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Hong Kong Med J 2010;16:6-11

A typical ketamine abuser is young (median age, 22 years), male, and comes to hospital suffering from impaired consciousness, abdominal pain, urinary problems, dizziness, very high heart rate or unexplained high blood pressure according to the world’s largest study analysing the characteristics of ketamine abusers needing medical help.

The study, published in the February edition of the Hong Kong Medical Journal, found that the main reason ketamine abusers come to hospital seeking help was loss of, or altered, consciousness. Up to 46% of the 233 patients studied had a period of altered consciousness some time after taking ketamine. The other major symptoms ketamine abusers suffered were abdominal pain (21%), lower urinary tract symptoms (12%), and dizziness.

Ketamine has been the drug most commonly abused by teenagers and young adults (<21 years) since 2005. In 2008, 40% of people who came to accident and emergency departments with problems caused by taking drugs of abuse were ketamine abusers.

The study, titled ‘Emergency department presentation of ketamine abusers in Hong Kong: a review of 233 cases’ analysed the symptoms, physical findings and test results of 233 people who came or were brought to accident and emergency departments in 15 public hospitals between 1 July 2005 and 30 June 2008.

The authors pointed out there were probably more cases than this, especially people involved in major accidents who were too severely injured to be asked about ketamine use; or those with symptoms like nosebleeds or minor injuries that may have been caused by ketamine whose doctors failed to ask about ketamine use.

The authors conclude that doctors need to be aware that young people suffering from the conditions described in this study may have abused ketamine. “The presence of white powder in nostrils is another important tell-tale sign. Notably, many patients denied a ketamine abuse but confessed only after the clinicians found white powder (ketamine) in their nostrils.”

Hong Kong Med J 2010;16:36-43

Chinese cobra attacks caused serious injuries to at least 18 Hong Kong people over the past 5 years, according to a study of people treated for snake injuries in the Tuen Mun and Pok Oi hospitals, which service the areas where most snake bites occur.

Of the 18 people injured, 15 were bitten and three suffered eye injuries from having venom spat into their faces. Most of the attacks happened during the summer and autumn months (August to November) and almost half (44%) occurred indoors. Even though the Chinese cobra is active during both the day and the night, most attacks occurred during the daytime.

All patients survived the bites but many had severe local injuries and most (14 out of 15 of those bitten) required at least two vials of Chinese cobra anti-venom to recover. One patient was given 21 vials of anti-venom to treat a bite to her right thumb that caused severe swelling of her hand and wrist. Five patients developed severe local tissue damage that needed surgery. Three patients needed skin grafts.