Recreational ketamine use has risen sharply in the Netherlands, especially among young adults in nightlife settings, leading to more first aid incidents often involving combinations with alcohol or MDMA that increase toxicity. Acute intoxication causes agitation, hallucinations, nausea, tachycardia, and hypertension; frequent use can lead to long-term complications like ketamine-induced uropathy. Although ketamine is not currently part of standard toxicological screenings, including it could help diagnose mixed intoxications, rule out other causes, and support referrals to follow-up care, improving diagnostic accuracy and addressing health risks from its growing prevalence.
Among critically ill patients with MDMA intoxication admitted to an intensive care unit in Amsterdam between 2010 and 2020, the most common reason for admission was a threatened airway due to trismus (jaw clenching), occurring in 47% of cases, which often led to respiratory acidosis. Hyponatraemia occurred in 39% of patients, and hyperthermia in 11%. Patients with hyperthermia frequently developed severe complications such as rhabdomyolysis, acute kidney injury, and liver failure. The median correction of serum sodium was greater than European guidelines recommend, but no osmotic demyelination was reported. Overall, 4% of the 74 patients died, though most recovered fully.