The Dark Side of Ketamine: Brain, Bladder, and Beyond: a Focused Clinical Review for Emergency Medicine Clinicians
Anatolian Journal of Emergency Medicine June 28, 2026 Sergey Motov
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.