Severe Rhabdomyolysis With Stage 3 Acute Kidney Injury After Ayahuasca Use Managed Without Renal Replacement Therapy: A Case Report.
Arya Kermanshah, Margo Stapleton, Christine M Mauriello, Miguel Cobas, Ivet T Cordoba Torres
Cureus September 17, 2025 DOI: 10.7759/cureus.92568 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A previously healthy man who ingested ayahuasca |
| Intervention | Ayahuasca |
| Topics | Ayahuasca |
| Keywords | Ayahuasca side effects Ayahuasca toxicity Ayahuasca risks Kidney failure Renal dysfunction Kidney damage Renal impairment Rhabdomyolysis muscle breakdown Muscle injury Myopathy Muscle damage Severe muscle breakdown Clinical intervention Patient care Treatment success Full recovery |
| Citations | 1 |
| Key findings | The authors report the first known case, to their knowledge, of ayahuasca-associated rhabdomyolysis with severe acute kidney injury, with creatine kinase peaking at 110,659 IU/L and creatinine rising to 13.6 mg/dL. They propose a multifactorial pathogenesis involving serotonergic hyperactivity, dehydration, and other circumstances, and suggest clinicians should consider ayahuasca and other serotonergic hallucinogens when evaluating unexplained rhabdomyolysis. |
Abstract
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.
Comparable studies
Other case reports and case series on ayahuasca, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| A fatal intoxication following the ingestion of 5-methoxy-N,N-dimethyltryptamine in an ayahuasca preparation. 25-year-old white male | 2005 | Case study | n = 1 |
| The Diaspora of Brazilian Religions | 2013 | Ethnographic case studies | |
| EEG Gamma Coherence and Other Correlates of Subjective Reports During Ayahuasca Experiences Experienced ayahuasca users | 2005 | Exploratory case series | n = 2 |
| Reply to “Ayahuasca turned on my mind’s eye”: A case of acquired versus congenital aphantasia, as evidenced with DMT use? Individual with apparent congenital aphantasia | 2018 | Case study | n = 1 |
| “Ayahuasca turned on my mind’s eye”: Enhanced visual imagery after ayahuasca intake in a man with “blind imagination” (aphantasia) A man self-diagnosed with long-lasting aphantasia | 2018 | Case study | n = 1 |
Citations in the library
Cites 3
- Ayahuasca: Pharmacology, neuroscience and therapeutic potential Brain Research Bulletin March 11, 2016
- Ayahuasca and Its DMT- and β-carbolines – Containing Ingredients Block the Expression of Ethanol-Induced Conditioned Place Preference in Mice: Role of the Treatment Environment Frontiers in Pharmacology May 29, 2018
- Ayahuasca and the traveller: A scoping review of risks and possible benefits Travel Medicine and Infectious Disease November 1, 2021