{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:30:02Z","timestamp":1788280202599,"version":"build-2803163510"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>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. Ketamine-associated cystitis (KAC) is a known complication of chronic recreational ketamine use; however, there are few reports of cystitis caused by intravenous esketamine in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1662542","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T14:44:33Z","timestamp":1759502673000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Hemorrhagic cystitis induced by intravenous esketamine in the treatment of new-onset refractory status epilepticus in children: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Jin-Meng","family":"Ding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Jun","family":"Miao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e1227","DOI":"10.1212\/WNL.0000000000200889","article-title":"Ketamine for management of neonatal and pediatric refractory status epilepticus","volume":"99","author":"Jacobwitz","year":"2022","journal-title":"Neurology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1016\/j.urology.2007.01.038","article-title":"Ketamine-associated ulcerative cystitis: a new clinical entity","volume":"69","author":"Shahani","year":"2007","journal-title":"Urology"},{"key":"B3","doi-asserted-by":"publisher","first-page":"502","DOI":"10.3390\/biology11040502","article-title":"Molecular pathophysiology and potential therapeutic strategies of ketamine-related cystitis","volume":"11","author":"Cl","year":"2022","journal-title":"Biology (Basel)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1213\/ANE.0000000000006851","article-title":"Esketamine: less drowsiness, more analgesia","volume":"139","author":"Mion","year":"2024","journal-title":"Anesth Analg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2200","DOI":"10.1111\/epi.18035","article-title":"A systematic review and meta-analysis of ketamine in pediatric status epilepticus","volume":"65","author":"Chiriboga","year":"2024","journal-title":"Epilepsia"},{"key":"B6","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/clpt.1981.154","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","journal-title":"Clin Pharmacol Ther"},{"key":"B7","doi-asserted-by":"publisher","first-page":"45","DOI":"10.14581\/jer.20008","article-title":"Diagnosis and treatment of status epilepticus","volume":"10","author":"Lee","year":"2020","journal-title":"J Epilepsy Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e24433","DOI":"10.1016\/j.heliyon.2024.e24433","article-title":"Ketamine: pro or antiepileptic agent? A systematic review","volume":"10","author":"Shehata","year":"2024","journal-title":"Heliyon"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3942","DOI":"10.1007\/s00415-024-12453-7","article-title":"The efficacy and safety of ketamine in the treatment of super-refractory status epilepticus: a systematic review","volume":"271","author":"Yan","year":"2024","journal-title":"J Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1016\/j.ajpath.2015.12.014","article-title":"Ketamine-induced apoptosis in normal human urothelial cells","volume":"186","author":"Baker","year":"2016","journal-title":"Am J Pathol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"38247","DOI":"10.52965\/001c.38247","article-title":"Ketamine-induced cystitis: a comprehensive review of the urologic effects of this psychoactive drug","volume":"10","author":"Anderson","year":"2022","journal-title":"Health Psychol Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1016\/j.ajpath.2017.06.004","article-title":"Elucidating mechanisms of bladder repair after hyaluronan instillation in ketamine-induced ulcerative cystitis in animal model","volume":"187","author":"Lee","year":"2017","journal-title":"Am J Pathol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1111\/iju.12841","article-title":"Possible pathophysiology of ketamine-related cystitis and associated treatment strategies","volume":"22","author":"Jhang","year":"2015","journal-title":"Int J Urol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1038\/s41386-023-01577-5","article-title":"Long-term safety and maintenance of response with esketamine nasal spray in participants with treatment-resistant depression: interim results of the SUSTAIN-3 study","volume":"48","author":"Zaki","year":"2023","journal-title":"Neuropsychopharmacology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1329436","DOI":"10.3389\/fphar.2024.1329436","article-title":"Comparing the adverse effects of ketamine and esketamine between genders using FAERS data","volume":"15","author":"Yang","year":"2024","journal-title":"Front Pharmacol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1762","DOI":"10.1111\/j.1464-410X.2012.11028.x","article-title":"The prevalence and natural history of urinary symptoms among recreational ketamine users","volume":"110","author":"Winstock","year":"2012","journal-title":"BJU Int"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1662542\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T14:44:34Z","timestamp":1759502674000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1662542\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":16,"alternative-id":["10.3389\/fped.2025.1662542"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1662542","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]},"article-number":"1662542"}}