones, and IV administration. Diazepam is generally dosed at 5 to 10 mg intramuscularly or intravenously, while lorazepam is typically dosed at 2 to 4 mg for seizure management. Benzodiazepines such as diazepam and lorazepam can alleviate psychomimetic agitation, hypertension, psychosis, and agitation. However, there are no U.S. FDA-approved medications for the treatment of ketamine overdose, according to the toxicology data network.
Dehydration can be improved by using crystalloids for hydration. Blurred vision and nystagmus can be treated and prevented by using physostigmine, while ketamine can be used to address associated excess salivation. Glycopyrrolate or atropine can also be used for treatment and prevention. Clonidine can be used to address acute symptoms and is an option for long-duration inpatient infusions. Clonidine is typically given orally in the form of patches, with a typical dose of 5-2 mcg/kg. Clonidine can prevent or treat the side effects of ketamine, such as the increase in blood pressure and the psychomimetic effects. Other medications can be used to manage other symptoms.