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. 2022 May;6(2):137-140.
doi: 10.5811/cpcem.2022.1.55277.

Acquired Methemoglobinemia in a Ketamine-induced Ulcerative Cystitis Patient: A Case Report

Spencer Kozik  1 , Cali Kirkham  2 , Gabriel Sudario  2
Affiliations

Acquired Methemoglobinemia in a Ketamine-induced Ulcerative Cystitis Patient: A Case Report

Spencer Kozik et al. Clin Pract Cases Emerg Med. 2022 May.

Abstract

Introduction: As ketamine gains traction as an alternative to opiates in the treatment of chronic pain, ketamine-induced ulcerative cystitis is now being recognized as a complication of its use. The first-line treatment is phenazopyridine, an over-the-counter medication for dysuria that historically has been known to cause methemoglobinemia. This report details the case of a patient presenting to the emergency department (ED) with methemoglobinemia.

Case report: A 66-year-old woman with a complicated medical history presented to the ED with anemia and hypoxia after extended use of phenazopyridine for treatment of ketamine-induced ulcerative cystitis. She was found to have methemoglobinemia secondary to phenazopyridine used to treat her ketamine-induced ulcerative cystitis, a previously undocumented sequelae of chronic ketamine use. She was admitted to the hospital for three days and made a full recovery.

Conclusion: This case highlights the need to suspect ketamine-induced ulcerative cystitis in patients who use ketamine chronically and be judicious in the use of phenazopyridine for symptom management to prevent life-threatening complications.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none. Dr. Gabriel Sudario is a member of WestJEM’s sponsoring society California ACEP.

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