Substance : Etomidate（依托咪酯） by（Vaping）
Schedule: Etomidate
was officially classified as a Category 2 (Class
II)
narcotic in
Taiwan on November 27, 2024. [2]
Common name:
Clinical primary use: A short-acting
intravenous anesthetic, commonly used for emergency intubation or
brief surgical procedures. 0.2-0.3 mg/kg IV infused over 30-60 seconds.
Street names: “Zombie vape,” “Sleep vape,” “Space Trip.” Space Oil太空油 [3]
Involving
system:
Etomidate acts as a GABA receptor
modulator. It induces rapid sedation and anesthesia by enhancing the
effects of GABA (gamma-aminobutyric acid), the primary inhibitory
neurotransmitter in the central nervous system. [4].
Route of Administration: Vaping (E-cigarette Inhalation)
Illicit
Transformation:
Powdered
Etomidate is dissolved into e-liquid carriers, typically consisting of
propylene glycol (PG) or vegetable glycerin (VG).
Pharmacokinetic Characteristics:
When
inhaled, the drug is absorbed through the pulmonary capillaries, causing blood
concentrations to spike instantaneously. By bypassing the hepatic first-pass
effect, the substance acts directly on the brain, leading to exceptionally high
and uncontrollable levels of toxicity and addictive potential.
Presentation
Typical
scenario: young adult, often recreational e‑cigarette user, may present with
agitation, hallucinations, impaired judgment, or bizarre behavior shortly after
vaping (onset ~15–20 minutes).
Neurological/psychiatric:
drowsiness or confusion, myoclonus/twitching, tremor, involuntary movements,
aggression, self‑harm, psychosis‑like symptoms. [5]
Adrenal/endocrine:
hypotension,
shock, fatigue, nausea, hypokalaemia, unexplained hypertension (from chronic
ACTH drive), and signs of adrenal insufficiency (hyponatraemia,
hyperpigmentation in chronic users).[6].
Chronic
use: insomnia, weight loss, endocrine dysfunction, and possible irreversible
brain damage or neuropsychiatric sequelae.
Neurological
symptoms: Control
myoclonus or seizures with benzodiazepines; avoid phenytoin or other agents
that may worsen CNS depression.
Antidote
- No specific antidote for etomidate toxicity;
treatment is supportive and steroid‑based for adrenal suppression.
- Stress‑dose
glucocorticoids (e.g., hydrocortisone 100 mg IV every 8 hours in
shock, then taper as adrenal function recovers) are recommended for
patients with hypotension or biochemical evidence of adrenal insufficiency
(low cortisol, low ACTH). [7].
- Mineralocorticoid
replacement is usually not needed, as adrenal suppression is mainly
glucocorticoid‑mediated. [7].
Airway,
breathing, circulation:
Protect
airway if agitated or obtunded; consider sedation with benzodiazepines for
agitation or seizures, avoiding further NMDA/ET‑1 agonists.
Treat
hypotension with IV fluids and
vasopressors if needed, plus stress‑dose hydrocortisone for suspected adrenal
insufficiency.
Provide
psychiatric support and observation for agitation, aggression, or self‑harm
risk.
Disposition:
Acute
intoxication:
Observe
≥12–24 hours in an acute care setting if there is significant agitation,
altered mental status, or hemodynamic instability.
Admit to
ICU for severe agitation, recurrent seizures, respiratory depression, or
circulatory shock, especially with hypotension responding to steroids.
Adrenal
insufficiency:
Continue
stress‑dose hydrocortisone until clinical recovery and evidence of adrenal axis
recovery; arrange outpatient endocrine follow‑up.
Chronic
misuse / addiction:
Screen
for other co‑ingested drugs (opioids, stimulants, benzodiazepines) and
electrolytes, glucose, renal/liver function. Refer to addiction or
substance‑use services and psychiatry for ongoing dependence and mental health
issues.
Counsel
patient on the high risk of fatal poisoning, adrenal failure, and irreversible
brain damage with continued use.
References
[1]. https://pubmed.ncbi.nlm.nih.gov/?term=etomidate+e-cigarette&sort=date&size=200
[2]. https://www.taipeitimes.com/News/taiwan/archives/2025/08/05/2003841506
[3]. https://pubmed.ncbi.nlm.nih.gov/41626923/
[4]. https://pubmed.ncbi.nlm.nih.gov/34060021/
[5]. https://pubmed.ncbi.nlm.nih.gov/38652218/
[6]. https://onlinelibrary.wiley.com/doi/10.1111/add.70151?af=R
[7]. https://www.hkmj.org/abstracts/v31n3/229.htm
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