A 31-year-old man with a three-year history of using ketamine by inhalation, injection, and intravenously visited the emergency department twice in one week with severe back and abdominal pain and indigestion. Standard tests and advanced imaging found no clear cause. The patient identified from Reddit that his symptoms likely stemmed from chronic ketamine use; after stopping ketamine, his pain improved within 24 hours. He then sought addiction treatment on his own. Emergency physicians should consider chronic ketamine use as a possible cause for gastrointestinal and urinary symptoms, and offer education, symptom relief, and links to substance use treatment.
Paradoxical vocal cord motion (PVCM) is a neuropsychiatric condition often mistaken for asthma or airway blockage. A 23-year-old woman with an acute PVCM attack did not improve with standard benzodiazepine treatment. She received a low (sub-dissociative) dose of intravenous ketamine, which resolved her symptoms and allowed her to leave the emergency department. The authors suggest that sub-dissociative ketamine may be a safe and effective option for PVCM flare-ups, and they discuss patient factors that may have influenced the successful outcome.
A 27-year-old man visited the emergency department twice after confirmed ingestion of a relatively new synthetic drug of abuse. The case report describes his symptoms, how they were managed, and how the drug was identified. Emergency physicians and prehospital providers are often the first to encounter patients using these increasingly popular recreational drugs.