I IV'ed 1.1ml of aqeous solution that contained 250mg ketamine (almost saturated) into my left vena mediana (in the antecubital fossa) 6 days ago.
All is fine so far. When I come back to reality, I decide to inject another 250mg. I usually go for two injections per session, but the second one has always been a little difficult to perform due to the ketamine intoxication.
It seemed that all went well, but I experienced no rush or instant knockout. It took a minute or two to enter k hole. When I came back I noticed that some skin (6-7mm round patch) was missing around the second injection site, along with some swelling around it. It seemed I injected the entire amount into the subcutaneous tissue above the vein. Due to being intoxicated, I felt no pain.
The next day I realized there was an actual hole (same size still, about 1mm deep), the edges being red or slightly purple and the center being white. I basically just waited how that would develope for two days, without covering it or applying any ointments. On day 3 I realized there was some serious necrosis, capillaries had obviously been destroyed and the wound wouldn't heal very quickly. I proceded to apply povidone-iodine, thyrotrycin and concentrated sucrose solution and covered up the wound for most of the day (I left it uncovered whenever I had to leave the house and kept my arm rotated or flexed so no one would notice). Surprisingly, there has been very little pain and hardly any itching during the entire 6 days.
So what has happened?
-Apparently ketamine extravasation can cause local ischemia and in turn ischemic necrosis (source).
-Since I noticed the bang of my injections increases with the concentration of the solution, I chose to almost saturate the solution at 250mg/1.1ml. This results in an osmolarity of over 900mOsm/L, which is higher than most tissue can take (source).
How to react if this happens to you:
-If you notice while the needle is still in there, draw as much liquid back up as you can.
-Since ketamine seems to exhibit vasocontrictive properties, applying cold is contraindicated (despite usually being the right measure after extravasation of most drugs).
-Elevation of the arm can help to clear liquid faster by increasing lymphatic flow.
-Povidone-iodine and sucrose solution have proven to be effective for treating ulcers (source, there are many more sources coming to the same conclusion).
-There are other ways to treat this, but the exact measures vary greatly depending on which drug was injected and evidence for effective treatment of ketamine extravasation is very sparse (since the damage usually isn't this bad for less concentrated solutions). To be safe, I would disadvise saline flushing attemps or application of other medication (e.g. nitroglycerin to rapidly counter vasoconstriction).
What you can do to avoid this from happening:
-Don't IV ketamine when you are already on it. Instead go for an intramuscular shot or even take it intranasally (yuk).
-Use a solution of 100mg/ml (400 mOsm/L which is safe) in order to avoid osmotic damage, this is even more important for IM/subcutaneous shots!!
It's hard to tell how much of the damage was due to ketamine itself causing ischemia and how much was due to the hyperosmolarity of the solution.
Now I'm stuck with this nasty-ass sloughing stage II ulcer which is gonna take forever to heal. I'm considering debridement by using clostridiopeptidase A to remove dead tissue which could temporarily make the wound look even uglier than it already does. Maggots which can be acquired prescription-fee through a pharmacy would similarly help get rid of the dead tissue in the center.
The current plan is to just wait for it to heal, trying to keep the wound moist so the body's enzymes can clear the dead tissue quicker to allow for healing and keep it from infecting by applying the mentioned solution. After 6 days, it already looks slightly better with the white center becoming pink (which is why I'll abstain from debridement if it continues to heal).
I expect this to take another 2-4 weeks at least to be completely gone and there will probably be a really nice scar, marking me as an IV drug abuser. YAY! I am also really looking forward to the many interactions with family and friends during this time, as well as picking my daughter up from kindergarten, visiting the playground and other places where there are parents around with her etc.
Stupidly enough I injected into the same vein, slightly proximal to the ulcer, on 5 out of 6 days. I can't inject into my right antecubital fossa since I have blood drawn almost every week and I can't for the life of me find any other suitable veins, the only visible ones being on my hands and the feet despite relatively low bodyfat.
I considered throwing all my needles away yesterday, since I have only recently starting IV'ing so frequently (only a couple of times per year before that) and have so rapidly seen such serious complications.
All is fine so far. When I come back to reality, I decide to inject another 250mg. I usually go for two injections per session, but the second one has always been a little difficult to perform due to the ketamine intoxication.
It seemed that all went well, but I experienced no rush or instant knockout. It took a minute or two to enter k hole. When I came back I noticed that some skin (6-7mm round patch) was missing around the second injection site, along with some swelling around it. It seemed I injected the entire amount into the subcutaneous tissue above the vein. Due to being intoxicated, I felt no pain.
The next day I realized there was an actual hole (same size still, about 1mm deep), the edges being red or slightly purple and the center being white. I basically just waited how that would develope for two days, without covering it or applying any ointments. On day 3 I realized there was some serious necrosis, capillaries had obviously been destroyed and the wound wouldn't heal very quickly. I proceded to apply povidone-iodine, thyrotrycin and concentrated sucrose solution and covered up the wound for most of the day (I left it uncovered whenever I had to leave the house and kept my arm rotated or flexed so no one would notice). Surprisingly, there has been very little pain and hardly any itching during the entire 6 days.
So what has happened?
-Apparently ketamine extravasation can cause local ischemia and in turn ischemic necrosis (source).
-Since I noticed the bang of my injections increases with the concentration of the solution, I chose to almost saturate the solution at 250mg/1.1ml. This results in an osmolarity of over 900mOsm/L, which is higher than most tissue can take (source).
How to react if this happens to you:
-If you notice while the needle is still in there, draw as much liquid back up as you can.
-Since ketamine seems to exhibit vasocontrictive properties, applying cold is contraindicated (despite usually being the right measure after extravasation of most drugs).
-Elevation of the arm can help to clear liquid faster by increasing lymphatic flow.
-Povidone-iodine and sucrose solution have proven to be effective for treating ulcers (source, there are many more sources coming to the same conclusion).
-There are other ways to treat this, but the exact measures vary greatly depending on which drug was injected and evidence for effective treatment of ketamine extravasation is very sparse (since the damage usually isn't this bad for less concentrated solutions). To be safe, I would disadvise saline flushing attemps or application of other medication (e.g. nitroglycerin to rapidly counter vasoconstriction).
What you can do to avoid this from happening:
-Don't IV ketamine when you are already on it. Instead go for an intramuscular shot or even take it intranasally (yuk).
-Use a solution of 100mg/ml (400 mOsm/L which is safe) in order to avoid osmotic damage, this is even more important for IM/subcutaneous shots!!
It's hard to tell how much of the damage was due to ketamine itself causing ischemia and how much was due to the hyperosmolarity of the solution.
Now I'm stuck with this nasty-ass sloughing stage II ulcer which is gonna take forever to heal. I'm considering debridement by using clostridiopeptidase A to remove dead tissue which could temporarily make the wound look even uglier than it already does. Maggots which can be acquired prescription-fee through a pharmacy would similarly help get rid of the dead tissue in the center.
The current plan is to just wait for it to heal, trying to keep the wound moist so the body's enzymes can clear the dead tissue quicker to allow for healing and keep it from infecting by applying the mentioned solution. After 6 days, it already looks slightly better with the white center becoming pink (which is why I'll abstain from debridement if it continues to heal).
I expect this to take another 2-4 weeks at least to be completely gone and there will probably be a really nice scar, marking me as an IV drug abuser. YAY! I am also really looking forward to the many interactions with family and friends during this time, as well as picking my daughter up from kindergarten, visiting the playground and other places where there are parents around with her etc.
Stupidly enough I injected into the same vein, slightly proximal to the ulcer, on 5 out of 6 days. I can't inject into my right antecubital fossa since I have blood drawn almost every week and I can't for the life of me find any other suitable veins, the only visible ones being on my hands and the feet despite relatively low bodyfat.
I considered throwing all my needles away yesterday, since I have only recently starting IV'ing so frequently (only a couple of times per year before that) and have so rapidly seen such serious complications.
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