Ketamine abuse
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Biliary tract disorders: 3 case reports Three patients experienced biliary tract disorders during ketamine abuse. A 27-year-old man was admitted with shortness of breath and abdominal pain. A CT scan revealed bilateral hydronephrosis and a dilated biliary system. He had a 4-year history of intranasal ketamine abuse [dosage not stated], and over the last 4 months he had been having frequent abdominal pains following ketamine administration. On examination, he had hypotension, tachycardia, tachypnoea, signs of acute renal failure and abnormal liver function tests. His condition deteriorated and he was admitted to an ICU. He was intubated and underwent continuous haemofiltration and received antibiotics. Renal ultrasound showed bilateral hydronephrosis and bilateral nephrostomies. A toxicology screen was positive for ketamine. He was discharged after 6 weeks. Repeat imaging showed a total resolution of hydronephrosis and absence of any biliary dilatation. He was re-admitted with abdominal pain and abnormal liver function tests 6 weeks later. Ultrasound showed recurrence of common bile duct dilatation, and a urine test was positive for ketamine. His condition improved after endoscopic retrograde cholangiopancreatography. Over the next few months, he experienced further episodes with ketamine use [patient outcome not stated]. A 27-year-old man, who had a 2-year history of ketamine 6 g/day abuse [route not stated], presented with cholestatic liver function tests. He also had a 1-year history of increased urinary frequency and nocturia, and a 7-month history of macroscopic haematuria. Episodes of colicky epigastric pain 4–5 hours after exposure to ketamine were reported. Ketamine had been discontinued 3 weeks prior to presentation. An ultrasound revealed a pre-void bladder volume of 24mL and a post-void volume of 9mL. Cystoscopy showed a red, oedematous and ulcerated bladder mucosa. He required a period of catheterisation, but recovered within a few weeks. Liver tests were not repeated and he was lost to follow-up [patient outcome not stated]. A 26-year-old man, who had a 7-year history of ketamine abuse [route and dosage not stated], presented with a 9-month history of increased urinary frequency, urgency, nocturia and haematuria. Biopsies showed inflammation, and he was managed with long-term catheterisation. Additionally, his liver function tests were persistently abnormal. Further tests were consistent with gallbladder dyskinesia [patient outcome not stated]. Lo RSC, et al. Cholestasis and biliary dilatation associated with chronic ketamine abuse: A case series. Singapore Medical Journal 52: e52-e55, No. 3, Mar 2011 803058118 United Kingdom
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Reactions 30 Jul 2011 No. 1362
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