Systemic ketamine toxicity following dermal application of a compounded pain cream.
Skyler Kessler, Bernard Weigel, Ross Ellison, Roy R Gerona, Jordan Trecki, Joshua Zimmerman, Michael Nelson
The American Journal of Emergency Medicine February 1, 2025 DOI: 10.1016/j.ajem.2024.12.031 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 61-year-old man with pyoderma gangrenosum |
| Interventions | Ketamine Lidocaine |
| Dose | 10% ketamine, 5% lidocaine, 5% amitriptyline (large amount applied) |
| Topics | Ketamine Esketamine |
| Keywords | Dermal application Pain cream Ketamine toxicity Topical drug safety Dermal absorption Adverse drug effects Pain medication complications |
| Citations | 5 |
| Key findings | Dermal application of a ketamine pain cream can cause systemic ketamine toxicity in patients with impaired skin barrier function. |
Abstract
Ketamine is an NMDA receptor antagonist commonly used as a dissociative anesthetic and analgesic. Though it is conventionally administered via the intravenous, intramuscular, or intranasal route, use as a compounded analgesic cream is becoming increasingly common. This is a case report of a 61-year-old man who was detained by the police for erratic driving. He was transported to the emergency department for bizarre behavior and altered mental status. Upon arrival, he was agitated and had torsional nystagmus. He had just applied a large amount of an analgesic cream containing 10 % ketamine, 5 % lidocaine, and 5 % amitriptyline to numerous ulcerations in his perineal and sacral region from pyoderma gangrenosum. His clinical presentation was consistent with ketamine toxicity, and mass spectrometry demonstrated an elevated urine ketamine concentration (32,300 ng/mL). His symptoms resolved spontaneously within a few hours and he was discharged. This is a unique case of systemic toxicity following dermal application of a ketamine pain cream in a patient with impaired skin barrier function due to pyoderma gangrenosum.
Comparable studies
Other case reports and case series on ketamine, most cited first.