Ketamine abuse in youngsters linked to kidney damage

Ketamine is a class III scheduled veterinary drug approved for use as an anaesthetic or to induce unconsciousness in a patient. It also possesses the additional ability to relax muscles and relieve pain. Because of its dissociated amnesia effect, it's also known as a "date rape drug." After entering the body, it is processed in the liver and eliminated by the kidneys, with the components present in high amounts in the urine. It's also a hallucinogen, which means it has strong qualities that might lead to erratic behaviour when abused.

In the long run, physical tolerance and dependence on this drug is the most consequential effect of repeated, high-dose ketamine abuse. All of these features make it a good drug for misuse and use among teenagers is on the rise as a result of globalization, notably in Southeast Asia, including India. It's normally taken orally or sniffed; but, it can also be administered intravenously or intramuscularly, which raises the risk of injury to veins, muscles, skin, and internal organs.

Severe side effects of this dissociative drug, such as kidney failure, heart attack, seizures, stroke, or respiratory failure, are more likely to occur. Acute overdosing can also lead to coma and death. Upon prolonged abuse of Ketamine, the byproducts of Ketamine accumulate in the urinary bladder, which results in chronic, usually irreversible damage (in early stages). However, with continued exposure, other complications can pursue such as a small shrunken urinary bladder, hydroureteronephrosis (excess fluid in the kidneys), which is found in 50% of the cases. This inevitably affects the overall functioning of the kidneys.

Symptoms usually include burning micturition, incontinence, increased frequency of urination, and bloody urine. Ulcerative cystitis is a type of painful bladder syndrome marked by damage to the bladder's tissue resulting in chronic, recurrent pelvic pain and ulcers (red, bleeding patches) on the bladder walls. This accounts for about 10% of all cystitis cases, and ketamine abuse increases the risk of developing this condition. According to the Interstitial Cystitis Association, about 33% of people who abuse ketamine experience this condition.

To treat patients who have urinary tract pathology as a result of ketamine use, a multidisciplinary approach is required. Ketamine use must be stopped in order to treat the disease and ensure that the treatment is effective. Medical treatment is mainly symptomatic, which includes pain relievers (apart from anti-inflammatory drugs), blood thinners, and urinary frequency reducing medications. Other classes of medications may be utilized to aid in the restoration of the mucosal bladder wall. Surgical treatment is usually required for late or severe disease, which varies from stenting of the ureters to Neobladder formation with the use of small bowel.

There is a possibility that despite the use of all the above treatments, symptoms may persist, and we may not be able to alleviate it completely. This makes it a point for medical professionals and family members to illicit drug abuse, especially in young individuals with recurrent urinary tract problems.

(The author is Consultant – Nephrology, Fortis Hospitals, Bangalore)