Ketamine in Refractory Cyclic Vomiting Syndrome: A Case Report and Review of Literature

Purpose: To describe the use of ketamine in an adult patient in aborting a cyclic vomiting syndrome (CVS) episode. Summary: A 40-year-old man with a history of CVS was admitted after several days of nausea and vomiting. He was given parenteral doses of lorazepam and ondansetron but was unable to remain emesis-free. Ketamine was recommended by Gastroenterology as a therapeutic option after exhausting all first- and second-line agents. Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that is widely used for its analgesic and sedative effects. While there is some data to support its use in CVS, most of the published literature has been limited to the Emergency Department setting and no specific therapeutic dose has been established. We will review our institution’s experience with low dose ketamine in an adult patient with a CVS episode that is refractory to first-line agents. Conclusion: In the case described, ketamine at a low sub-anesthetic dose successfully aborted a CVS episode with no appreciable side effects. As much of ketamine’s full effects remain relatively unknown, additional studies are needed to determine optimal strategies for ketamine use in patients with a CVS episode.