CASE REPORT article
Front. Pediatr.
Sec. Pediatric Critical Care
Volume 13 - 2025 | doi: 10.3389/fped.2025.1662542
This article is part of the Research TopicNew Insights into Pediatric Neurology: Neurological Disorders and Epileptic EncephalopathiesView all 14 articles
Hemorrhagic Cystitis Induced by Intravenous Esketamine in the Treatment of New-onset Refractory Status Epilepticus in Children: A Case Report
Provisionally accepted
- 1The Affiliated Taizhou People's Hospital, Nanjing Medical University, Taizhou, China
- 2Children's Hospital of Nanjing Medical University, Nanjing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Esketamine, the S-enantiomer of ketamine, has been considered for terminating new-onset refractory status epilepticus (NORSE). However, there is limited large-scale data on its safety and comparative effectiveness. There are few reports of cystitis caused by intravenous esketamine in children. We report a 9-year-old boy diagnosed with NORSE, who was treated with esketamine as an anesthetic to terminate status epilepticus. He received a continuous intravenous infusion of esketamine, starting at 2 mg/kg/h and gradually increasing to a maximum of 5 mg/kg/h. The dose was reduced starting on day 9 with no apparent convulsive seizure. On day 13, he developed fluid imbalance, and an ultrasound revealed bladder wall thickening. By day 16, he exhibited gross hematuria. According to the Naranjo adverse reaction probability scale, esketamine was the possible cause of the Adverse Drug Reaction (ADR). After stopping esketamine and initiating urine alkalinization with sodium bicarbonate, his urinalysis and sedimentation rate normalized. Hemorrhagic cystitis may occur during continuous high-dose intravenous esketamine infusions. Early multidisciplinary monitoring of lower urinary tract symptoms and implementation of preventive measures in pediatric patients is essential to avoid serious urinary tract complications.
Keywords: Esketamine, New-onset refractory status epilepticus, pediatric, Ketamine-associated cystitis, Hematuria
Received: 09 Jul 2025; Accepted: 12 Sep 2025.
Copyright: © 2025 Ding, Liu and Miao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yao Liu, liuyao_nch@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.