TY - JOUR T1 - Magnesium-induced ketamine toxicity JF - BMJ Supportive & Palliative Care JO - BMJ Support Palliat Care DO - 10.1136/bmjspcare-2021-002886 SP - bmjspcare-2021-002886 AU - Robert McConnell AU - Anne Pelham AU - Felicity Dewhurst AU - Rachel Quibell Y1 - 2021/02/16 UR - http://spcare.bmj.com/content/early/2021/02/15/bmjspcare-2021-002886.abstract N2 - 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. ER -