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Drug-induced (secondary) sclerosing cholangitis has recently been observed with a number of agents (1). Ketamine is a remarkably safe anesthetic, providing sedation and analgesia as adjunct to or substitute for more traditional sedative medications. Although prior reports of recreational ketamine abuse have been associated with findings of secondary sclerosing cholangitis (SSC; 2,3), we report here a novel presentation of the syndrome in association with prolonged ketamine use in the intensive care unit.The cathepsin K (CatK) enzyme is a
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