CKY Ngai, CCA Fu

Abstract

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 "space oil" electronic cigarettes. Beyond its immediate effects on the central nervous system, etomidate presents substantial risks due to its adrenal toxicity and the potential for long term impairments in cognitive and endocrine functions. The effects of inhaled etomidate is hypothesised to cause similar adrenal suppression. Here we investigate the endocrine risks of adrenal suppression in 13 adolescent aged patients who were found to have positive urine toxicology results for etomidate and its metabolites in a local centre in Hong Kong. Baseline blood tests and low dose short synacthen test (LDSST) were performed in patients with confirmed positive urine toxicology results. Three out of six patients were confirmed with adrenal insufficiency via LDSST. Out of 13 patients, four demonstrated elevated baseline ACTH levels as well as elevated 11-deoxycortisol, highlighting the potential toxicity of vaping etomidate, with findings suggest vaping "space oil" etomidate e-cigarettes can cause primary adrenal insufficiency. Protecting our younger generations, especially those from more complex social backgrounds, remain a clinician's collective responsibility that requires concerted efforts in education, intervention, and policy-making.