KETAMINE

Psychiatric Therapeutic Context (Microdosing Ketamine Therapy Treatment)

• Transient dissociation (common)
• Mild blood pressure increase (often peaks around ~40 minutes)
• Headache
• Drowsiness
• Anxiety during infusion
• Rare mania induction (in bipolar patients)

CNS / Psychiatric Effects from Ketamine Use

• Dissociation (“out-of-body” sensation)
• Depersonalization / derealization
• Altered perception of time
• Dizziness
• Sedation
• Impaired attention and memory
• Anxiety
• Confusion
• Agitation
• Emotional lability
• Blurred vision
• Nystagmus

CNS / Psychiatric Effects from Clinical Anesthesia Ketamine Use

• Vivid dreams
• Hallucinations
• Delirium
• Nightmares
• Paranoia

NoteEmergence reactions are more common in adults than children.

Cardiovascular Effects from Ketamine Use

• Sympathomimetic (increases catecholamines)
• Hypertension
• Tachycardia
• Increased cardiac output
• Increased myocardial oxygen demand
• Cathecholamine-depleted patients(septic shock) may experience Hypotension
• Arrhythmias (rare)
• Chest pain (rare)
• Cardiomyopathy (chronic abuse)

Respiratory Effects from Ketamine Use

• Minimal respiratory depression (compared with opioids/propofol)
• Bronchodilation (beneficial in asthma)
• Hypoventilation (high dose or with other depressants) (rare)
• Apnea (large IV bolus) (rare)
• Laryngospasm (rare; important in pediatrics) (rare)
• Hypersalivation (rare)

Neurologic Effects from Ketamine Use

• Increased intracranial pressure
• Increased intraocular pressure
• Tremor
• Myoclonus
• Seizures (rare)

Gastrointestinal Effects from Ketamine Use

• Nausea
• Vomiting
• Anorexia (short-term)
• Decreased appetite (with chronic use)

Genitourinary Effects from Ketamine Use (chronic recreational use)

• Bladder / Ulcerative Cystitis
• Dysuria
• Increased urinary frequency
• Hematuria
• Pelvic pain
• Reduced bladder capacity
• Hydronephrosis (severe cases)

Hepatic Effects from Ketamine Use

• Elevated AST/ALT (repeated infusions)
• Cholestatic liver injury (rare)

Oral / Nasal Effects from Ketamine Use (intranasal recreational use)

• Chronic sinusitis
• Septal perforation
• Epistaxis
• Sore throat

Cognitive Effects from Ketamine Use (chronic recreational use)

• Memory impairment
• Executive dysfunction
• Slowed processing speed
• Reduced verbal fluency
• Persistent dissociation
• Depression rebound between uses

Dependence & Withdrawal from Ketamine Use

• Cravings
• Compulsive redosing
• Anxiety
• Irritability
• Depression
• Fatigue
• Sleep disturbance

Rare but Severe Adverse Effects

• Rhabdomyolysis
• Acute kidney injury (secondary to rhabdo or obstruction)
• Severe hypertension crisis
• Malignant arrhythmia
• Coma
• Death (usually from polysubstance use)