Adult Cocaine Overdose (Severely Agitated): Ketamine dosing.

• A. 2 mg/kg IM
• B. 4 mg/kg IM
• C. 6 mg/kg IM
• D. 10 mg/kg IM

Answer: (B)

In severely agitated cocaine intoxication, you want a sedative that works fast, preserves the airway, and counteracts extreme agitation. Ketamine given by intramuscular injection at about 4 mg/kg hits that mark: it produces rapid dissociation and sedation within minutes, which helps quickly calm the patient and make assessment and management safer for everyone involved. This dose is high enough to control intense agitation without stepping into deeper anesthesia or causing excessive respiratory depression, which can be more likely at higher doses. Lower amounts, like 2 mg/kg, may not be sufficient for severe agitation, while larger doses (6 or 10 mg/kg) raise the risk of deeper sedation and more pronounced cardiovascular or recovery effects. If needed, a second dose can be given per protocol. In practice, benzodiazepines are often considered first-line for stimulant agitation, with ketamine as an option when rapid control is necessary or when benzodiazepines alone aren’t enough. Monitor blood pressure, heart rate, and airway closely, as ketamine can raise sympathetic activity and has other potential side effects.