Etomidate, traditionally an anesthetic agent, has recently emerged as a substance of misuse through the adulteration of e-vaporizers. Previous reports have raised concerns of associated adrenal dysfunction. In this case report, we describe two patients with a history of etomidate-laced vaporizer use who were incidentally found to have asymptomatic hypokalemia (serum potassium 2.9 mmol/L and 3.3 mmol/L) during outpatient evaluation. Both patients also presented with diffuse and palmer crease hyperpigmentation, a clinical sign frequently seen in adrenal dysfunction. Unlike previously reported cases presenting with neuromuscular weakness or adrenal crisis, this case report highlights subclinical manifestations of endocrine disruption associated with etomidate use. Early screening of asymptomatic hypokalemia in etomidate misuse is therefore important for clinicians treating this emerging group of patients, as this may facilitate timely investigation and prevention progression to severe adrenal complications.
Radically different