Ketamine Therapy in a Pregnant Adolescent with Status Asthmaticus

A report describes a case of a 15-year-old female gravida 1 para 0 (G1P0) who presented with shortness of breath. Her first-trimester sonography indicated the fetus with an estimated gestational age (EGA) of 35 weeks at the time of presentation. The patient had a history of asthma and suicide attempts via drug overdose. 

Examination revealed the patient to be tripoding and thus received standard management protocol of nebulizer and albuterol treatments for asthma exacerbation. A few hours following treatment, the patient progressed to status asthmaticus and thus was rushed to the intensive care unit (ICU). 

The patient was intubated concerning extreme respiratory acidosis. She received sedation with ketamine, which is sometimes used in status asthmaticus in refractory patients, regardless of pregnancy status. 

Her age prompted her transfer to a facility with a pediatric ICU and an attached neonatal ICU. The patient then received a repeat dosage of ketamine during her travel. She later developed late decelerations, which demanded emergent primary cesarean section. The patient delivered an infant with Apgar scores of 1, 2, and 2. She was gradually weaned off the ventilator over about one week and received discharge about 1 - 2 weeks later with several medications to address her asthma and prevent future attacks of this magnitude.

Tadjali A, Smithhart M, Pope R, Chapa H. Ketamine Therapy in an Adolescent Patient at 35 Weeks of Gestation With Status Asthmaticus. J Clin Gynecol Obstet. 2023;12(1):24-27. doi: https://doi.org/10.14740/jcgo855