Abstract

While reports of ketamine abuse are increasing, reports of ketamine deaths and tissue concentrations associated with fatalities are rare. We report here a case of a mixed drug fatality involving ketamine and ethanol. Ketamine analysis was carried out by gas chromatography with a nitrogen-phosphorus detector (NPD). We found the following tissue concentrations: blood 1.8 mg/L; urine 2.0 mg/L; brain 4.3 mg/kg; spleen 6.1 mg/kg; liver 4.9 mg/kg, and kidney 3.6 mg/kg. The blood ethanol concentration was 170 mg/dL. Because an empty nalbuphine ampule was found in the possession of the deceased, the blood was assayed for this opioid compound using a gas chromatography/mass spectrometry (GC/MS) method. None was detected at a limit of detection of 0.02 mg/L.

References

1.
White
P F
,
Way
W L
,
Trevor
A J
.
Ketamine—Its Pharmacology and therapeutic uses
.
Anesthesiology
 0003-3022
1982
;
56
(
2
):
119
-
36
.
2.
Moreton
J E
,
Meisch
R A
,
Stark
K
, et al
Ketamine self-administration by the rhesus monkey
.
J Pharmacol Exp Ther
1977
;
203
:
303
-
9
.
3.
Lawrence
J
.
Drug intelligence report: Ketamine abuse increasing
.
Microgram
29
(
8
:202.
4.
White
P F
,
Ham
J
,
Way
W L
.
Pharmacology of ketamine isomers in surgical patients
.
Anesthesiology
 0003-3022
1980
;
52
:
231
-
9
.
5.
Slogoff
S
,
Allen
G W
,
Wessels
J V
.
Clinical experience with subanesthetic ketamine
.
Anesth Analg (Cleve)
1974
;
53
:
354
-
8
.
6.
Wright
M
.
Pharmacologic effects of ketamine and its use in veterinary medicine
.
J Am Vet Med Assoc
1982
;
180
(
12
):
1462
-
71
.
7.
Folts
J D
,
Afonso
S
,
Rowe
G G
.
Systemic and coronary hemodynamic effects of ketamine in intact anaesthetized and unanesthetized dogs
.
Br J Anaesth
1975
;
47
:
686
-
93
.
8.
Zsigmond
E K
,
Matsuki
A
,
Kothary
S P
.
Arterial hypoxemia caused by intravenous ketamine
.
Anesth Analg (Cleve)
1976
;
55
:
311
-
4
.
9.
Cohen
M L
,
Trevor
A J
.
On the cerebral accumulation of ketamine and the relationship between metabolism of the drug and its pharmacological effects
.
J Pharmacol Exp Ther
1974
;
189
:
351
-
8
.
10.
Baselt
R C
,
Cravey
R H
, editors.
Disposition of toxic drugs and chemicals in man
.
Foster City, California
,
Chemical Toxicology Institute
,
1995
:
412
-
4
.
11.
Kintz
P
,
Sengler
C
,
Mangin
P
.
Fatal anesthesia accident involving ketamine in a 6 week old baby
.
Bull Int Assoc Forensic Tox
1996
;
26
(
3
):
32
-
3
.
12.
Peyton
S H
,
Couch
A T
,
Bost
R O
.
Tissue distribution of ketamine: two case reports
.
J Anal Tox
1988
;
12
:
268
-
9
.
13.
Licata
M
,
Pierini
G
,
Popoli
G
.
A fatal ketamine poisoning
.
J Forensic Sci
1994
;
39
(
5
):
1314
-
20
.
14.
Rall
T W
.
Hypnotics and sedatives; ethanol
. In:
Gilman
A G
,
Rall
T W
,
Nies
A S
,
Taylor
P
, editors.
Goodman and Gilman's the pharmacological basis of therapeutics
.
New York
,
Pergammon Press
,
1990
:
370
-
8
.
15.
Zsigmond
E K
,
Domino
E F
.
Ketamine-Clinical pharmacology, pharmacokinetics, and current clinical uses
.
Anesth Rev
1980
;
7
:
13
-
33
.
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