Severe Rhabdomyolysis and Acute Kidney Injury Following Ayahuasca‐Related Trauma: A Case Report

A 32-year-old man developed severe rhabdomyolysis and acute kidney injury after ingesting ayahuasca, a hallucinogenic brew. His creatine phosphokinase peaked at 170,329 U/L and creatinine rose to 12.8 mg/dL by hospital day 5. Aggressive intravenous fluids (4-6 liters per day of isotonic saline) and diuretics (bumetanide, metolazone) were used to manage fluid balance. By discharge on day 9, his creatinine had decreased without needing dialysis. Ayahuasca may cause muscle ischemia through vasoconstriction and mitochondrial stress, a distinct mechanism from other causes like cocaine or statins. This case illustrates conservative management that avoided renal replacement therapy.

Study at a glance

Abstract

Background Ayahuasca, a traditional hallucinogenic brew, is a rare but emerging cause of rhabdomyolysis- induced acute kidney injury (AKI). Unlike more common etiologies of rhabdomyolysis, such as cocaine use or statin therapy, these patients may present without positive toxicology or relevant medication history. This case provides clinical insight into how individualized fluid and diuretic management was used to prevent renal deterioration. Case Presentation A 32-year-old male with no significant past medical or family history presented with generalized weakness and muscle pain after ingesting ayahuasca. He was brought to our ED via EMS due to worsening symptoms. He arrived with severe rhabdomyolysis (CPK 170,329U/L), acute kidney injury (initial Cr 6.9mg/dL), hyperkalemia, hyponatremia, transaminitis, and leukocytosis. He was admitted to the ICU for close monitoring and serial labs with an uptrending creatinine of 12.8 mg/dL by hospital day 5. By discharge day 9, his creatinine had decreased without the need for renal replacement therapy. During his stay in the ICU, he received a full workup, aggressive IV fluids (4-6 L/day isotonic saline), and diuretics (bumetanide, metolazone). Discussion This case of severe rhabdomyolysis and kidney injury involved the combined effects of ayahuasca ingestion and an uncertain degree of trauma. Ayahuasca, which contains N,N- dimethyltryptamine and β-carboline alkaloid, can increase sympathetic tone and vasoconstriction, impairing renal perfusion. The association of ayahuasca with severe rhabdomyolysis and AKI appears to be unique in the literature. While rhabdomyolysis from cocaine or statin use can directly cause myotoxic and mitochondrial dysfunction, ayahuasca induces muscle ischemia utilizing different vasoconstrictive and mitochondrial stress mechanisms, suggesting a distinct pathophysiology. The decision to pursue conservative management in this patient provides valuable guidance, especially for centers without specialty services. The patient's non-oliguric status after diuretic challenge with clear urine output was somewhat reassuring, however, renal function could still deteriorate [1]; which further exemplifies the complexity of managing a case like this. Guidelines emphasize the importance of fluid resuscitation and diuretics for the kidneys during the maintenance phase of AKI [2]. This method helped keep fluid balance and contributed to renal recovery without the need for RRT, which may be necessary for refractory hyperkalemia, severe acidosis, or volume overload [3]. With the increasing popularity of recreational ayahuasca use, further research is essential to optimize management strategies for ayahuasca-induced rhabdomyolysis and its long-term effects.