Severe coughing from oral ketamine troches resulting in large rectus sheath hematoma.

Introduction: Ketamine oral formulations are being increasingly used off-label for complex regional pain syndrome with several studies supporting its therapeutic effect. While generally noted to be well-tolerated, ketamine or its excipients may provoke airway irritation and severe coughing. We present a rare complication of a rectus sheath hematoma secondary to severe coughing triggered by oral ketamine.