Can inhaled ketamine cause epigastric pain?

Inhaled Ketamine and Epigastric Pain

Yes, inhaled ketamine can cause epigastric pain, particularly with chronic or recreational use, and this is well-documented as part of a syndrome known as "K-cramps" among users. 1, 2, 3, 4, 5

Mechanism and Presentation

Ketamine-induced gastrointestinal toxicity presents primarily as:

• Epigastric pain (most common symptom, occurring in 25.4% of ketamine users) 5
• Gastritis (found in 85.7% of ketamine users who underwent endoscopy) 3
• Nausea and vomiting
• Dyspepsia
• Potential for gastrointestinal bleeding in severe cases 5

Risk Factors for Ketamine-Related Epigastric Pain

Several factors increase the likelihood of developing epigastric pain with ketamine use:

• Duration of use: Longer periods of ketamine use significantly increase risk 5
• Frequency and dose: Higher doses and more frequent use correlate with symptom severity 1
• Age: Older users appear to have higher susceptibility (OR 1.06) 5
• Active use status: Current users are more likely to experience symptoms than those who have stopped (OR 1.60) 5

Clinical Significance

Ketamine-induced epigastric pain is:

• Often underrecognized by healthcare providers 1, 2
• Frequently H. pylori negative on testing 3
• Typically precedes urological symptoms by several years in chronic users 5
• Resistant to standard treatments while ketamine use continues 3

Management Approach

For patients presenting with epigastric pain who use inhaled ketamine:

1. Rule out other causes of epigastric pain through appropriate workup 1, 2

2. Provide symptomatic relief with:

   • IV fluids
   • Antiemetics
   • Benzodiazepines may help with acute symptoms 1

3. Address the underlying cause:

   • Abstinence from ketamine is strongly associated with symptom relief (OR 12.5) 3
   • Refer to addiction medicine services 1, 2

Important Considerations

• Ketamine causes sympathetic stimulation with increased heart rate, blood pressure, and cardiac output 6
• It should be used cautiously in patients with cardiovascular conditions 6
• When used therapeutically in controlled settings with appropriate monitoring, ketamine has a more favorable safety profile than recreational use 6

Clinical Pearls

• In young patients presenting with unexplained epigastric pain, consider ketamine use as a potential cause 5
• Standard treatments for gastritis may be ineffective if ketamine use continues 3
• The term "K-cramps" is commonly used among ketamine users to describe this syndrome 1, 2
• Symptoms typically resolve within 24 hours to days after discontinuing ketamine 2

Understanding this association is important as both medical and recreational ketamine use continues to increase, likely leading to more presentations of this condition in clinical settings.