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Ketamine/morphine Transient amnesia with confusion and slowed speech and neuropsychiatric effects: case report

A 69-year-old woman developed transient amnesia with confusion and slowed speech and neuropsychiatric effects during treatment with ketamine and morphine for shoulder pain. The woman, who had a history of chronic Lyme disease, glaucoma and insomnia, had been receiving amitriptyline. She experienced a fall at her residence, and she received IV morphine 5mg, followed by an additional 5mg in 5 min. After 10 min, she continued to experience pain in the right shoulder, and she received IV ketamine 16mg, which was provided by the paramedics. After 3 minutes, she became lethargic; however, she continued to follow commands, and the lethargy resolved within 2 min. She was moved to the emergency department (ED). Following an X-ray, which demonstrated an acute comminuted nondisplaced right humeral head and neck fracture, she received an additional dose of morphine 4mg at 20 min after presentation. Concomitantly, she received ondansetron after 1 hour. The pain decreased. However, prior to discharge, she became acutely confused, and the speech slowed. She exhibited difficulty with word finding, amnesia to the event and anterograde amnesia, which was evidenced by repetitive questioning. After 7h, mental status had not improved. Therefore, the woman was again admitted for observation. The cognition improved gradually overnight, and the cognition was found to be normal at the time of neurology evaluation. She was discharged ~24h following presentation; however, she continued to remain amnestic to the event at the time of discharge. She had developed transient memory loss with delayed recovery along with confusion, slowed speech and neuropsychiatric effects secondary to ketamine and morphine [times to reactions onsets not stated]. Aljadeed R, et al. Transient amnesia following prehospital low-dose ketamine administration. American Journal of Emergency Medicine 38: 1544.e5-1544.e6, No. 7, Jul 2020. Available from: URL: http://doi.org/10.1016/j.ajem.2020.04.012 803499289

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Reactions 5 Sep 2020 No. 1820