Ketamine-associated ulcerative cystitis

[leungkachong]

Bad news for the k-tards! I've been in correspondance with one of the authoring urologists of this study. This is also a bit of a local epidemic.

Taken from:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=17482909&query_hl=1&itool=pubmed_docsum

OBJECTIVES: Ketamine hydrochloride is an N-methyl-D-aspartic acid receptor antagonist used as an anesthetic agent in human and veterinary procedures. Increasingly, it is being used as a recreational drug. Recreational ketamine users have anecdotally reported increased lower urinary tract symptoms while using the substance. METHODS: We describe a series of 9 patients, all of whom were daily ketamine users, who presented with severe dysuria, frequency, urgency, and gross hematuria. Investigations, including urine culture, microscopy, and cytology, in addition to computed tomography, cystoscopy, and bladder biopsies, were performed to identify a relationship between recreational ketamine use and these symptoms. RESULTS: The urine cultures were sterile in all cases. Computed tomography revealed marked thickening of the bladder wall, a small capacity, and perivesicular stranding, consistent with severe inflammation. At cystoscopy, all patients had severe ulcerative cystitis. Biopsies in 4 patients revealed epithelial denudation and inflammation with a mild eosinophilic infiltrate. Cessation of ketamine use, with the addition of pentosan polysulfate, appeared to provide some symptomatic relief. CONCLUSIONS: This case series has described a new clinical entity of severe ulcerative cystitis as a result of chronic ketamine use. As illicit ketamine becomes more easily available, ulcerative cystitis and potential long-term bladder sequelae related to its use may be a more prevalent problem confronting urologists.

 

[nanobrain]

i bet the k-tards are pissin themselves...sorry, couldn't help it.

 

[fastandbulbous]

Probably because solutions of ketamine have a low pH for a salt (just over 5 if I recall) and the bladder isn't meant to hold anything outside a very narrow pH range. Drinking lots of water if you're going to do lots of ketamine would go a long way to preventing this, but when has common sense ever impinged on drug use?

 

[General alcazar]

It is more likely the ketamine itself. The amount of acidified solution is minute in a dose of ketamine, so I doubt it would be enough to cause cystitis. More likely it has some kind of direct ulcerative effect on bladder walls. Might be worth taking pyridium or other antiinflammatory with ketamine and of course lots of water. Something to alkalinize the urine would be good too, if urinary pH is a factor (doubtful..).
Maybe ketamine should be reserved for occasional use ?

 

[fastandbulbous]

Well the low pH is the main reason that injections can be painful, and the lining of the bladder is very sensitive, so reduced pH is quite a likely candidate. If it was due to some pharmacological action, then you should also see this in chronic PCP users (which I don't think happens) and other drugs with either NMDA antagonism or sympathiomimetic effects

 

[General alcazar]

NMDA antagonism may not be the mechanism of damage. A pH of 5 alone would be unlikely to ulcerate a bladder though it could cause bladder irritation. More likely there is some other property of the molecule which causes this to happen like inhibition of mucus production of the wall of the bladder. However, unless someone performs a study to elucidate the exact mechanism, it will likely remain a mystery.
As an aside, the chemotherapeutic cytoxan (cyclophosphamide) has a metabolic product, arecolein, which causes cell damage to the bladder wall and can cause a severe necrotizing, ulcerative cystitis. Besides diuresis, the other recommendation is to keep moving so that urine metabolites to not settle onto one part of the bladder and damage it with a higher concentration of the arecolein.
Therefore chronic ketamine users might want to roll over periodically while tripping to keep one wall of the bladder from being damaged more. That and drink a lot of water. Don't inhale the water, though, since ketamine is of course an anesthetic...

 

[vecktor]

this is interesting stuff.
no time to comment right now but thanks for finding it.
V

 

[kidamnesiac]

Drinking a glass of cranberry juice would go much further to acidify your bladder than 100mg of K would. As would grapefruit juice or lemons or a vinaigrette on a salad. Shit, coca-cola is pH ~3 and people drink that by the gallon.
I would say it has more to do with metabolic by-products from that phenyl chloride or purty ketone. But I'm guessing in the dark here as my knowledge of k metabolite is minimal.

Heres another question I've had for a while. Most K is sold in the vial as the HCl salt. However, a friend had a vial of K that listed the ingredient as the base. He had never taken any other K but said this stuff did not seem to effect him like reports he had heard and read and generally made him feel rather crappy after about 1 hour from the 100mg IM dose.
I've discussed this with several trusted sources who say that the salt form or freebase even make no difference when the compound is eaten (as it will become the HCl salt in the gut anyway). I'm wondering if an IM dose of the freebase would provide a qualitatively different experience.
Anyone?

 

[General alcazar]

Possibly due to tissue distribution. It would certainly not salt out in the bloodstream, but should be equally effective - even more so since the molecular weight is lower. BTW, I agree with your first statement that cranberry juice and coke are also acidic, but the body deals with acid in the bloodstream and acidic compounds do not necessarily accumulate in the bladder to an equivalent degree. However, acidic urine is listed as a risk factor for ulcerative cysititis, so it should not be entirely discounted. I think that your theory is correct, though.
Another thing about freebase ket is that it is likely from the 3rd world, and may be of inferior quality...

 

[fastandbulbous]

Actually it'll br norketamine in the bladder, not ketamine and as norketamine is a weaker base (secondary amines are the most basic of the three, primary amines like norketamine the least) it implies that a salt solution will have an even lower pH, all other things being equal.

The acid compounds in cranberry & coca-cola are not excreted but are metabolized to CO2 & water as they act as substrates for entry into the Krebs cycle, so they are not going to result in much more acid urine in comparison

As an aside, the chemotherapeutic cytoxan (cyclophosphamide) has a metabolic product, arecolein, which causes cell damage to the bladder wall and can cause a severe necrotizing, ulcerative cystitis.

Cyclophosphamide is a cytotoxic alkylating agent so any physiological responses to that are almost certainly from it's cytotoxicity and nothing to do with urinary pH changes. Cytotoxicity will cause more than just localized damage

 

[kidamnesiac]

Cranberry juice contains benzoic acid, which is metabolized to hippuric acid and this is pee'd out. It is well established to acidify the urine and is prescribed for OTC treatments of certain urinary tract issues (benzoic acid being anti-microbial). Also great to eliminate amphetamines or other amines from the body when you're finished with them as it acidifies the blood, facilitating the removal of bases.
It's not the carbonation that makes coke so acidic, its the phosphoric acid. This certainly effects the pH of the gastrointestinal tract, whether it effects the bladder I won't speculate on.

I still think that the acid from the injection will rapidly dissolve in muscle and probably eat a little bone before it would end up in the urine. HCl is just another ionic pair that is ubiquitous in the body and will diffuse around and about unless LARGE amounts are injected (100ml of pH 5 material into a 70kg person times 55 mols H2O/kg (3850 Moles of H2O) is infinitesimally small amount of acid). Ketamine and norketamine MUST be sequestered in the bladder (either as a salt probably near pH 7 or even as the freebase) before it is excreted out. K really seems to irritate my monkeys bladders as well, not that they experience too many IM injections.

I also think that there would be a lot more damage to intranasal k users noses if it was the acid causing the problem. However, the argument could be made against the K itself causing it too.

The manufacturing quality issue is also worth considering with a lack of clinical evidence from repetitive use with material of a known quality.

Nobody worry, when they come looking for volunteers to test out that Roche made K, KA will but his urinary tract on the chopping block to insure your continued safety

 

[Ravr]

does method of adminstration matter? sniffing, opposed to injecting...

 

[almost-]

https://rikki.fi/tajkor/bl/Ketamine-associated_ulcerative_cystitis_-_a_new_clinical_entity.pdf

 

[Jamshyd]

As my friend Leung mentioned in the original post, this seems to be something of a local epidemic.

I am inclined to say it might be a cut in the Ketamine. In the past, I've used Ketamine daily for months (albeit in TINY doses) with no ill effects, during and after use. My use included some of the Toronto Ketamine (which is what I assume this article pertains to, correct me if I'm wrong), but the rest was from other sources unrelated to that.

So I wonder whether this is due to a common adultrant used in this area, or if it is due to extreme ease of availability in certain circles (I have seen compulsive IV use of massive ammounts that would make Arnofsky blush!), hence encouraging irresponsible use.

Interesting nontheless. Ketamine is a good diuretic, thats for sure. But even myself, with my somewhat iffy kidneys, have never noticed anything beyond caffeine-like diuresis...

 

[dirtmcgirt]

i used ALOT of mexican K from the fort dodge to tokkyo to anasket over the course of a few yeras and would use pretty heavy for a week, take a week off, use for a couple weeks more nights a week than normal (say 3 100mg IM injects each night i used)....

ive gotten extensive blood work and tests for other problems and my kidneys are fine..... if this is in regards to K that is bought already cooked and perhaps cut with something, maybe it has to do with the cuts?

 

[dr_zoidberg590]

k-pains

After a couple-week ketamine binge, my k-pains which I thought were gone for good (I dont know why I thought this) have come back and they are agony.

It is ulcerative cystitis. I've been using buscopan and ibuprofen for the pain but they help but I'm still in much pain.

I stopped using K when the pain started, does anyone know what else I can do or how long it is likely to last. I've had this before and it lasted like 3 days.

thanks

 

[fastandbulbous]

i used ALOT of mexican K from the fort dodge to tokkyo to anasket over the course of a few yeras and would use pretty heavy for a week, take a week off, use for a couple weeks more nights a week than normal (say 3 100mg IM injects each night i used)....

ive gotten extensive blood work and tests for other problems and my kidneys are fine..... if this is in regards to K that is bought already cooked and perhaps cut with something, maybe it has to do with the cuts?

I got bladder pains from using pure ketamine hydrochloride (I know a person who imports it from an overseas lab), so I doubt it's anything to do with any cuts (although I did know of a speed dealers years ago who cut speed with the white crust that forms around car batteries as 'the more it stung when snorted, the better it was' 8). He was a used car dealer as well!).

Not dicksizing, but that's not a lot; I would go on binges where I'd use every day for several weeks and each day would consume in excess of 1g a day via IM route. The bladder pain was a big consideration in making me quit using ket

 

[phase_dancer]

(although I did know of a speed dealers years ago who cut speed with the white crust that forms around car batteries as 'the more it stung when snorted, the better it was' .

What, lead sulphate!? Hope no one bought up big with that one 8(

 

[fastandbulbous]

Luckily lead sulphate is insoluble. If car batteries used nitric acid (lead nitrate), there's have been a spate of lead poisoning in NE England!

 

[phase_dancer]

I suppose the speed would have been amph sulfate, but I wonder if it had been a HCl salt would there have been potential for lead poisoning, as PbSO4 is somewhat soluble in dilute HCl