Ketamine plus Alcohol: What We Know and What We Can Expect about This

Kobayashi, Natália Harumi Correa; Farias, Sarah Viana; Luz, Diandra Araújo; Machado-Ferraro, Kissila Márvia; Conceição, Brenda Costa da; Silveira, Cinthia Cristina Menezes da; Fernandes, Luanna Melo Pereira; Cartágenes, Sabrina de Carvalho; Ferreira, Vânia Maria Moraes; Fontes-Júnior, Enéas Andrade; Maia, Cristiane do Socorro Ferraz

doi:10.3390/ijms23147800

Cited by 8 publications

(3 citation statements)

References 189 publications

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“…In animal studies, ketamine has also been shown to induce hepatic CYP enzymes [ 11 , 12 ], including CYP2E1 which may potentiate toxicities from other medications such as ethanol and acetaminophen by increasing the concentration of their toxic metabolites [ 13 , 14 ]. The coingestion of ketamine with alcohol has been shown to increase the risk of hepatotoxicity [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation

Yoo,

Thomas,

Bender

et al. 2024

Case Reports in Critical Care

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Ketamine, initially developed as an anesthetic, has shown versatility in medical applications, including pain management, treatment-resistant depression, and sedation in the intensive care unit (ICU). While generally well-tolerated, long-term use at high doses raises concerns about potential toxicities, particularly in the liver. We present a case of a 27-year-old female with a complex medical history who received ketamine infusion for ICU sedation and experienced a sudden rise in liver function tests (LFTs), indicating possible ketamine-induced liver injury (KILI). The patient’s liver function normalized after ketamine discontinuation. KILI is infrequent with short-term ketamine use, but emerging case reports suggest it may be associated with chronic or intermittent exposure. The underlying mechanisms for KILI are not fully understood but may involve the accumulation of ketamine metabolites, causing direct toxic effects on the liver. As ketamine’s use expands, especially in critical care settings, clinicians should be vigilant for the potential development of KILI. Further research is needed to better understand its risk factors and mechanisms, as early detection and management of KILI are crucial to ensuring patient safety and optimizing ketamine’s therapeutic benefits.

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Section: Discussionmentioning

confidence: 99%

A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation

Yoo,

Thomas,

Bender

et al. 2024

Case Reports in Critical Care

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show abstract

“…The patients involved in this review were rather young, which can be explained by the recreational nature of the ketamine abuse. Concomitant alcohol abuse is quite common in ketamine abuser population and can be up to 25% [ 28 ]. Due to the possible cytotoxic effect of ketamine on urothelium, patients often experience urinary symptoms [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Features of biliary tract diseases in ketamine abusers: a systematic review of case reports

Teymouri,

Nasoori,

Fakheri

et al. 2024

J Med Case Reports

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Background and aims Anesthesiologists prefer ketamine for certain surgeries due to its effectiveness as a non-competitive inhibitor of the N-methyl-D-aspartate receptor in the brain. Recently, this agent has also shown promise as an antidepressant. However, ketamine can cause hallucinogenic effects and is sometimes abused as an illicit drug. Ketamine abuse has been associated with liver and bile duct complications. This systematic study aims to better understand cholangiopathy in ketamine abusers by reviewing case reports. Methods and material In this systematic review, a comprehensive literature search was conducted with the terms “biliary tract diseases” and “ketamine”. Case reports and case series of adult patients with documented ketamine abuse and reported cholangiopathy or biliary tract disease were included. We extracted the data of relevant information and the results were reported through narrative synthesis and descriptive statistics. Results A total of 48 studies were initially identified, and 11 studies were finally included in the review. The mean age of the patients was 25.88 years. Of the 17 patients, 64.7% were men. Symptoms often included abdominal pain, nausea, and vomiting. Most patients were discharged with improved symptoms and liver function. Common bile duct dilation and other findings were observed in imaging results and other diagnostic studies. Conclusion This review highlights the diverse presentations and diagnostic modalities used in ketamine-induced cholangiography. These patients tend to be young men with deranged liver function tests and abdominal pain, which should be taken into consideration. These patients often require a multidisciplinary approach in their management.

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“…Inhibition of NMDA receptors on GABAergic interneurons leads to disinhibition and activation of AMPA receptor pathways [31]. The pleiotropic nature of ketamine [32] is evident in this study by the different fits provided by its minimum energy conformer on the GTP template, which include those characteristic of SERT, glycine, GABA, NMDA, kainate and AMPA ligands (see Williams 2018, Figure 2) [33]. The wide spectrum of effects on cells produced by low ketamine concentrations, including oxidative stress and apoptosis, is of some concern in the clinical context [34].…”

Section: Discussionmentioning

confidence: 99%

Nucleotide Contribution to the Functioning of SERT, Na<sup> </sup>/K<sup> </sup> ATPase and GPCR Proteins

Williams

2024

JBM

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Purine nucleotides are crucial for the effective operation of cell membrane proteins maintaining the neurotransmitter responses of 5-HT. Major protein targets in the treatment of depression include SERT, N/K ATPase and GPCR. Each protein target is responsive to a specific complement of drugs: antidepressants (SERT), lithium and cardiogenic steroids (N/K ATPase), 5-HT receptor ligands (GPCR). Computational software is useful for comparing molecular similarity within ligand-ligand and ligand-nucleotide structures. Previous studies demonstrate that GPCR ligands of different pharmacologic classes display relative molecular similarity to nucleotide structures. The current study applies this methodology to compound structures modulating SERT and N/K ATPase receptors. Minimum energy conformers of SERT antagonists demonstrate relative molecular similarity to the structural template of GTP nucleotide. GTP template fits of 5-HT and psilocin are similar, whereas a SERT-like fit is one of several for the ketamine structure. Endogenous and pharmaceutical modulators of Na/K ATPase relate to adenine nucleotide. The fits of cardiogenic steroids to a cGMP template demonstrate similarities and differences between compounds. Relative molecular similarity within the structures of hormones, drugs and nucleotides has implications for neurotransmitter transport and cell signal transduction processes.

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Ketamine plus Alcohol: What We Know and What We Can Expect about This

Cited by 8 publications

References 189 publications

A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation

A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation

Features of biliary tract diseases in ketamine abusers: a systematic review of case reports

Nucleotide Contribution to the Functioning of SERT, Na<sup> </sup>/K<sup> </sup> ATPase and GPCR Proteins

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Ketamine plus Alcohol: What We Know and What We Can Expect about This

Cited by 8 publications

References 189 publications

A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation

A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation

Features of biliary tract diseases in ketamine abusers: a systematic review of case reports

Nucleotide Contribution to the Functioning of SERT, Na&lt;sup&gt; &lt;/sup&gt;/K&lt;sup&gt; &lt;/sup&gt; ATPase and GPCR Proteins

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Nucleotide Contribution to the Functioning of SERT, Na<sup> </sup>/K<sup> </sup> ATPase and GPCR Proteins