Near fatal accidental transdermal overdose of compounded ketamine, baclofen, amitriptyline, lidocaine, and ketoprofen: A case report

• Published in: Journal of toxicology. Clinical toxicology 2003-08, Vol.41 (5), p.672-672
• Main Authors: Sigillito, R J, Tuckler, V E, Van Meter, KW, Martinez, J
• Format: Article
• Language: English
• ISSN: 0731-3810

Use of transdermal compounds containing analgesics, tricyclic antidepressants, and neuroinhibitors for the management of chronic pain is an emerging practice. Reports of overdose of these agents by the enteral and parenteral routes are abundant. Overdose by transdermal absorption has not previously been described. A 35 year old male presented in an apparent post-ictal state after suffering a seizure. Over the ensuing 2 hours, his level of consciousness deteriorated to a GCS of 3, and he lost all brainstem reflexes. He required intubation and mechanical ventilation for 2 one half days. CT scan of the brain was normal. EEG demonstrated a burst suppression pattern, previously reported in baclofen overdose. Urine drug screen for drugs of abuse revealed the presence of benzodiazepenes and tricyclic antidepressants. Routine cerebrospinal fluid analyses were normal. Later, it was revealed that the patient had applied an excessive amount of a compounded cream prescribed for relief of chronic pain. He received a total dose of ketamine 900 mg, baclofen 900 mg, amitriptyline 360 mg, lidocaine 900 mg, ketoprofen 1800 mg. Ketamine was detected in the CSF by gas chromatography and mass spectrometry. He was discharged neurologically intact after 4 days. Transdermal absorption of ketamine, baclofen, amitriptyline, lidocaine, and ketoprofen resulted in a prolonged, profound coma.