Tuesday, December 31, 2019

Ketamine and Clonidine

Back in 2014 I was involved in a major fireworks accident that left me with serious burns to 20% of my body. I went into hypovolemic shock and had to be helicopter lifted to the burn unit of a major hospital.  There's a whole other story to that incident but it'll have to wait until another day.  This blog post is a recollection of just a small part of my experience, soon after my arrival at the hospital...

So I had a memory flashback from my burn accident last night. I'd just arrived at the hospital by helicopter and was already doped up on 14mg of morphine but was still in a lot of pain. The doctors were just beginning the first stages of treatment after my initial admission through the trauma unit.

One of the woman doctors gave me an injection of ketamine to help with the pain but because my body was already so fired up with adrenaline, it just made me angry. Ketamine is known to dysregulate the adrenaline system, and this was the beginnings of ketamine rage that I was experiencing. I started telling the doctors that they're giving me something that's making me really angry. The doctors were saying not to be angry because they were trying to help me. I said I can't help it, it's something they're giving me that's making me super pissed off, and I think it's the ketamine. The same woman doctor came and gave me some more ketamine and I politely said "No more ketamine, it's making me angry", but she gave it to me anyway.

There was a bit of a panic and rush going on with the doctors and nurses to get me stabilized. Little did they know that the ketamine was making me enraged and furious and I couldn't control it. They decided to strap me into the hospital gurney in case I started writhing with pain or behaving oddly from the cocktail of drugs they were giving me. I told them again, "No more ketamine". That same woman doctor heard me and thought I wanted more ketamine and came at me with a needle to give me more, so I yelled at her "NO MORE FUCKING KETAMINE!".

The anger continued to become a furious rage and I couldn't stop it. I started yelling at the doctors, "YOU'VE GIVEN ME TOO MUCH FUCKING KETAMINE!"  I told them I was going into a ketamine rage and needed xylazine. I remembered from my scientist days, we always gave ketamine and xylazine together for anesthetizing animals. By this time my vital signs were starting to go through the roof as the rage increased. The doctors noticed this. The rage was incredible, like those stories you hear of people on angel dust who go on a rampage and still keep running even when the cops have shot them a bunch of times. Angel dust, or phencyclidine, otherwise known as PCP, is in the same class of chemicals as ketamine and has many of the same effects, and this rage was similar to those angel dust horror stories. It was like those stories you sometimes hear about some grandma who saved her husband who was trapped under a car, in which she had some sort of adrenaline burst and lifted the car with one arm and dragged her husband out from underneath the car with the other.

So there I was in emergency room going into a Hulk rage. All my’s muscles were at full flex, and I no longer had the normal levels of inhibition that protect us from damaging ourselves by flexing our muscles to their true capacity. I said "I NEED FUCKING XYLAXINE!" By this time my whole adrenaline system was on double overtime and I started joking around to try and keep calm. I said "MY NAME IS NOT QUAID”, a reference to the scene in Total Recall where Arnold Schwarzenegger's character, Douglas Quaid, pops his memory cap while at Recall. I continued yelling "I NEED FUCKING XYLAZINE". They asked what's xylazine? I yelled "USE YOUR FUCKING PHONE AND LOOK IT UP!”.  A doctor asked me how to spell it, so I started spelling it out "X-Y-L-A-fucking-Z-I-N-E!". Someone got it up on their phone and read what it said, "It's an alpha-2 adrenergic blocker and an analogue of clonidine".  Suddenly one of the doctors paused and said "clonidine" and raced off to get some.

By now the rage was severe and becoming uncontrollable. The doctors debated about adding clonidine to the cocktail of drugs they'd already pumped into me. By this time I was furious and decided to test out my new-found Hulk muscles by flexing against the straps that were holding me down on the hospital gurney. I flexed my arms and was worried about the straps cutting through the burned skin on my arms, but I kept flexing. Suddenly one of the straps popped.

For a moment there was silence and the doctors all took a step back in terror. One of them said they should call security. I said "I DON'T WANT TO HURT ANYONE BUT I CAN'T HELP BEING ANGRY. I JUST NEED XYLAZINE". The doctor who'd gone to get some clonidine finally returned. The doctors debated quickly about what the dosage should be and loaded up a syringe.  The same woman doctor who'd given me too much ketamine now came at me with a syringe full of clonidine and administered it intravenously. Within a few seconds my muscles relaxed, the rage faded away, and I let out a couple of sighs of relief as I become almost completely normal again. Right away I said to the doctor who'd given me too much ketamine, "Don't ever do that to anyone ever again". She said "How did you know you needed Xylazine?". I said "Because I'm a fucking neuroscientist!".

Soon things were back to normal and I was stabilized and wheeled away to the intensive care unit. As I was pushed out the door I said "You learned some pharmacology tonight, they didn't teach you that in medical school".  They didn't seem to happy with that comment.

For months after that, whenever I returned to the hospital, I would jokingly ask them for drugs that I knew they would never give me. When I asked for ketamine they'd say "There's no way you're ever getting that again".

So there you go folks, watch out for ketamine, it can turn you into a rage monster. The antidote is clonidine.

-Dave Bad Person

Just so you get some idea of what I went through, here's a picture they took at the hospital a few days after my admission

Here's a picture from just after my skin graft surgery

Here's an anniversary card I gave to my wife eight years earlier. At that time I was known for putting bottles and cans filled with diesel onto campfires as a pyrotechnic effect, and sometimes it hadn't worked out well.

Ketamine structural formula

Structural formulas of Xylazine (left) and Clonidine (right)




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