Rapid Improvement in Consciousness After Low-Dose Ketamine in a Patient With Acute Confusion - A Case Report

Sep 29, 2026

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Ketamine, widely used for procedural sedation, may have underrecognized neuroprotective and cognition-modulating effects. A 66-year-old female presented with acute confusion likely secondary to a urinary tract infection, with a Glasgow Coma Scale score of 12/15. After receiving 40 mg intravenous ketamine for nasogastric tube insertion, she regained full consciousness within 45 minutes, reaching 15/15. No other sedatives or interventions were given during this period, suggesting rapid reversal of acute confusion and enhanced arousal in selected scenarios and supporting further study beyond established indications.

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CategoryHealthcare

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Abstract

Introduction

Case Presentation

Clinical presentation and assessments

Laboratory and imaging findings

How to cite this article

Review began 11/22/2025 Review ended 12/01/2025 Published 12/07/2025 © Copyright 2025 Khalid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98635 Open Access Case Report Rapid Improvement in Consciousness After LowDose Ketamine in a Patient With Acute Confusion: A Case Report Waleed Khalid Khalafallah Khalid 1, Ibtisam Ahmed Abdullah Al Hoqani 2 , Hind Abdelazim Mirghani Ibrahim 3 , 2 1. Emergency Medicine, Royal College of Emergency Medicine, London, GBR 2. Emergency Medicine, Khoula Hospital, Muscat, OMN 3. Emergency Medicine, Ahfad University For Women, Omdurman, SDN Corresponding author: Waleed Khalid Khalafallah Khalid, [deeloo121@live.com](deeloo121@live.com) Abstract Ketamine, widely used for procedural sedation, may possess underrecognized neuroprotective and cognitivemodulating effects. We report the case of a 66-year-old female patient who presented with acute confusion (Glasgow Coma Scale (GCS) 12/15; E3V4M5), likely secondary to a urinary tract infection. Remarkably, she regained full consciousness (GCS 15/15; E4V5M6) within 45 minutes of receiving 40 mg of intravenous ketamine for nasogastric tube insertion. No other sedatives or interventions were administered during this period. This observation raises the possibility that ketamine may play a role in rapidly reversing acute confusion and enhancing arousal in select clinical scenarios. While anecdotal, such findings align with emerging literature and warrant further exploration of ketamine’s neurocognitive effects beyond its established indications. Categories: Emergency Medicine, Pharmacology, Anesthesiology Keywords: acute confusion, delirium, emergency medicine, gcs recovery, glasgow coma scale, intravenous ketamine, ketamine, procedural sedation, rapid arousal, urinary tract infection Introduction Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is widely recognized as a versatile drug in emergency medicine. It is commonly used for sedation, analgesia, asthma exacerbation management, seizure control, rapid sequence intubation (RSI) in hypotensive patients, awake intubation, and cerebroprotection in head trauma. Ketamine’s diverse therapeutic applications have made it a favorite among emergency physicians. Traditionally, ketamine has been widely used in emergency care for procedural sedation, analgesia, reduction of dislocations, burn dressing changes, and as an adjunct in the management of seizures and severe asthma. These diverse effects are mediated through NMDA receptor antagonism. In addition to these established uses, emerging literature highlights its potential in enhancing cognition, reducing delirium, improving levels of consciousness, and treating major depressive disorder resistant to standard therapy [1-5]. Ketamine has also been studied for its potential to reduce postoperative delirium and cognitive decline, especially in elderly surgical patients [6,7] . This case illustrates ketamine’s surprising neuroactivating effect in the context of acute confusion. Case Presentation A 66-year-old female patient with end-stage renal disease on regular haemodialysis, breast cancer on hormonal therapy, long-standing hypertension, and a history of recurrent urinary tract infections (UTIs) presented to the Emergency Department (ED) with acute confusion characterised by fluctuating attention, severe disorientation to time, place, and person, impaired comprehension, and marked agitation. Her symptoms had been gradually progressive over approximately 26 hours. The confusion had progressed gradually. On arrival, her Glasgow Coma Scale (GCS) was 12/15 (E3V4M5) . Vital signs showed a blood pressure (BP) of 195/85 mmHg, heart rate (HR) 81 beats per minute, respiratory rate (RR) 18

FAQs

What condition did the patient present with before ketamine was given?

The patient presented with acute confusion characterized by fluctuating attention, severe disorientation, impaired comprehension, and marked agitation.

How quickly did the patient’s consciousness improve after low-dose intravenous ketamine?

Within 45 minutes of receiving 40 mg intravenous ketamine, her Glasgow Coma Scale improved from 12/15 to 15/15.

What evidence supported urinary tract infection as the likely cause?

Urinalysis showed leukocytes and urine microscopy revealed 20 WBCs per cumm, and fever at 38.1°C supported an acute UTI; cerebrospinal fluid and CT head findings did not indicate an acute structural brain cause.

Sep 29, 2026

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