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Comment by dj_mc_merlin | Hacker News Reader

> He got 500 milligrams because they thought he weighed 220 pounds, but he was only 140 pounds and should have received 315 milligrams.

315 milligrams is still.. a lot. Especially injected into the bloodstream (I presume?) all at one time. Enough to really wrangle your marbles even if you're used to that kind of stuff.

edit: To expand, that's about the dosage most people would get delusions of some sort, but not be 100% immobilized. That is a recipe for disaster around angry cops.

edit2: It's bio-availability is actually twice as high intramuscularilly than insufflated.. well you wouldn't be fighting the cops but dear god I would not want to experience that.

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I’ve seen club kids go into what I can only describe as an ‘ambulatory trance state’ at the dosage levels you speak of.

I talked down one or two people from completely destroying their environment while in such a state, by using deliberately de-escalatory calming techniques.

I’m aghast the police would use such a substance because it is indeed a recipe for disaster when mixed with their expectations of behavior.

Where can I learn de-escalatory calming techniques?

Social workers and ER nurses, in particular, have field-tested practices for dealing with people who are anxiously disoriented — or violently psychotic - in a manner which resolves the situation peacefully.

All I can say for what I did at the time was an intuition that I was confronted with a half-tranquilized, large confused ape and so acted as to prevent them from panicking and running amok with calm words, movements, and (most importantly I suspect in that state) caring touch.

People taking ketamine in clubs usually use much less than k-hole or anaesthetic doses, because the effects are more conducive to partying. They generally take small bumps over the course of a night.

I really doubt the club kids to saw had taken anything like the equivelant of 300mg or 500mg taken IM (2x the bioavailability of intranasal), or even intranasally. If you are standing, 50-75mg taken intranasally can cause transient, trance-like states like you describe. 100mg taken intranasally (50g IM equivalent) is enough such that most people couldn't safely walk, and would have closed-eye visuals almost like a lucid dream. 150mg intranasally will guarantee a k-hole for most people, and 300mg plus would render all but those with extreme tolerances unconscious.

It's probably obvious, but the doses I mention are regarding pharmaceutical ketamine, straight from the vial, rather than for street ketamine.

Let’s say these particular kids had access to the good stuff. Cooked straight from the vial, albeit from Mexico or some further place. Done by the plateful and not in bumps.

I should also add that the ones whom I had to talk down were probably also on heaven-knows what other substances at the time.

> 315 milligrams is still.. a lot. Especially injected into the bloodstream (I presume?)

Iv dose for induction of general anesthesia is ~3-5 mg/kg. Or ~5 mg/kg intramuscularly.

The main thing with ketamine is that it causes tachycardia/arrhythmias and increases blood pressure. While that can be desirable for people in shock, it is a big problem if the person is already under proarrhythmic drugs (e.g. cocaine).

In Europe, we use antipsychotics for similar situations (haloperidol).

I’m pretty sure the lit goes up to 8 mg/kg for IM. In the case of a 100lb pt, that’s what, 50kg? So they give the pt 6 mg per kg. It’s not out of the range of sanity, all else equal.

Key point though: you wouldn’t give the pt 8 mg/kg in a fucking bolus. Time to onset for sedative effect is fast (10min or so); time to peripheral adverse effects can easily take an hour. You’d start way lower than 8, and work your way up if you needed to.

> So they give the pt 6 mg per kg. It’s not out of the range of sanity, all else equal.

Well yeah, but as I understand it the goal is not to intubate in this case, right? So in my opinion, 6 is already way too much.

In fact, I don't think we can agree on a safe standard dose in this case. Which suggests that it's not the right choice of drug for that use case...

It is a lot by recreational standards, but the anesthetic doses of ketamine are higher than the recreational doses.

I was wondering how one could be so bad at estimating weight.

But yes, it’s a lot.

How do you estimate the weight of a person?

I know how much I weigh, but I don't know how much anyone else weighs. I guess some other people don't even weigh themselves so don't even know how much they weigh.

How do you estimate it?

Height + bellysize + muscle size?

Right... how do I get a number from looking at those?

Compare those values to your own weight, and pay attention when you hear someone’s weight to see if it matches your heuristic.

> pay attention when you hear someone’s weight to see if it matches your heuristic

I don't think I've ever heard an adult male ever mention their own weight in public. You can see why it'd be hard to estimate when you don't have any data.

You’ll have to get a job at a county fair running the weight guessing attraction to get enough data. There’s no other way to do it, it’s how we all figured out how to estimate the weight of a human. I’ll call my friend Chucky, he’ll get you a gig in a traveling carnival for the summer.

Or simply any job that requires checking IDs. Bouncer, bartender, cashier in a store that sells alcohol/cigarettes, etc.

Huh, I have never seen weight specified on any ID.

Every US ID and driver's license I've ever seen (and I've seen many) list height and weight.

Watch a fair amount of boxing and practice that way.

> How do you estimate the weight of a person?

Practice. In theory if you're doing this a lot, you should be able do a decent job of estimating +/- 10%, which is more than accurate enough.

There are certainly other complications (some medications are dosed on "ideal body weight" (ignoring subcutaneous fat), etc...)

I'll second this. Climbers tend to get at least half-way decent estimating the weight of other climbers because it's pretty relevant if you're lead belaying somebody.

In fairness, we're usually estimating the weight of people of fairly fit builds, but with some practice estimating people of other builds, I agree that you'd get within 10%.

One more reason to leave drugs to qualified personell.

A very large part of police work is providing and reacting to descriptions of suspects. If there is no training on this provided then this seems to be a very large oversight. Based on the fact that police constantly arrest and harrass people who 'matched the description' perhaps there is no training, or perhaps the officers simply don't care and are just looking for a person that fits their bias.

I would be really surprised if they estimated this poorly and would guess they were just irritated by him and decided to up the dose as punishment. If I am wrong then they receive zero training when estimating weight and multiple officers are terrible at it. To mistakenly confuse a 140lb for 220lb is poor judgement to the point that it strains credulity.

FWIW: My wife work in health care and just a couple of months or so told me how difficult it can be to estimate the weight of a person. She had recently seen some pictures with examples of persons and their actual weights and it had surprised even her.

It doesn't strain credulity for me. Most descriptions of the black victims of police brutality by law enforcement inflate them to a monstrous size, and use animal metaphors to describe their terrifying faces.

Never underestimate the degree to which racism is driven by actual, irrational terror.

There are actually documented cases of police officers in the early 20th century requesting heavier calibers and hotter loads from gun manufacturers because they believed their firearms were incapable of stopping an enraged <slur deleted>.

Biologically, this is utter nonsense. But the belief that black people are tougher, stronger, and more capable of withstanding pain and drugs is a surprisingly common belief. Doctors are notorious for downgrading black pain in clinical situations as compared to white patients, and administer less pain killers.

The uncomfortable truth is that authorities regularly misidentify black men as being bigger/taller/older/darker than they actually are. Whether that's an issue specific to police indoctrination or to American culture in general, it's clearly part of what happened here.

Apologies to the HN users who will be incensed at the notion of race playing a role in this situation.

> Apologies to the HN users who will be incensed at the notion of race playing a role in this situation.

No apologies necessary, receiving a dose of reality is good for them.

So true.

Even today a common misconception among white doctors is that black people have thicker skin than white people or even that their nerv endings are less sensitive.

https://www.aamc.org/news-insights/how-we-fail-black-patient...

As I’ve mentioned elsewhere, cops in the early 20th century requested larger calibers and hotter loads from gun manufacturers because they believed black people survived gun shots better than white people.

Police in the U.S. are usually extremely overweight. They might not know that a healthy 5'10 adult should weigh 150 pounds.

That seems like an overly generalised thing to say.

There are FBI reports that say the same thing, referenced here:

https://inpublicsafety.com/2015/01/tackling-the-obesity-epid...

and here:

"FBI: 80 Percent Of Police Officers Are Overweight"

https://dfw.cbslocal.com/2014/08/14/fbi-80-percent-of-police...

Why on earth would you come to challenge something without first checking if its true?

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