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Ketamine Toxicity.


StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020-.
2019 Dec 26.

Author information

Beth Israel Deaconess Medical Center
Johns Hopkins University
Johns Hopkins School of Medicine


Ketamine is a structural analog of the dissociative anesthetic and recreational drug phencyclidine (PCP).[1] Similar to phenylcyclidine, ketamine causes analgesia and amnesia without the cardiovascular and respiratory depression associated with common anesthetics.[1] Originally called CI-581, ketamine has one-tenth the potency of PCP and causes less severe dysphoria and hallucinations.[1] After the chemist, Calvin Stevens, first synthesized ketamine in 1962, ketamine was tested in clinical trials performed in pediatric and adult surgical patients, and the Food and Drug Administration approved it for human use in 1970.[1][2] Ketamine was the most common battlefield anesthetic used during the Vietnam War (fact file on ketamine). Intramuscular and intravenous forms of ketamine are commonly used to provide pediatric anesthesia, especially for high-risk children or patients in limited-resource settings.[3] In surgical settings, ketamine is typically combined with benzodiazepines, which can reduce the adverse psychological symptoms that occur during emergence.[4] Off-label, subanesthetic doses of ketamine also has a use for acute and chronic pain management, sedation, and treatment of severe depression.[5][6][7] Like its chemical cousin phencyclidine, ketamine’s psychomimetic effects have made it a popular recreational drug.  In low doses, it’s euphoric and dissociative effects are sometimes referred to as “k-land,” whereas at high doses, the immobilizing and hallucinogenic effects are referred to as being in a “k-hole.”[1][8][1] In the context of an illegal, recreational drug, ketamine goes by the street names “K,” “vitamin K,” “super K,” “special K,” “super C,” “special LA coke,” “jet,” “superacid,” “green,” and “cat Valium”.[8][9] Ketamine toxicity can cause a variety of neurological, cardiovascular, psychiatric, urogenital and abdominal symptoms, which are dose-dependent, and whether ketamine administration was in an iatrogenic or illicit context.  For example, some experts have attributed the higher incidence of ulcerative cystitis in recreational users to the adulterants with which the drug is mixed.  Emergency medicine providers should become aware of the various mechanisms to treat ketamine toxicity and to prevent acute complications such as rhabdomyolysis and seizures, and chronic complications such as psychiatric disturbances and ulcerative cystitis.

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