In emergency department patients with acute pain, intravenous and nebulized ketamine provide similar short-term pain relief. A randomized trial compared a single dose of 0.3 mg/kg intravenous ketamine to 0.75 mg/kg nebulized ketamine in 150 adults with pain scores of 5 or higher on a 0–10 scale. At 30 minutes, mean pain scores fell from 8.2 to 3.6 (intravenous) and 3.8 (nebulized), a difference of 0.23 points that is neither clinically nor statistically significant. No serious adverse events occurred. Both routes offer a meaningful reduction in moderate to severe acute pain without safety concerns.
Ketamine, while essential in emergency medicine, can cause four specific adverse effects that clinicians must recognize. Acute psycho-perceptual effects occur in up to 92% of patients receiving sub-dissociative ketamine by intravenous push but can be reduced by about 40% with slow infusion. Ketamine-induced cystitis affects 25–27% of chronic users and is progressive but partially reversible with early cessation. Ketamine-induced cholangiopathy occurs in roughly 10% of chronic users and mimics primary sclerosing cholangitis. Recreational ketamine use has surged globally, with US seizures increasing over 1,100% between 2017 and 2022 and UK treatment admissions rising fivefold since 2015. Across all chronic toxicity syndromes, ketamine cessation is the single most important intervention.