Abstract
Ketamine is increasingly used as a recreational drug. The report outlines the various multi-organ dysfunctions identified following chronic abuse in a 24-year-old patient with no significant past medical history and the subsequent patient management. Besides ketamine cessation, other treatments only provide suboptimal relief to the damage inflicted by the toxic ketamine metabolites. Introduction
Ketamine is a noncompetitive glutamate N-methyl-D-aspartate receptor (NMDAR) antagonist that causes muscle relaxation. It was initially developed as an anesthetic agent in 1963 [1] . Over the last 20 years, recreational use of ketamine has continued to rise among the young, predominantly male population, to induce a dissociative state and hallucinogenic experience [2,3,4] . Multiple organ damage involving the genitourinary system, hepatobiliary tract, gastrointestinal tract, heart, and brain have been identified in chronic ketamine users [1,3,5] . Case Presentation
A 24-year-old male became generally unwell following a recent use of 3 grams of ketamine about three days before presentation. He is known to abuse ketamine through sniffing for over one year, with abstinence of about 60 days before the current use. His past medical history involves anxiety and depression. He was under investigation for ongoing hematuria by the urology team and was planned for a flexible cystoscopy, which he failed to attend.
On admission, he appeared clinically cachectic, jaundiced, and dehydrated. His clinical observations at presentation based on the National Early Warning Score (NEWS) was five, comprising a pulse rate of 115 bpm, a respiratory rate of 26/min, a blood pressure of 139/97 mmHg, a temperature of 36.4°C, and oxygen saturation (SpO 2 ) of 100% (on air). His venous blood gas (VBG) showed metabolic acidosis, and blood tests (Table 1 ) showed reduced renal function, severely deranged liver function, normocytic normochromic anemia, and raised inflammatory markers. The urine dip revealed hematuria. Besides this, blood culture yielded heavy growth of Streptococcus sanguinis. His toxicology screen for salicylate and paracetamol came back negative. Test Result Normal range Sodium 129 133 – 146 mmol/L Potassium 3.4 3.5 – 5.3 mmol/L Bicarbonate 11 22 – 29 mmol/L Urea 32.2 2.5 – 7.8 mmol/L Creatinine 480 59 – 104 umol/L […]
Multi-organ Failure in a Patient With Chronic Ketamine Use: A Case Report
