Chronic Ketamine Abuse Associated with Cholestasis and Cholangitis: A Case Report

Abstract

Ketamine is an anesthetic drug that has been used in clinical settings since the 1960s. Unfortunately, this medication has been abused as a recreational drug among partygoers and youth over the last 30 years. Recently, mounting of evidence has shown the association between chronic ketamine abuse and urinary tract complications. However, not many are aware that chronic ketamine abuse may also be responsible for cholestasis and cholangitis. We report a case of urinary tract complication from chronic ketamine abuse in combination with cholestasis, cholangitis, and early liver cirrhosis related to the drug. Public awareness about ketamine abuse and its complications should be communicated. Physicians should have a high index of suspicion for ketamine abuse in someone presenting with lower urinary tract symptoms along with jaundice, abdominal pain, and abnormal liver function.rectal examination and other systemic examinations were unremarkable. His urine analysis showed the presence of leukocytes and a mild trace of blood.An ultrasound of the abdomen showed bilateral mild to moderate hydronephrosis and hydroureter with no evidence of urinary stones. Cystoscopy examination revealed features of urethritis and cystitis. Renal computed tomography (CT) showed features of right pyelonephritis and bilateral obstructive uropathy, with no apparent cause identified (Figure 1). On the CT scan, there was mild intrahepatic duct dilation with no apparent distal obstruction. The renal profile was mildly deranged (urea: 14.1 mmol/L; sodium: 129 mmol/L; potassium: 3.2 mmol/L; creatinine: 136 µmol/L).The patient was treated for urosepsis with bilateral obstructive uropathy. Intravenous antibiotics were started, and his condition initially improved. Since the patient also had elevated alkaline phosphatase (ALP: 1032u/L) and total bilirubin (TB: 51 µmol/L), he was referred to the hepatology team for further investigation, but the patient refused.