Effect of Catha edulis and Atorvastatin on Electrolyte Imbalance: An Experimental Study

Background: Chewing the leaves of Catha edulis, commonly known as khat, is a habitual practice embraced by individuals across various societal strata in Yemen and East Africa. The interaction of medications used to treat chronic diseases with khat has not been adequately studied, particularly in relation to electrolyte imbalances. Therefore, this study aimed to investigate the effect of khat extract and atorvastatin, either alone or in combination, on electrolyte imbalance in a rat model. Methods: Khat was extracted by the methanolic extraction protocol. A total of 24 healthy albino rats were randomly divided into four groups of six rats: control group, khat extract-treated group, atorvastatin-treated group, and khat plus atorvastatin-treated group. All drugs were administered orally using a metal gavage needle from day 1 to 28, and body weight was measured weekly. Blood samples were collected from the tail vein to measure serum levels of sodium, potassium, chloride, calcium, and ionized calcium. The mean values of body weight and serum electrolytes were compared using appropriate statistical tests. Results: On day 28, the mean body weights of rats treated with khat plus atorvastatin (153.17±30.30), atorvastatin (155.67±19.53) and khat extract (194.17± 26.73) were significantly lower than the mean body weight of the control group (246.50±39.73). In addition, significantly higher mean serum sodium levels (mmol/L) were observed in rats treated with khat extract (157±2.22), atorvastatin (161±7.21) and khat plus atorvastatin (167±4.14) compared to the control group (139±1.71). However, there were no statistically significant differences in the mean serum potassium levels (mmol/L) in rats treated with khat extract (5.07±0.33), atorvastatin (5.21±.036) and khat plus atorvastatin (5.48±0.68) compared to the control group (4.66±0.39). Regarding serum chloride, significantly higher mean levels (mmol/L) were observed in rats treated with khat extract (111±5.49), atorvastatin (114±3.31) and khat plus atorvastatin (120±2.64) compared to the control group (99±1.77) on day 28. However, significantly lower mean serum calcium and ionized calcium levels (mmol/L) were observed in rats treated with atorvastatin (2.68±0.16 and 1.24±0.09, respectively) and khat plus atorvastatin (2.61±0.10 and 1.23±0.05, respectively) compared to the control group (2.82±0.09 and 1.37±0.08, respectively). Conclusion: Khat and atorvastatin alone or in combination can reduce body weight and potentially induce hyper­natremia, hyperchloremia and hypocalcemia, with no obvious effects on serum potassium levels in the rat model. Therefore, clinicians should be aware of these electrolyte imbalances induced by khat and statins in people who chew khat. Clinical studies are needed to better understand the mechanisms behind these effects and to determine the extent of risk in the human population.