The other day, I was called to the ED to assist in chemically
controlling one of our psychiatric usual suspects who had been
admitted with her customary friday night OD. This time she had
ingested an unknown amount of the Lamotrigine she was on for a
bipolar disorder.  Our patient Most lamotrigin ODs experience
minor clinical effects like drowsiness or tachycardia. Our
patient was, on the contrary, extremely agitated with
choreatic/ataxic flailing movements of her extremities. It is a
known, but uncommon presentation of Lamotrigine toxicity.  At my
arrival two nurses and two paramedics were pretty much sitting
on the patient.For her own safety and to at all manage the
situation, the patient urgently needed to be sedated. We opted
for an intubation and then sedation in the ICU over night. For
no particular reason, other than that there were too many
unknowns in this scenario, I decided to use ketamine for
induction.  The not so rapid sequence induction After three
minutes of forced pre-oxygenation we decided t