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

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.