You buy a vape.
You inhale.
And the drug you’re inhaling is normally used to put people under anesthesia.
A recent case report out of Singapore describes two young men who had been using vapes containing etomidate, a short acting anesthetic drug normally given intravenously for things like general anesthesia, rapid sequence intubation, and procedural sedation.
Etomidate vapes have acquired some appropriately dystopian nicknames.
In Singapore, they’re called “K pods.”
In Hong Kong, “Space Oil.”
And in Taiwan, perhaps most ominously, “Zombie Vapes.”
Which immediately raises a question.
Why would anyone want to vape an anesthetic?
Because etomidate doesn’t necessarily knock someone unconscious.
The effects depend on dose, and these two men actually provide a pretty good illustration of some of its psychoactive effects.
The first said using etomidate made him feel “calmer and more relaxed.”
The second described “numbing of emotions” and feeling sedated. I assume that’s what he was going for?
It’s safe to say people aren’t necessarily vaping etomidate because they have an upcoming colonoscopy and would like to take matters into their own hands.
They’re using it recreationally for its psychoactive effects.
And in these two cases, the men knew they were using etomidate-containing vapes. Both reported etomidate use and had previously been apprehended by authorities in possession of etomidate-laced vaporizers.
But illicit vape markets introduce another problem.
You don’t necessarily know exactly what you’re getting or how much.
The researchers point out that the concentration of etomidate in illicit vape pods is neither standardized nor disclosed. They couldn’t even meaningfully calculate the doses these patients had received.
And these vapes are becoming enough of a problem in parts of Asia to get the attention of public health officials.
According to the case report, between September 1 and November 2, 2025, authorities in Singapore caught 1,929 people for e vaporizer related offenses. Of those, 167 were confirmed to possess vapes containing etomidate.
When authorities randomly tested confiscated pods in July 2025, about one third contained etomidate.
But the really interesting part of this story isn’t what etomidate does to your brain.
It’s what it can do to your adrenal glands.
What does an anesthetic have to do with potassium?
Etomidate interferes with an enzyme in the adrenal glands called 11β hydroxylase.
That enzyme is needed to make cortisol, one of the body’s major stress hormones. Block the enzyme and cortisol production can fall.
But that’s not all that happens.
Blocking 11β hydroxylase also causes substances that normally get converted into other adrenal hormones to pile up behind the blockage. One of those substances, 11 deoxycorticosterone, has mineralocorticoid activity, meaning it can act somewhat like aldosterone.
Aldosterone has an important job. Among other things, it tells your kidneys to hold onto sodium and get rid of potassium.
So etomidate can essentially create a hormonal traffic jam:
Less cortisol. More mineralocorticoid activity. More potassium lost in the urine.
That’s how someone vaping an anesthetic can wind up with surprisingly low potassium.
And potassium is not just some obscure number buried halfway down your bloodwork.
Your nerves and muscles need it to function normally, including the muscle you would particularly like to continue functioning indefinitely: your heart.
Normal serum potassium is generally around 3.5 to 5.0 mmol/L, although laboratory reference ranges vary slightly.
When potassium gets too low, people can develop muscle weakness, paralysis, abnormal heart rhythms, and other potentially serious complications.
Previous reports of etomidate misuse have included profound hypokalemia, hypokalemic paralysis, adrenal dysfunction, and even adrenal crisis.
Which brings us back to our two patients.
Patient #1 felt basically fine
The first patient was 24 years old and had been using etomidate vapes socially for about three months, averaging two to three pods per week.
Remember, he said the drug made him feel calmer and more relaxed.
By the time doctors evaluated him, he had already stopped vaping for two weeks.
His potassium level was:
2.9 mmol/L.
That’s well below the usual lower limit of around 3.5.
But here’s the strange part.
He wasn’t particularly sick.
His neurological examination was normal. His ECG was normal. He wasn’t experiencing significant physical symptoms that interfered with his daily life.
Doctors did notice something else, though.
His skin was unusually darkened in sun exposed areas, and there was noticeable hyperpigmentation in the creases of his palms.
Keep that detail in mind.
Patient #2 wasn’t particularly sick either
The second patient was 23.
He had been using etomidate vapes for about a year, although less frequently. He reported using them about once a month, consuming around two pods each time.
He described the experience as “numbing of emotions” and feeling sedated.
His potassium was:
3.3 mmol/L.
Also low.
His blood pressure was 158/98, which was high.
And just like the first patient, doctors noticed diffuse skin darkening and hyperpigmentation in the creases of his palms.
Yet again, he wasn’t showing up in medical crisis.
These abnormalities were discovered during outpatient evaluation.
And that’s what makes these cases particularly interesting.
Then there’s the 40 percent number
These two patients weren’t the only people showing low potassium.
According to the case report, as of May 4, 2026, 256 people in Singapore had been referred to the National Addictions Management Service for rehabilitation because of etomidate vape misuse.
Researchers had preliminary screening data from 122 patients.
Of those 122 people:
49 had hypokalemia.
That’s approximately 40 percent.
And the large majority of them were asymptomatic.
That’s arguably the most interesting finding from a public health perspective.
Severe poisoning tends to announce itself.
You collapse. You become weak. Your heart rhythm changes. Something happens that sends you to a hospital.
But biochemical abnormalities can be quietly developing while someone still feels relatively normal.
And unless somebody thinks to look for them, they can go unnoticed.
So what’s with the darkened skin?
Remember the hyperpigmentation in both patients?
That may also point toward the adrenal glands.
When cortisol production falls, the pituitary gland can respond by increasing production of ACTH, a hormone that tells the adrenal glands to make more cortisol.
Increased activity in this hormonal pathway can also stimulate melanin production.
That’s why hyperpigmentation, particularly in places such as the creases of the palms, is a classic clue doctors look for in conditions involving adrenal insufficiency, including Addison disease.
The researchers suggest that similar pigmentation in someone using etomidate could potentially serve as a visible clue that something is happening underneath the surface.
Which is pretty remarkable when you think about it.
A person could be vaping an anesthetic drug recreationally, feel relatively normal, and the clues that something is wrong might be a potassium result on routine bloodwork and the creases of their hands.
But there is an important caveat
This is where we have to put the brakes on the WTF train for a moment.
This paper is a case report, not a controlled study.
And there are important limitations.
Although both patients reported using etomidate and had previously been caught with etomidate containing vapes, researchers didn’t perform toxicology testing at the time of their evaluations.
More importantly, they didn’t measure the hormones that would have helped directly demonstrate adrenal dysfunction, including cortisol, ACTH, aldosterone, and renin.
That means the proposed connection between etomidate, adrenal dysfunction, and the abnormalities seen in these particular patients remains inferential rather than directly demonstrated.
There’s another frustrating wrinkle.
Both patients were supposed to have their potassium checked again.
Neither returned for the repeat testing.
So we don’t get a beautifully wrapped up ending showing exactly what happened to their potassium levels after they stopped vaping.
Previous published cases do provide biological evidence connecting etomidate misuse with adrenal suppression and mineralocorticoid excess, but researchers say much more work is needed to understand how the amount and duration of recreational etomidate use relate to potassium levels and adrenal function.
The bigger WTF
Etomidate isn’t some mysterious new designer drug invented in a clandestine laboratory.
It’s a legitimate medical drug.
In a controlled medical setting, clinicians know what they’re giving, why they’re giving it, how much they’re giving, and what effects to watch for.
Put that same pharmacologically active substance into an illicit vape with an unknown concentration and unpredictable dosing, and you’ve created an entirely different situation.
That’s why the authors recommend that clinicians caring for people with a history of etomidate misuse consider something remarkably simple:
Check their blood pressure. Check their potassium. And don’t assume that feeling fine means everything is fine.
Sometimes the strangest thing about a drug isn’t what it does.
It’s where it turns up.
Source: Low TL, Cheok CCS and Zhang MW (2026) Case Report: A literature review of the medical complications arising from etomidate-laced vapes and two case studies of hypokalemia associated with etomidate use. Front. Psychiatry 17:1808879. doi: 10.3389/fpsyt.2026.1808879
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