A 62-year-old man with metastatic
duodenal cancer was admitted to a hospice for a trial of
ketamine to manage complex neuropathic
abdominal pain. The patient was incrementally established on a dose of 150 mg orally four times day with no adverse effects. Following treatment of hypomagnesaemia intravenously, the patient experienced marked symptoms of
ketamine toxicity, known as a 'K-hole' amongst recreational users, following the next dose of
ketamine.
Ketamine and
magnesium are both antagonists of the
N-methyl-D-aspartate receptor, which plays a part in central sensitisation to
pain. There is some evidence that correction of hypomagnesaemia may improve
analgesia and that there is synergism between
ketamine and
magnesium in
analgesia, but this relationship is poorly understood. This is the first report suggesting that blood
magnesium levels may affect the side effects of a stable dose of
ketamine.