key: cord-1030408-37kma80y
authors: Mallet, Vincent
title: Intravenous ketamine is a risk factor for jaundice in Covid-19 patients
date: 2021-06-24
journal: J Hepatol
DOI: 10.1016/j.jhep.2021.06.024
sha: a4d8c1d6e5bac5798163bb35bdb443ddf11ee3b7
doc_id: 1030408
cord_uid: 37kma80y

nan

In their reply to our initial report, (1) Deltenre, Moreno and Trepo (2) postulated that vasculobiliary injuries could have contributed to our cases of Covid-19 cholangiopathies, which is, undeniably, a possibility. However, critical care vasculobiliary injuries are associated with haemodynamic instability and hepatic ischemia. In our series, the maximum serum lactate level remained, in three out of five patients, below 2.5 mmol/L, which rules out shock and tissue, including hepatic, hypoperfusion. In another series of 12 patients with patient, and categorized as > median ("higher") and ≤ median ("lower") drug consumptions.

The sample comprised 2,258 [mean (standard deviation) age 60 (13); 73% men] patients.

Their characteristics, overall and by ketamine consumption are presented in the supplementary table. Patients in the lower ketamine group were older (P = 0.043), and were more severe, in terms of comorbidities (P < 0.001) and of initial serum C-reactive protein J o u r n a l P r e -p r o o f level (P = 0.045). Sex, maximum serum creatinine level, and mortality were similar between lower and higher ketamine patient group. The mean (standard deviation) maximum total serum bilirubin level was 19 (24) and 17 (20) µmol/L in the higher and lower ketamine groups, respectively (P=0.016). Other surrogates of the intensive care effort, including higher consumptions of midazolam (P=0.025) and of propofol (P=0.62), were not associated with higher levels of total serum bilirubin (see figure) . Therefore, ketamine was associated with jaundice in this cohort. Whether ketamine-associated jaundice contributed, or not, to organ failure is unknown and should be investigated. The guidelines for maintenance sedation of patients with acute respiratory distress syndrome (ARDS), regardless of Covid-19, include ketamine as a second-line agent. We think that clinicians should refrain from using ketamine to sedate ARDS patients, including those with Covid-19. If cornered to such a prescription, a short-term period and a close monitoring of bilirubin is mandatory. 

Intravenous ketamine and progressive cholangiopathy in COVID-19 patients

Progressive cholangiopathy in Covid-19 patients: Other possible diagnoses than ketamine-induced cholangiopathy should be considered

Cholangiopathy After Severe COVID-19: Clinical Features and Prognostic Implications

Ketamine-Induced Sclerosing Cholangitis (KISC) in a Critically Ill Patient With

Secondary sclerosing cholangitis as cause of persistent jaundice in patients with severe COVID-19