Magnesium-induced ketamine toxicity.
Robert McConnellAnne PelhamFelicity DewhurstRachel QuibellPublished in: BMJ supportive & palliative care (2021)
A 62-year-old man with metastatic duodenal cancer was admitted to a hospice for a trial of ketamine to manage complex neuropathic abdominal pain. The patient was incrementally established on a dose of 150 mg orally four times day with no adverse effects. Following treatment of hypomagnesaemia intravenously, the patient experienced marked symptoms of ketamine toxicity, known as a 'K-hole' amongst recreational users, following the next dose of ketamine. Ketamine and magnesium are both antagonists of the N-methyl-D-aspartate receptor, which plays a part in central sensitisation to pain. There is some evidence that correction of hypomagnesaemia may improve analgesia and that there is synergism between ketamine and magnesium in analgesia, but this relationship is poorly understood. This is the first report suggesting that blood magnesium levels may affect the side effects of a stable dose of ketamine.
Keyphrases
- pain management
- chronic pain
- case report
- small cell lung cancer
- oxidative stress
- squamous cell carcinoma
- palliative care
- randomized controlled trial
- depressive symptoms
- young adults
- drug induced
- ultrasound guided
- physical activity
- binding protein
- high glucose
- diabetic rats
- double blind
- endothelial cells
- squamous cell
- stress induced
- replacement therapy