Ketamine-precipitated syndrome of inappropriate antidiuretic hormone secretion in a patient with persistent lumbar pain: a case report

Ketamine-Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion and Hyponatremia

“…Ketamine is expected to be completely cleared from adult circulation within 12.5-17.5 hours. The older age, low body mass, and impaired renal function of this patient may prolong the elimination of Ketamine [6]. Limited literature is available that describes the rare and unusual association between Ketamine and syndrome of inappropriate antidiuretic hormone (SIADH) [6].…”

“…The above properties make it distinct from other general anesthetics and drugs used for sedation and analgesia. It can be effective in managing non-responsive pain and complex regional pain syndrome (CRPS) [6].…”

“…Reported adverse effects of Ketamine include tachycardia, hypertension, anxiety, dysphoria, nightmares, hallucinations, disorientation, insomnia, euphoria agitation, blurred vision, sedation, and elevation of liver enzymes [4][5][6].…”

“…As a physiologic reflex, the increase in TBW transiently promotes urinary sodium excretion in an attempt to normalize the extracellular volume and equilibrate sodium concentration gradients. This reflexive process further reduces plasma sodium concentration and causes hyponatremia [6].…”

“…On our assessment, the results satisfied the 1967 Bartter and Schwartz diagnostic criteria for SIADH, namely evidence of hyponatremia with corresponding hypo-osmolarity, continued renal excretion of sodium, and no evidence of volume depletion, and subsequent correction of hyponatremia by fluid restriction. Alternate causes of hyponatremia including hepatic disease, cardiac failure, adrenal, and hypothyroidism were absent [6]. Naranjo score of 9 was calculated, suggesting that the correlation between ketamine and hyponatremia was definitive [6].…”