Chronic ketamine use can cause sphincter of Oddi dysfunction (SOD), leading to hepatobiliary complications such as cholestasis, biliary sepsis, and even death. A case of a 29-year-old woman with upper abdominal pain from SOD due to chronic ketamine abuse is presented. Ketamine induces SOD by activating muscarinic receptors in the sphincter of Oddi, obstructing or impairing bile and pancreatic ducts. Taking a detailed substance abuse history is crucial for early identification of ketamine-induced SOD. Early treatment can prevent permanent liver and pancreas damage.
MDMA and cocaine can cause rhabdomyolysis that begins suddenly, but delayed-onset rhabdomyolysis also occurs and its underlying mechanisms are concerning. Early treatment improves outcomes; patients with such cases should be quickly transferred to and treated in hospitals with intensive care and kidney replacement therapy capabilities.
A 42-year-old patient with severe treatment-resistant depression and psychiatric comorbidities attempted suicide five weeks after hospital admission. After starting dextromethorphan/bupropion, her mood improved and suicide risk decreased, allowing discharge.