Health - 'Street ketamine'–associated bladder and kidney dysfunction: a report of 10 cases

[Niteflights]

SWIM has realized what may be an important factor in ketamine related kidney disfunction. Once many moons ago SWIM had a daily IM ketamine habit that lasted for several months. Although SWIMs health was not the best, no cramps or serious pains were noted.

A couple of years later, SWIM had a sabbatical and engaged in a 3 month daily ketamine binge, however this time was with nasal administration, as SWIM decided to avoid needles.

After the 3 months daily nasal use SWIM had definite strong cramps and impaired bladder function. Since then, after a couple years of abstinence and careful diet with herbal liver tonics, SWIM seems back to normal. Had SWIM continued daily use after 3 months he has no doubt he would have ended with major permanent kidney and liver damage.

Seeing as John Lilly as well as several others have used IM ketamine heavily for years without reporting cramps or kidney dysfunction, SWIM suspects that IM route may prevent most of the damage to the vital organs.

regards
andrei

[enquirewithin]

Originally Posted by Niteflights

Seeing as John Lilly as well as several others have used IM ketamine heavily for years without reporting cramps or kidney dysfunction, SWIM suspects that IM route may prevent most of the damage to the vital organs.

Good point-- had wondered about that. Neither Moore nor Lilly, the pioneers of ketamine abuse (!), reported these problems. Lilly would have mentioned it. This is anecdotal rather than scientifically recorded but it may be that ketamine when sniffed drips into the stomach and that causes the problems?

[ThirdEyeFloond]

Originally Posted by enquirewithin

Good point-- had wondered about that. Neither Moore nor Lilly, the pioneers of ketamine abuse (!), reported these problems. Lilly would have mentioned it. This is anecdotal rather than scientifically recorded but it may be that ketamine when sniffed drips into the stomach and that causes the problems?

SWIM primarily used the IM route, and so did his friend, he is familiar with another case here where the user mainly used it nasally, so administration route doesn't seem to play a key factor. As far as SWIM remembers, Lilly redosed continuosly with 50mg increments, which may be less harmfull than doing +600mg at a time.

[enquirewithin]

Originally Posted by ThirdEyeFloond

SWIM primarily used the IM route, and so did his friend, he is familiar with another case here where the user mainly used it nasally, so administration route doesn't seem to play a key factor. As far as SWIM remembers, Lilly redosed continuosly with 50mg increments, which may be less harmfull than doing +600mg at a time.

So he said. It seems hard to believe that he really kept to that dosage. He does describe incidents where he took more. Perhaps he found out that with ketamine less is more.

[Lettish]

Originally Posted by enquirewithin

Good point-- had wondered about that. Neither Moore nor Lilly, the pioneers of ketamine abuse (!), reported these problems. Lilly would have mentioned it. This is anecdotal rather than scientifically recorded but it may be that ketamine when sniffed drips into the stomach and that causes the problems?

That would be Swim's route of knowledge. Insufflated ketamine is practically ingested and I would assume has some connection to making its way through the digestive system, thus affecting those organs, especially at chronic abuse levels, where a lot of the ketamine probably goes straight down the back of the throat into the digestive system. Whereas, IM will go directly into the blood and not touch any of those organs, accept the kidneys where the blood is cleaned/processed.

Interesting topic.

[jaffacake]

This sounds like the biggest load of antidrug propaganda bullshit I have read since "People who take LSD look at the sun untill they are blind".

Reputation Comments on this post:

Did you read any of the other posts in the thread?

[enquirewithin]

Originally Posted by jaffacake

This sounds like the biggest load of antidrug propaganda bullshit I have read since "People who take LSD look at the sun untill they are blind".

There is an element of propaganda certainly, but the several forum members have complained about "K pains" after long periods of ketamine use, apparently after sniffing rather than injecting it.

[ThirdEyeFloond]

Originally Posted by enquirewithin

There is an element of propaganda certainly, but the several forum members have complained about "K pains" after long periods of ketamine use, apparently after sniffing rather than injecting it.

As stated earlier SWIM and AFOSWIM mainly used ketamine by IM/SC injection and there is case reports on nasal, oral and IM/IV use causing problems so administration route doesn't seem to matter much. The problem is dose-dependent as these two articles also suggest:

A24: Toxic Effects of Ketamine Hydrochloride (VetalarTMV) on Cultures of Marmoset Bladder Epithelial Cells and Whole Rat Bladders In Vitro
D.G. Nemitz1, C. Westmoreland1, E. George1, J. Klapwijk2, and N. Watts1. 1Safety Assessment, GlaxoSmithKline, Ware, UK; 2Tossicologia, Milan, Italy. dgn1384@ask.com.

During pre-clinical safety studies, lesions resembling varying degrees of cystitis occurred in the bladders of the common marmoset in control and treated animals. An adverse reaction to ketamine, routinely used to sedate marmosets prior to electrocardiogram measurements, was considered. In vitro investigations on primary marmoset bladder epithelial cells were carried out as an alternative to an in vivo study using concentrations of ketamine likely to occur in marmoset urine following administration for sedation. Cultures were treated for 24 hours, and cytotoxicity was assessed by morphology, 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) reduction and lactate dehydrogenase (LDH) leakage. Also, whole rat bladders were treated for 6 and 24 hours in vitro to establish if the toxic effect of ketamine was species-specific. Toxicity was assessed microscopically by the degree of urothelial damage. In both in vitro models, significant compound-related toxicity was apparent at concentrations of ketamine that can occur in the bladder in vivo. These in vitro investigations concluded that high concentrations of ketamine hydrochloride in marmoset urine were probably responsible for the lesions seen in marmoset bladders. Lower concentrations have since been administered with no adverse effects.

A Pediatric Case of Ketamine-associated Cystitis (Letter-to-the-Editor RE: Shahani R, Streutker C, Dickson B, et al: Ketamine-associated Ulcerative Cystitis: A New Clinical Entity.
We would like to report the first case of a pediatric
patient who developed cystitis following the use of oral
ketamine as an adjuvant medication for chronic pain.
Our patient, a 16-year-old female with a complex medical
history, developed complex regional pain syndrome
(CRPS–Type I) about 2 years ago. After unsuccessful
trials of multiple medications, oral ketamine was added to
her regimen, and she reported a significant decrease in
her neuropathic pain. The dose was quickly titrated to 8
mg/kg per day. After 9 days on ketamine, she started to
develop dysuria, frequency, urgency, and incontinence.
The urinalysis was normal and the urine culture was
negative. The symptoms decreased after decreasing the
ketamine dose to 6 mg/kg per day and completely disappeared
at 2 mg/kg per day. The ketamine was eventually
stopped following improvement of the CRPS symptoms.
A few months later, as her pain was flaring up again, we
restarted ketamine and the urinary symptoms reappeared
at a dose of 5 mg/kg per day. Similar to the first episode,
the cystitis symptoms stopped after lowering the ketamine
dose to 3 mg/kg per day.

The above articles also suggest that pharmaceutical grade and not just illicit 'street' ketamine can cause the problem.

[serpent]

i wonder if this could be caused by excessive salt intake?6 grams a day seems to be the reccomeneded advice for salt,if your doubling that with ketamine intake,would that acount for the damage?
t.e.f have you noticed any cognitive impairment,memory issues or flashbacks of disasociation?ive had the cramps before,thankfully ive managed to stop using.unfortunately the main factor in my stopping using is that it now fails to effect me at all.all pain and no gain.

[adzket]

swim is a bit worry about this they have not been in k forum for a while as use had fallen to a few times a year but they where in the first group of clubbers to be taking k in the uk in the erly 90's and use built up heavily resently whent on a bender and used 1 ltr in 10 days would of done it quicker if did not have to go out in public. a few friends have symptoms to.

[Niteflights]

SWIM wished the K pains SWIM experienced were propaganda. It was a week of agony when SWIM quit. Bladder function was impaired for at least a year.

SWIM strongly suspects that the quality and purity of the ketamine is related to the problems. Not that it is cut or adulterated, but that the synthesis was of poor quality. As illicit recreational diversion increases from India and China, more of these 2nd rate chemists are jumping the train and making poor grade material. SWIMs seen several batches of "pure" HCL... most where brownish with a heavy odor. The best one USP27 grade was pure fine white crystals like tablesalt. SWIM never noticed any K pains when he took this grade of ketamine even in heroic quantities. But then again the problem is cumulative and by the time you experience symptoms, the damage may be considerable.

This is nothing like the LSD myths. Just check medline there are *LOTS* of peer reviewed clinical studies published on this. What is interesting is the amount of clinical research interest into ketamine. It's rather obvious to SWIM that many researchers would love to get a shipment in for "testing".

An interesting question: Has anyone who has used exclusively injectible ketamine from fresh vials experienced the problems?

[Devilsmile]

There's more truth in this than you realize, swim was injecting ketamine a lot recently and now has sevre pain in his lower back, is urinating every 20 mins and only a few drops and the sevre burning in the tip of his penis, im pretty certain this is kidney stones caused my the crystalization when trying to pass out the ketamine, or maybe a kidney infection, swim is going to hospital today to get xrays and even more bloodtests done...

[enquirewithin]

SWIM has come across anecdotal evidence that K does negatively affect bladder functions too. If use is only occasional (one or twice a week) it is not an issue.

[adzket]

swim has been able to get this more upto date information from the bmj.
:An emerging problem
Urinary tract disease associated with chronic ketamine use.
Regarding the case study by Dhillon et al,1 we have seen an alarming increase in people presenting to urological services in South West England with bladder symptoms associated with chronic ketamine use. Two case series in Hong Kong and Canada have been published, but ketamine associated bladder pathology has not been reported in the UK.2 3

Over the past two years, nine patients have presented to local urologists with symptoms of severe urinary frequency, urgency, macroscopic haematuria, and suprapubic pain. They all had a history of chronic ketamine use, either recreationally or therapeutically for chronic pain. Urine culture results were negative and cystoscopy showed a contracted shrunken bladder with erythema and contact bleeding. Histological examination showed ulcerative cystitis and a severely denuded urothelium.

They were given analgesics and encouraged not to use ketamine. Complications included hydronephrosis and renal impairment. They were treated by nephrostomy and insertion of a suprapubic catheter to . . .
swim unfortunatly does not have full acess till they go back to collage but hope this can point swiys in direction of information.

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Intersting info. Please tell us more when you access to more info.