Ketamine Crisis: Case Report on the Complications of Ketamine Usage and Its Rise in the United States

The recreational use of ketamine poses various health risks, including addiction, cognitive impairments, and physical harm. The patient is a 24-year-old female who presented with 30 lbs. unintentional weight loss, generalized weakness, and urinary incontinence over four months. She endorses right upper quadrant and suprapubic pain with occasional gross hematuria. The patient denied recreational drug use. Urine drug screen was negative. Gynecologic exam and STI testing were without concerns. On exam, she had positive right lower quadrant tenderness, suprapubic tenderness, and costovertebral angle tenderness bilaterally. The patient was admitted to the ICU due to weakness and significant hyponatremia at 115. She was treated symptomatically, started on Zosyn for UTI, normal saline for hyponatremia, calcium bicarbonate and insulin for hyperkalemia. CT abdomen and pelvis showed striated perinephric fat stranding, cholangitis, and pyelonephritis with right sided hydronephrosis. Admission of intranasal ketamine use was documented. The patient was able to tolerate PO intake and lab values returned to normal. Unfortunately, urinary function has delayed recovery after stopping ketamine use. It is unusual to see this collection of symptoms present in one person. The full constellation of symptoms that are associated with ketamine usage in this case are: anxiety, cholangitis, hydronephrosis with pyelonephritis and urinary incontinence, loss of taste, weight loss, euvolemic hyponatremia, hyperkalemia. This case illustrates the importance of appropriate testing in the circumstance of an unreliable narrator in patient care. There are no current established guidelines regarding ketamine toxicity management.