- Robert J Hoffman, MD
Robert J Hoffman, MD
- Division of Emergency Medicine
- Sidra Medical and Research Center
- Section Editor
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Ketamine was synthesized in 1962 by Parke Davis and first used in humans in 1965 [1,2]. The United States military used ketamine as a field anesthetic during the Vietnam War, and the agent gradually gained popularity for use in brief surgical procedures as both an induction and maintenance agent for sedation and general anesthesia. Currently, use of ketamine is expanding to include acute treatment of psychomotor agitation in the emergency setting , acute therapy of depression , treatment of chronic migraine headache , treatment of status epilepticus , and in low or sub-dissociative doses to treat pain .
By the 1970s, ketamine became a widely used recreational drug, with street names such as K, Special K, Kitkat, Vitamine K, Ket, and Super K. Ketamine abuse is closely associated worldwide with the use of other "club drugs" including "Molly" or “ecstasy” (3,4-methylenedioxymethamphetamine or MDMA), gamma hydroxybutyrate (GHB), and methamphetamine, often in the setting of large dance parties (sometimes referred to as raves) . (See "MDMA (ecstasy) intoxication" and "Gamma hydroxybutyrate (GHB) intoxication" and "Methamphetamine: Acute intoxication".)
Ketamine is produced by a complex, multistep synthesis that essentially precludes easy clandestine drug production. Most if not all ketamine sold illicitly in the United States is obtained by diversion of legitimate supplies.
This topic review will discuss the presentation and treatment of ketamine intoxication, as well as poisoning with ketamine analogues, including methoxketamine, methoxetamine, tiletamine, and similar substances. A summary table to facilitate emergent management is provided (table 1). Discussions of the use of ketamine for procedural sedation and induction for rapid sequence intubation (RSI) are found separately. (See "Procedural sedation in adults outside the operating room", section on 'Ketamine' and "Induction agents for rapid sequence intubation in adults outside the operating room", section on 'Ketamine' and "Pharmacologic agents for pediatric procedural sedation outside of the operating room", section on 'Ketamine'.)
Ketamine is an arylcycloalkylamine that is structurally related to phencyclidine (PCP). Ketamine is a dissociative anesthetic and hallucinogen. It acts primarily as an antagonist of the N-methyl-D-aspartate (NMDA) receptor, but also possesses some opioid receptor activity and sympathomimetic properties. The latter results in enhanced central and peripheral monoaminergic transmission and inhibition of central and peripheral cholinergic transmission . The primary site of ketamine's central nervous system (CNS) activity appears to be the thalamocortical projection system, where it causes depression of certain cortical and thalamic functions and stimulation of parts of the limbic system .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- KINETICS AND METABOLISM
- DOSAGES AND FORMULATIONS
- CLINICAL PRESENTATION
- Vital signs
- Central nervous system (CNS) effects
- Respiratory and airway effects
- Cardiovascular effects
- Ocular effects
- Other effects from chronic abuse
- Presentation after iatrogenic administration
- Presentation after illicit use
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- Airway and breathing support
- - Laryngospasm
- - Respiratory depression
- - Salivation
- Cardiovascular support
- Supportive care
- Psychomotor agitation, muscle rigidity, hallucination
- Gastrointestinal decontamination
- Enhanced elimination
- PEDIATRIC CONSIDERATIONS
- ADDITIONAL RESOURCES
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS
- Presentation and evaluation