Dialysis-Requiring Acute Kidney Injury Secondary to Severe Rhabdomyolysis in a Recreational Ketamine User.

Authors

Jon Owen, Noel Fernando

Published in

Cureus. Volume 18. Issue 6. Pages e111521. Epub Jun 25, 2026.

Abstract

Ketamine misuse is increasingly implicated in significant urological morbidity, most notably ulcerative cystitis and progressive bladder fibrosis. Rhabdomyolysis represents a less frequently recognised complication but carries the potential for life-threatening electrolyte derangement and acute kidney injury (AKI). We report a man in his mid-20s with heavy recreational ketamine use presenting after collapse with severe hyperkalaemia (8.2 mmol/L), marked rhabdomyolysis (peak creatine kinase ~40,000 IU/L), and stage 3 AKI requiring continuous venovenous haemodiafiltration (CVVHDF). Clinical management was further complicated by ketamine-associated bladder dysfunction, which precluded urethral catheterisation. This case study gives an overview of a patient who presented with a number of unusual features: severe ketamine-associated rhabdomyolysis, dialysis-requiring AKI, and complex electrolyte management on a background of established uropathy. We propose that renal failure was principally attributable to myoglobin-mediated acute tubular injury arising from rhabdomyolysis, potentiated by dehydration, prolonged immobilisation, sympathetic overactivity, and impaired urinary clearance.

PMID:
42504375
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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