Abdominal Pain and Dysuria Secondary to Chronic Recreational Ketamine Use: A Case Report on K-cramps

Medical and recreational ketamine use is increasing in the United States; however, little is known regarding the side effects associated with chronic, frequent, and high-dose use. The lack of emergency physician awareness regarding ketamine-induced abdominal pain, nausea, vomiting, and dysuria, collectively and colloquially known as K-cramps, results in delayed recognition, underreporting, and inappropriate diagnostic workup and treatment. A 25-year-old woman with a history of anxiety, asthma, obsessive-compulsive disorder, and chronic high-dose (500-1000 milligrams weekly) ketamine use presented to the emergency department with severe abdominal pain in the right upper quadrant, epigastric, and suprapubic regions, along with nausea, vomiting, and dysuria. Physical exam revealed localized abdominal tenderness but no other significant findings. Lab results including a complete blood count, comprehensive metabolic panel, lipase, beta-human chorionic gonadotropin, and urinalysis were normal. Given the patient's reported symptoms and frequent, chronic, and high-dose ketamine use, the diagnosis of ketamine-induced abdominal pain and dysuria, or K-cramps, was made. The patient was treated with intravenous fluids, antiemetics, and benzodiazepines. Upon reassessment, all symptoms resolved, and the patient passed an oral challenge. She was discharged with prescriptions for antiemetics and provided with a referral to addiction medicine. Ketamine-induced abdominal cramping and dysuria, or K-cramps, are scarcely reported in the medical literature but are widely known among chronic users. Treatment in the acute care setting includes a comprehensive history and physical examination, consideration and workup of alternative causes, symptom management, counseling regarding harm reduction, and a referral to addiction medicine resources.