Systemic ketamine toxicity following dermal application of a compounded pain cream.
The American journal of emergency medicine February 1, 2025 Skyler Kessler, Bernard Weigel, Ross Ellison et al. 5 citations
A 61-year-old man with open skin ulcers from pyoderma gangrenosum developed ketamine toxicity after applying a large amount of a compounded analgesic cream containing 10% ketamine, 5% lidocaine, and 5% amitriptyline to his perineal and sacral region. He was brought to the emergency department with agitation, altered mental status, and torsional nystagmus after erratic driving. Urine testing showed a ketamine concentration of 32,300 ng/mL. His symptoms resolved spontaneously within a few hours. This case demonstrates that dermal application of ketamine cream can cause systemic toxicity when skin barrier function is impaired.