60F with a history of Hepatitis C cirrhosis presents to the ED with acute onset of hematemesis. She is treated immediately with two large bore IVs and her airway is successfully secured with RSI, using Ketamine and Rocuronium. She is treated initially with Protonix and Octreotide as per gastroenterology’s recommendations. She is given Ceftriaxone empirically in the setting of an upper gastrointestinal bleed.
She is resuscitated with blood products to a stable hematocrit, maintains a stable blood pressure, remains fully sedated, is afebrile with no clear source of infection, but continues to be tachycardic as she waits for endoscopy.
What agent caused her persistent tachycardia?
Answer: Ketamine, which is hepatically metabolized, will have a longer half-life in cirrhotic patients, thereby providing sedation and sympathomimetic effects for a longer duration in this subset of patients.
Here are some street names for Ketamine
Special K, Jet, Super Acid, Special LA Coke, KitKat, Vitamin K, HOSS, The Hoos, and tranq