title: Allergic Reaction to Ketamine as Monotherapy for Procedural Sedation.
abstract: BACKGROUND
  Ketamine is a cyclohexamine derivative that acts as a noncompetitive N-methyl D-aspartate receptor antagonist. Its use for procedural sedation is recommended by national clinical policy. However, its immunogenic potential is not well documented.
  
  
  METHODS
  We report a case of allergic reaction associated with the administration of intravenous ketamine for procedural sedation in a 16-year-old male. Minutes after administration, the patient developed a morbilliform, erythematous rash that extended to the upper and lower torso and resolved with intravenous diphenhydramine. It is most likely that this allergic reaction was caused by a ketamine-induced histamine release that has been described in vitro. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This is the first case report in which ketamine was used as monotherapy in the emergency department for the facilitation of procedural sedation that resulted in an allergic reaction. Supportive measures, including advanced airway procedures and hemodynamic support, may be necessary in more severe anaphylactic cases. Providers should be aware of this potential adverse effect when using ketamine for procedural sedation.
authors: Department of Pharmacy, Virginia Commonwealth University Medical Center, Richmond, Virginia; Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors: Tammy T
authors: TT
authors: Nguyen
authors: Department of Pharmacy, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors: Bethany
authors: B
authors: Baker
authors: Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors: Jeffrey D
authors: JD
authors: Ferguson
mesh_terms: D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000494:pharmacology / Q000627:therapeutic use; D016292:Procedural Sedation / Q000379:methods*; D004155:Diphenhydramine / Q000494:pharmacology / Q000627:therapeutic use; D003875:Drug Eruptions / Q000150:complications / Q000209:etiology; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005269:Femur / Q000293:injuries; D050723:Fractures, Bone / Q000188:drug therapy / Q000601:surgery; D006634:Histamine H1 Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy* / Q000209:etiology; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male
chemical_list: D000778:Anesthetics, Dissociative; D006634:Histamine H1 Antagonists; D006993:Hypnotics and Sedatives; D007649:Ketamine; D004155:Diphenhydramine
keywords: allergic reaction; ketamine; procedural sedation