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Int J Med Invest 2021, 10(4): 14-22 Back to browse issues page
Ketamin Intoxication Review: Pathophysiology And Management
Foad Fouladi, Fakhteh Aliakbari, Marzieh Khataee, Hooman Esfahani *
Department of Emegency Medicine, School of Medical, Shahrekord University of Medical Sciences, Shahrekord Iran.
Abstract:   (1023 Views)
The first reported non-medical use of ketamine appears to date from the 1960s. However, recreational  use of this medication as a drug was not common until the 1990s; But in recent years, the recreational use of ketamine has increased in many parts of the world and has created many problems. Visual hallucinations, severe personality duality and the feeling of leaving the body following the use of ketamine are the most attractive aspects of drug abuse. Although many studies have been done on the mechanism and effects of ketamine anesthesia, research on the side effects of ketamine on the body is very limited and intoxication is less marked. Therefore, in the present study, we tried to review Ketamin intoxication based on its pathophysiology and management methods. Based on our review, ketamin might be available in various routes of administration as well as  intravenous, intramuscular, subcutaneous, sublingual, intranasal, and oral. Symptoms of hallucinations, nightmares, increased bronchial and salivary secretions, and palpitation may happen following the toxicity. Clinical signs of intoxication are increased blood pressure, CSF pressure, and IOP, altered level of consciousness and tachycardia. Treatment strategies mainly include application of  benzodiazepines; while lacking clinical evidence in lethal doses.
Keywords: Ketamin, Intoxication, Toxicity, Recreational Use, Drug Abuse
Full-Text [PDF 178 kb]   (328 Downloads)    
Type of Study: Review | Subject: General
1. 1.‎ Li L, Vlisides PE. Ketamine: 50 Years of Modulating the Mind. Front Hum Neurosci. 2016;10:612.‎ ‎2.‎ F. Aroni, N. Iacovidou, I. Dontas, C. Pourzitaki, and T. Xanthos, “Pharmacological aspects and potential ‎new clinical applications of ketamine: reevaluation of an old drug,” Journal of Clinical Pharmacology, ‎vol. 49, no. 8, pp. 957–964, 2009.‎ ‎3.‎ J. Persson, “Ketamine in pain management,” CNS Neuroscience & Therapeutics, vol. 19, no. 6, pp. ‎‎396–402, 2013.‎ ‎4.‎ Liao Y, Tang YL, Hao W. Ketamine and international regulations. Am J Drug Alcohol Abuse. 2017 ‎Sep;43(5):495-504.‎ ‎5.‎ Cartwright PD, Pingel SM. Midazolam and diazepam in ketamine anaesthesia. Anaesthesia. 1984 ‎May;39(5):439-42. ‎ ‎6.‎ Andrade C. Ketamine for Depression, 1: Clinical Summary of Issues Related to Efficacy, Adverse ‎Effects, and Mechanism of Action. J Clin Psychiatry. 2017 Apr;78(4):e415-e419.‎ ‎7.‎ M. Naughton, G. Clarke, O. F. O'Leary, J. F. Cryan, and T. G. Dinan, “A review of ketamine in affective ‎disorders: current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed ‎mechanisms of action,” Journal of Affective Disorders, vol. 156, pp. 24–35, 2014.‎ ‎8.‎ P. Azari, D. R. Lindsay, D. Briones, C. Clarke, T. Buchheit, and S. Pyati, “Efficacy and safety of ketamine ‎in patients with complex regional pain syndrome: a systematic review,” CNS Drugs, vol. 26, no. 3, pp. ‎‎215–228, 2012.‎ ‎9.‎ R. F. Bell, C. Eccleston, and E. A. Kalso, “Ketamine as an adjuvant to opioids for cancer pain,” The ‎Cochrane Database of Systematic Reviews, no. 11, Article ID CD003351, 2012.‎ ‎10.‎ J. H. Krystal, S. Madonick, E. Perry et al., “Potentiation of low dose ketamine effects by naltrexone: ‎potential implications for the pharmacotherapy of alcoholism,” Neuropsychopharmacology, vol. 31, no. ‎‎8, pp. 1793–1800, 2006. ‎ ‎11.‎ E. Krupitsky, A. Burakov, T. Romanova, I. Dunaevsky, R. Strassman, and A. Grinenko, “Ketamine ‎psychotherapy for heroin addiction: immediate effects and two-year follow-up,” Journal of Substance ‎Abuse Treatment, vol. 23, no. 4, pp. 273–283, 2002.‎ ‎12.‎ K. R. Jat and D. Chawla, “Ketamine for management of acute exacerbations of asthma in children,” The ‎Cochrane Database of Systematic Reviews, vol. 11, Article ID CD009293, 2012.‎ ‎13.‎ K. R. Jat, C. Azad, and V. Guglani, “Use of ketamine for refractory wheezing in an infant,” Indian ‎Pediatrics, vol. 49, no. 7, pp. 587–588, 2012.‎ ‎14.‎ M. Wang, Q. Wang, Y. Y. Yu, and W. S. Wang, “An effective dose of ketamine for eliminating pain ‎during injection of propofol: a dose response study,” Annales Francaises d'Anesthesie et de ‎Reanimation, vol. 32, no. 9, pp. e103–e106, 2013.‎ ‎15.‎ N. Katalinic, R. Lai, A. Somogyi, P. B. Mitchell, P. Glue, and C. K. Loo, “Ketamine as a new treatment for ‎depression: a review of its efficacy and adverse effects,” The Australian and New Zealand Journal of ‎Psychiatry, vol. 47, no. 8, pp. 710–727, 2013.‎ ‎16.‎ Passie T, Adams HA, Logemann F, Brandt SD, Wiese B, Karst M. Comparative effects of (S)-ketamine ‎and racemic (R/S)-ketamine on psychopathology, state of consciousness and neurocognitive ‎performance in healthy volunteers. European Neuropsychopharmacology. 2021 Mar 1;44:92-104.‎ ‎17.‎ Domino EF. Neuronal mechanisms of ketamine-induced anesthesia. International journal of ‎neuropharmacology. 1968 Nov 1;7(6):557-73.‎ ‎18.‎ Oye I, Paulsen O, Maurset A. Effects of ketamine on sensory perception: evidence for a role of N-‎methyl-D-aspartate receptors. J Pharmacol Exp Ther. 1992 Mar;260(3):1209-13.‎ ‎19.‎ Ben-Shlomo I, Rosenbaum A, Hadash O, Katz Y. Intravenous midazolam significantly enhances the ‎lethal effect of thiopental but not that of ketamine in mice. Pharmacol Res. 2001 Dec;44(6):509-12. ‎ ‎20.‎ Hansen G, Jensen SB, Chandresh L, Hilden T. The psychotropic effect of ketamine. J Psychoactive ‎Drugs. 1988 Oct-Dec;20(4):419-25. ‎ ‎21.‎ Deer TR, Pope JE, Hayek SM, Lamer TJ, Veizi IE, Erdek M, Wallace MS, Grider JS, Levy RM, Prager J, ‎Rosen SM, Saulino M, Yaksh TL, De Andrés JA, Abejon Gonzalez D, Vesper J, Schu S, Simpson B, ‎Mekhail N. The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug ‎Delivery: Guidance for Improving Safety and Mitigating Risks. Neuromodulation. 2017 Feb;20(2):155-‎‎176.‎ ‎22.‎ C. J. A. Morgan and H. V. Curran, “Ketamine use: a review,” Addiction, vol. 107, no. 1, pp. 27–38, 2012. ‎ ‎23.‎ R. J. Strayer and L. S. Nelson, “Adverse events associated with ketamine for procedural sedation in ‎adults,” The American journal of emergency medicine, vol. 26, no. 9, pp. 985–1028, 2008.‎ ‎24.‎ P. Azari, D. R. Lindsay, D. Briones, C. Clarke, T. Buchheit, and S. Pyati, “Efficacy and safety of ketamine ‎in patients with complex regional pain syndrome: a systematic review,” CNS Drugs, vol. 26, no. 3, pp. ‎‎215–228, 2012.‎ ‎25.‎ N. Katalinic, R. Lai, A. Somogyi, P. B. Mitchell, P. Glue, and C. K. Loo, “Ketamine as a new treatment for ‎depression: a review of its efficacy and adverse effects,” The Australian and New Zealand Journal of ‎Psychiatry, vol. 47, no. 8, pp. 710–727, 2013.‎ ‎26.‎ S. Himmelseher and M. E. Durieux, “Ketamine for perioperative pain management,” Anesthesiology, vol. ‎‎102, no. 1, pp. 211–220, 2005.‎ ‎27.‎ H. S. Smith, “Ketamine-induced urologic insult (KIUI),” Pain Physician, vol. 13, no. 6, pp. E343–E346, ‎‎2010.‎ ‎28.‎ A. C. Scallet, L. C. Schmued, W. Slikker Jr. et al., “Developmental neurotoxicity of ketamine: ‎morphometric confirmation, exposure parameters, and multiple fluorescent labeling of apoptotic ‎neurons,” Toxicological Sciences, vol. 81, no. 2, pp. 364–370, 2004.‎ ‎29.‎ V. Jevtovic-Todorovic, D. F. Wozniak, N. D. Benshoff, and J. W. Olney, “A comparative evaluation of the ‎neurotoxic properties of ketamine and nitrous oxide,” Brain Research, vol. 895, no. 1-2, pp. 264–267, ‎‎2001.‎ ‎30.‎ C. Dong and K. J. S. Anand, “Developmental neurotoxicity of ketamine in pediatric clinical use,” ‎Toxicology Letters, vol. 220, no. 1, pp. 53–60, 2013.‎ ‎31.‎ M. G. Paule, M. Li, R. R. Allen et al., “Ketamine anesthesia during the first week of life can cause long-‎lasting cognitive deficits in rhesus monkeys,” Neurotoxicology and Teratology, vol. 33, no. 2, pp. 220–‎‎230, 2011.‎ ‎32.‎ L. C. Chang, S. R. Raty, J. Ortiz, N. S. Bailard, and S. J. Mathew, “The emerging use of ketamine for ‎anesthesia and sedation in traumatic brain injuries,” CNS Neuroscience & Therapeutics, vol. 19, no. 6, ‎pp. 390–395, 2013.‎ ‎33.‎ K. Michalczyk, J. E. Sullivan, and J. W. Berkenbosch, “Pretreatment with midazolam blunts the rise in ‎intracranial pressure associated with ketamine sedation for lumbar puncture in children,” Pediatric ‎Critical Care Medicine, vol. 14, no. 3, pp. e149–e155, 2013.‎ ‎34.‎ N. Gaspard, B. Foreman, L. M. Judd et al., “Intravenous ketamine for the treatment of refractory status ‎epilepticus: a retrospective multicenter study,” Epilepsia, vol. 54, no. 8, pp. 1498–1503, 2013.‎ ‎35.‎ E. B. Perry Jr., J. A. Cramer, H.-S. Cho et al., “Psychiatric safety of ketamine in psychopharmacology ‎research,” Psychopharmacology, vol. 192, no. 2, pp. 253–260, 2007.‎ ‎36.‎ Demaria S, Weinkauf JL. Cocaine and the club drugs. Int Anesthesiol Clin. 2011 Winter;49(1):79-101. ‎ ‎37.‎ Tobias JD, Leder M. Procedural sedation: A review of sedative agents, monitoring, and management of ‎complications. Saudi J Anaesth. 2011 Oct;5(4):395-410.‎ ‎38.‎ Bokor G, Anderson PD. Ketamine: an update on its abuse. J Pharm Pract. 2014 Dec;27(6):582-6.‎ ‎39.‎ Cohen SP, Bhatia A, Buvanendran A, Schwenk ES, Wasan AD, Hurley RW, Viscusi ER, Narouze S, ‎Davis FN, Ritchie EC, Lubenow TR, Hooten WM. Consensus Guidelines on the Use of Intravenous ‎Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain ‎Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. ‎Reg Anesth Pain Med. 2018 Jul;43(5):521-546.‎ ‎40.‎ Trivedi S, Kumar R, Tripathi AK, Mehta RK. A Comparative Study of Dexmedetomidine and Midazolam ‎in Reducing Delirium Caused by Ketamine. J Clin Diagn Res. 2016 Aug;10(8):UC01-4. ‎ ‎41.‎ Sollazzi L, Modesti C, Vitale F, Sacco T, Ciocchetti P, Idra AS, Tacchino RM, Perilli V. Preinductive use ‎of clonidine and ketamine improves recovery and reduces postoperative pain after bariatric surgery. ‎Surg Obes Relat Dis. 2009 Jan-Feb;5(1):67-71.‎
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Fouladi F, Aliakbari F, Khataee M, Esfahani H. Ketamin Intoxication Review: Pathophysiology And Management. Int J Med Invest. 2021; 10 (4) :14-22
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Volume 10, Issue 4 (12-2021) Back to browse issues page
International Journal of Medical Investigation
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