Iatrogenic Propylene Glycol Intoxication Due to High-Dose Pentobarbital for Refractory Intracranial Hypertension: A Case Report

Abstract

Propylene glycol is a rarely reported toxicity from high-dose administration of certain intravenous drugs, including lorazepam and pentobarbital. We present a case of iatrogenic propylene glycol toxicity secondary to a high-dose pentobarbital infusion for the treatment of refractory intracranial hypertension due to cerebral venous sinus thrombosis. The patient developed metabolic acidosis and acute kidney failure secondary to propylene glycol toxicity. After initiation of continuous renal replacement therapy, the patient’s acute renal failure and lactic acidosis resolved. Using the Naranjo scale, this case received a score of 5, defining it as a “probable” adverse drug event. In patients who develop lactic acidosis and acute renal failure after initiation of high-dose pentobarbital, propylene glycol toxicity should be higher up in the differential diagnosis. Monitoring the serum osmolality while on pentobarbital could help provide valuable information to prevent iatrogenic propylene glycol toxicity.

UHPLC-Q-Orbitrap-Based Integrated Lipidomics and Proteomics Reveal Propane-1,2-diol Exposure Accelerating Degradation of Lipids via the Allosteric Effect and Reducing the Nutritional Value of Milk

“…Excessive absorption will cause the accumulation of lactic acid in blood and the kidney and result in poisoning symptoms such as shock, low heart rate, and slow breathing. All these toxic symptoms had been documented in both animals and humans. − The variation of substances in the milk system caused by PD exposure is uncharted, and the key indicators to evaluate the adverse risks of PD in dairy products are elusive. Therefore, it is crucial to improve the quality of milk to explore the interaction mechanism between PD and milk and the potential threat to health.…”