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Dhillon, B S; Nuttall, M C; Coull, Nadine; O’Brien, Tim

doi:10.1136/bmj.39548.521852.47

Cited by 8 publications

(3 citation statements)

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“…3 In some patients abusing ketamine, long-term irreversible damage leads to renal failure and dialysis. 2,3 The histological finding of papilliary necrosis may be due to direct toxic effect on the papillary medullary cells with consequent ureteric obstruction. Lower tract scarring may also lead to hydronephrosis and renal damage.…”

Section: Discussionmentioning

confidence: 99%

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Can ketamine prescribed for pain cause damage to the urinary tract?

Storr¹,

Quibell

2009

Palliat Med

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and R Quibell Royal Victoria Infirmary, Newcastle upon Presentation of three palliative care patients who were given ketamine as an analgesic and subsequently developed significant and debilitating urological symptoms. In one patient there was resolution of symptoms following cessation of ketamine, but some symptoms persisted until death in the other two. Possible mechanisms for damage to the urothelium by ketamine are suggested.

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Section: Discussionmentioning

confidence: 99%

“…Urological side effects to ketamine have been reported in the last 12 months as an emerging problem amongst the drug user population [1][2][3] and more latterly in a chronic pain patient. 4 Ketamine, an N-methyl-D-aspartic acid antagonist, is used as an analgesic in sub-anaesthetic doses for chronic pain and refractory cancer pain.…”

Section: Introductionmentioning

confidence: 99%

Can ketamine prescribed for pain cause damage to the urinary tract?

Storr¹,

Quibell

2009

Palliat Med

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“…lem amongst the drug user population (25,29,32). Storr and Quibell describe three patients where significant urological symptoms have arisen, possibly as a result of taking ketamine as an analgesic (33).…”

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Ketamine-Induced Urologic Insult (KIUI)

Smith

2010

Pain Phys

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K etamine initially introduced as an anesthetic agent in the 1960s, is a receptor complex antagonist n-methyl-d-aspartic acid that has been used as an anesthetic and/or analgesic for many years. In the past decade the use of ketamine as an analgesic or "analgesic adjuvant" appears to have increased. Subanesthetic doses of ketamine have been utilized for analgesia and opioid-sparing effects in chronic pain as well as in refractory cancer pain, and palliative medicine (1-11). Additionally, recently its use studied seems to have grown for chronic noncancer pain (12,13). Its increased use studied overall has largely been for neuropathic pain and especially for the treatment of refractory complex regional pain syndrome (14-17). Ketamine has also been studied to reduce allodynia in patients with complex regional pain syndrome (18). Different routes of administration have been reported to produce beneficial results such as low-dose intranasal (S)-ketamine in patients with complex regional pain syndrome (18). The mechanism of action has been considered to be mainly a noncompetitive antagonism of the N-methyl-D-aspartic acid (NMDA) receptor [19], however, its mechanisms of action may be extremely complex as ketamine may interact with multiple other receptors (19,20). Ketamine has also been shown to inhibit tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6) gene expressions in lipopolysaccharide (LPS)-activated macrophages (21). It has even been speculated that the antiproinflammatory effects may be responsible for antihyperalgesic effects of ketamine (22). The ketamine molecule contains a chiral carbon atom marking a chiral center. Ketamine can exist in two forms, or enantiomers; S-ketamine and R-ketamine. The physical properties of the enantiomers are identical, but their interactions with complex molecules, underlying PK/PD parameters, might differ (23). The elimination clearance of S-ketamine is more than that of R-ketamine (24). Although anesthesiologists and pain specialists alike are familiar with the classic and common potential adverse effects of ketamine, they may not be as familiar with an increasingly recognized potential association of ketamine that clinicians should be aware of when prescribing ketamine. The observation that ketamine may lead to significant urological side-effects was first recognized in chronic ketamine recreational use (25-27). In the South West of England, Cottrell and colleagues have reported increasing numbers of patients referred to urological services with complications of chronic ketamine use (28). Other cases have been reported in mainland Europe, Canada, Malaysia (26, 29) and the UK (30). Chen and colleagues discovered 4 female patients, ages 18 to 25 years, who presented to emergency department (ED) with urinary urgency, frequency, and pelvic pain, who had negative work-up and no response to antibiotic therapy were diagnosed with presumed interstial cystitis (31). More detailed history revealed that they were recreational ketamine users. Their symptoms significantly i...

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General anesthetics and therapeutic gases

Flockton¹,

Leuwer²

2011

Side Effects of Drugs Annual

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Cited by 8 publications

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Can ketamine prescribed for pain cause damage to the urinary tract?

Can ketamine prescribed for pain cause damage to the urinary tract?

Ketamine-Induced Urologic Insult (KIUI)

General anesthetics and therapeutic gases

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