Ketamine and Urology

Case: 77-year-old patient has been in ICU intubated due to severe community-acquired pneumonia for the last 2 weeks. The patient was unable to tolerate propofol, dexmedetomidine, or benzodiazepine infusions either due to exaggerated response or reports of allergy. Finally, ketamine infusion appears to work well with the patient. On the 12th day of infusion, it is noted that the patient's BUN and creatinine are rising, and the urine bag shows signs of hematuria. What is your concern?

Answer: Urologic injury 

Ketamine causes irritation of the urologic system. In an unintubated patient, it includes symptoms of urge incontinence, decreased bladder compliance, decreased bladder volume, detrusor overactivity, and hematuria. In an intubated patient, as the patient is sedated and may not be able to complain, it progressively leads to hydronephrosis or papillary necrosis, eventually leading to renal failure. 

Patients who develop concomitant liver injury may have worse outcomes. It is a serious complication as ketamine-induced uropathy can be a permanent injury. 

Ketamine abuse (with a mushroom of ketamine inhalation bars in various parts of the world), a large number of erectile dysfunction is reported among chronic male users.

#pharmacology

#nephrology

#toxicology

References:

1. Shahani R, Streutker C, Dickson B, Stewart RJ. Ketamine-associated ulcerative cystitis: a new clinical entity. Urology 2007; 69:810. 

 2. Middela S, Pearce I. Ketamine-induced vesicopathy: a literature review. Int J Clin Pract 2011; 65:27. 

 3. Suppiah B, Vicknasingam B, Singh D, Narayanan S. Erectile Dysfunction among People Who Use Ketamine and Poly-Drugs. J Psychoactive Drugs 2016; 48:86. 

 4. Yang SS, Jang MY, Lee KH, et al. Sexual and bladder dysfunction in male ketamine abusers: A large-scale questionnaire study. PLoS One 2018; 13:e0207927. 

5. Ou SH, Wu LY, Chen HY, et al. Risk of Renal Function Decline in Patients with Ketamine-Associated Uropathy. Int J Environ Res Public Health 2020; 17.