Ketamine and Serotonin Syndrome: a Case Report
Residents’ Voices Ketamine and serotonin syndrome: A case report Clay Gueits, MD, and Martin Witkin, DO ong utilized as a rapid anesthetic, ket- with haloperidol (dose unknown) with amine has been increasingly used in reportedly good effect. On Day 7, she was Lsub-anesthetic doses for several psy- discharged home. chiatric indications, including depression, Upon returning home, she experienced suicidality, and chronic pain. Recently, persistent altered mental status. Her signifi- an intranasal form of esketamine—the cant other brought her to our hospital for fur- S-enantiomer of ketamine—was FDA- ther workup. Ms. O’s body temperature was Clay Gueits, MD approved for treatment-resistant depression. 37.6°C, and she was diaphoretic. Her blood Previously, researchers believed ketamine pressure was 154/100 mm Hg, and her heart mediated its analgesic and psychotropic rate was 125 bpm. On physical examination, effects solely via N-methyl-d-aspartate she had 4+ patellar and Achilles reflexes (NMDA) receptor antagonism, but emerg- with left ankle clonus and crossed adductors. ing research has described a seemingly more Her mental status exam showed increased complex receptor profile.1 One such ancillary latency of thought and speech, with bizarre pharmacologic mechanism is occupation of affect as evidenced by illogical mannerisms Martin Witkin, DO the serotonin receptor.1,2 However, there and appearance. She said she was “not feel- is sparse literature describing the possible ing myself” and would stare at walls for pro- Dr. Gueits is a PGY-2 Psychiatry extent of ketamine’s involvement in sero- longed periods of time, appearing internally Resident, Department of Psychiatry, tonin syndrome.3 Here, we describe a case preoccupied and confused.
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