Authors (including presenting author) :
Fu Antony(1), Ngai Clara(1)
Affiliation :
(1)Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
Introduction :
There is a growing concern about the misuse of etomidate, a drug used to be a general anaesthetic agent, which is now being abused in the community through vaping via electronic cigarettes. Apart from its immediate effects on the central nervous system, etomidate poses significant risks owing to its adrenal toxicity and the potential for long-term damage to cognitive and endocrine functions.
Objectives :
We hereby report a retrospective cohort review of all paediatric patients, who are defined as age at or below 18 years old, with etomidate detected in their urine toxicology analyses upon admissions to Princess Margaret Hospital between 1 January 2024 and 31 December 2024 inclusively.
Methodology :
In the above "objective" session
Result & Outcome :
Thirteen adolescents (7 females) were identified (age 14.1-17.9 years). They reported to have vaped etomidate for an average of two months (range: 1–8 months) before presenting to the hospital. Seven of them admitted co-administration of other substances. Common presenting complaints included confusion and dizziness (3/13), unsteady gait (2/13), suicidal attempt/deliberate self-harm (2/13). At presentation, five of them had hypertension (systolic blood pressure range: 94-160 mmHg). All did not manifest signs of hyperandrogenism. One patient was managed in paediatric intensive care unit (ICU) owing to inhalation injury upon the fire accident related to e-cigarette vaping. Morning cortisol was found low in 3 out of 8 patients (range: 44-83; reference >133 nmol/L). Short synacthen test showed adrenal insufficiency in 3 out of 6 patients (peak cortisol range: 74-238; reference >376 nmol/L). Baseline ACTH levels were elevated in three cases (range: 28-55; reference 1.6-13.9 pmol/L). Renin and aldosterone were both undetectable in six of the patients. 11-deoxycortisol, the precursor hormone accumulated right above the inhibition of 11β-hydroxylase (range: 72.4-564; reference ≤4.3 nmol/L) and 17-OHP (range 8.7-11; reference < 4 nmol/L) along the glucocorticoid pathway of steroidogenesis were found elevated in four patients.
These alarming consequences have heightened awareness among healthcare professionals and the wider community, emphasizing the urgent need to identify, intercept, and prevent the proliferation of this harmful substance. Protecting our younger generations from the devastating impact of such abuse is a collective responsibility that requires concerted efforts in education, intervention, and policy-making.
