Content area
Full text
Ketamine is a general anesthetic agent commonly used in pediatric patients, especially for neurosurgery and for surgeries requiring cardiopulmonary bypass (1). Ketamine can produce a dissociative state and hallucinations and therefore is not commonly used in adult anesthetic practice. Because of the hallucinatory effects of the drug, recreational ketamine abuse has been increasingly reported in recent years. Chronic ketamine abuse can damage many body organs (1, 2). We report a patient with chronic ketamine abuse who presented with severe cachexia, upper gastrointestinal involvement, hepatobiliary dysfunction, and acute kidney injury.
CASE PRESENTATION
A 59-year-old man presented to the emergency department with vomiting, lower abdominal pain, dysuria, and urinary incontinence of 5 days duration. For several months he had a poor appetite and dyspepsia, and he had gradually lost weight. He was known to have chronic obstructive airway disease and enlarged kidneys detected by an ultrasonographic study. He had a 40 pack-year history of smoking, consumed about 20 units of alcohol (1 unit = 10 mL of pure alcohol) weekly, and inhaled ketamine powder intranasally almost every day for about 3 years. He lived alone and was not sexually active in the immediate past.
On examination he looked dehydrated and cachectic, and his sclerae were mildly icteric. His body mass index was 14.5 kg/m2 and his blood pressure, 90/60 mm Hg. Biochemical and hematological laboratory results are shown in . The electrocardiograph and chest radiograph did not show any abnormalities. An abdominal ultrasonographic study revealed bilateral hydronephrosis and hydroureter, hypoechoic liver with periportal hyperechogenicity, and mild dilatation of the common bile duct. The urinary bladder wall was thickened with increased trabeculations. A computed tomographic scan of the abdomen without contrast revealed a full distended stomach (), bilateral hydronephrosis () and hydroureter, and a thickened urinary bladder wall (). The bladder was contracted.
[Figure omitted, see PDF]
Figure 1.
Table 1.
The patient was initially managed with intravenous hydration, thiamine, and continuous urinary drainage through an indwelling catheter. Esophagogastroduodenoscopy showed grade 3 esophagitis and mild gastritis. The histology from the esophageal mucosa revealed only chronic inflammatory changes. A magnetic resonance cholangiopancreatography showed mild...