KETAMINE TOXICITY

Course overview

KETAMINE IS A STRUCTURAL ANALOG OF THE DISSOCIATIVE ANESTHETIC AND RECREATIONAL DRUG PHENCYCLIDINE (PCP). SIMILAR TO PHENCYCLIDINE, KETAMINE CAUSES ANALGESIA AND AMNESIA WITHOUT THE CARDIOVASCULAR AND RESPIRATORY DEPRESSION ASSOCIATED WITH COMMON ANESTHETICS. ORIGINALLY CALLED CI-581, KETAMINE HAS ONE-TENTH THE POTENCY OF PCP AND CAUSES LESS SEVERE DYSPHORIA AND HALLUCINATIONS. INTRAMUSCULAR AND INTRAVENOUS FORMS OF KETAMINE ARE COMMONLY USED TO PROVIDE PEDIATRIC ANESTHESIA, ESPECIALLY FOR HIGH-RISK CHILDREN OR PATIENTS IN LIMITED-RESOURCE SETTINGS. IN SURGICAL SETTINGS, KETAMINE IS TYPICALLY COMBINED WITH BENZODIAZEPINES, WHICH CAN REDUCE THE ADVERSE PSYCHOLOGICAL SYMPTOMS THAT OCCUR DURING EMERGENCE. OFF-LABEL, SUBANESTHETIC DOSES OF KETAMINE ALSO HAVE A USE FOR ACUTE AND CHRONIC PAIN MANAGEMENT, SEDATION, AND TREATMENT OF SEVERE DEPRESSION. 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.” 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,” AND “GREEN.” 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. PROVIDERS USING KETAMINE SHOULD BE 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. THIS ACTIVITY REVIEWS THE EVALUATION OF KETAMINE TOXICITY AND THE ROLE OF THE INTERPROFESSIONAL TEAM IN MANAGING THIS CONDITION.