A Fatal Chronic Ketamine Poisoning

Abstract

A few papers in the literature reported incident deaths by acute ketamine poisoning. In this paper, we report an unusual homicide caused by chronic ketamine poisoning. The victim was a 34-year old married woman with no previous medical history (except as reported herein) who died in her own home. The court investigation revealed that she was chronically poisoned by her husband over a period of about one year in an act of homicide. Determination of ketamine concentrations in autopsy specimens was carried out with gas-chromatography/mass spectrometry (GC-MS). The results showed that ketamine concentration was 21 µg/mL in gastric contents, 3.8 µg/mL in blood and 1.2 µg/mL in urine. The most striking forensic findings were cardiac muscle fibrosis and hyaline degeneration of small arteries in victim's heart, the pathological features of ketamine poisoning previous reported only in animal studies.

Ketamine‐induced ventricular structural, sympathetic and electrophysiological remodelling: pathological consequences and protective effects of metoprolol

“…The analgesic effects of ketamine occur at low doses and amnestic effects appear at high doses (Smith et al ., 2002). Recently, two reports showed unusual cases of death caused by acute or chronic ketamine poisoning (Licata et al ., 1994; Tao et al ., 2005). In our study, three rats died during the course of chronic ketamine administration.…”

“…More importantly, long‐term use of ketamine may damage the cardiovascular system and increase the risk of sudden death (Weiner et al ., 2000). Even though there was no information on ketamine‐related morbidity and mortality upon routine data collections, recently, two reports have shown unusual cases of death caused by acute or chronic ketamine poisoning, and myocardial fibrosis and hyaline degeneration of small arteries were presented in a chronic ketamine poison victim's heart (Licata et al ., 1994; Tao et al ., 2005). Echocardiography under ketamine–xylazine anaesthesia revealed an increased left ventricular (LV) wall thickness and a decreased LV lumen diameter (Kamphoven et al ., 2001).…”

Transient ST Elevation After Ketamine Intoxication: A New Cause of Acquired Brugada ECG Pattern

“…These psychic side effects explain the apparition of illegal ketamine abuses for 10 years. Reports of abuse of ketamine and ketamine‐related death are actually constantly increasing 12–15 …”

“…Ketamine has known toxic histological effects on the myocardium at high concentrations 13,17 . The presumed mechanism may involve massive release of catecholamines 11 .…”

“…Reports of abuse of ketamine and ketamine-related death are actually constantly increasing. [12][13][14][15] Ketamine has a short half-life (about 2.5 hours), with hepatic metabolism and urinal elimination. 11 Cardiovascular side effects of ketamine seem to be poor, at least in the field of medical use.…”