Severe Rhabdomyolysis With Stage 3 Acute Kidney Injury After Ayahuasca Use Managed Without Renal Replacement Therapy: A Case Report

Ayahuasca, a brew containing N,N-dimethyltryptamine (DMT) with monoamine oxidase-inhibiting β-carbolines, has expanded from traditional use to global retreats. Reported adverse effects include vomiting, agitation, serotonin toxicity-like syndromes, and cardiovascular events. Rhabdomyolysis has been described with other classic hallucinogens (e.g., lysergic acid diethylamide and psilocybin), but, to our knowledge, an ayahuasca-associated rhabdomyolysis case has not been previously reported. Our case is of a previously healthy man who ingested ayahuasca and undertook prolonged travel before presenting with diffuse myalgias and dark urine. Initial laboratory results showed creatine kinase (CK) at 110,659 IU/L, serum creatinine (Cr) at 6.8 mg/dL, and blood urea nitrogen (BUN) at approximately 95 mg/dL. Comprehensive hospital toxicology screens were negative for non-prescribed substances. Despite early treatment, Cr rose to 13.6 mg/dL (hospital day 7), with BUN peaking at approximately 130 mg/dL, consistent with severe acute kidney injury (AKI). CK declined rapidly with care, reaching <1,500 IU/L by day 9 and 730 IU/L by day 11. There was no clinical evidence of compartment syndrome. The patient received guideline-concordant management with high-volume isotonic fluids, electrolyte monitoring and correction, avoidance of nephrotoxins, and Intensive Care Unit (ICU) observation. Kidney function began to downtrend after the Cr peak but remained impaired at discharge, with nephrology follow-up arranged. This case highlights a plausible multifactorial pathogenesis: catecholaminergic surge and hyperactivity from a serotonergic psychedelic, combined with dehydration and questionable circumstances, culminating in profound rhabdomyolysis and AKI. Recognizing plant-based hallucinogen exposure is critical when evaluating unexplained CK levels that are more than five times the upper limit of normal. Our patient's trajectory - CK normalization preceding delayed renal recovery - mirrors classic myoglobinuric AKI. Clinicians should consider ayahuasca and other serotonergic hallucinogens when assessing rhabdomyolysis, anticipate renal complications, and institute early, aggressive fluid resuscitation and nephrotoxin avoidance. While rhabdomyolysis is recognized with other hallucinogens, this case suggests ayahuasca may carry similar or synergistic effects.