Propylene Glycol‐Associated Renal Toxicity from Lorazepam Infusion

Abstract

The patients' increased serum creatinine concentrations are likely to have resulted from exposure to propylene glycol as a result of lorazepam infusion. Serum osmolality and osmol gap may be useful markers for propylene glycol toxicity.

Positive Propylene Glycol Result in a Patient with Ethylene Glycol Poisoning

“…PG is also a solvent in many pharmaceuticals. Intravenous infusion of large amount of medications that use PG as a vehicle can cause PG poisoning (3)(4)(5). In our case, consumption of antifreeze led to the initial positive EG result, and the phenytoin treatment and a subsequent high-dose lorazepam infusion, both which contained PG, led to the positive PG result.…”

“…In our case, consumption of antifreeze led to the initial positive EG result, and the phenytoin treatment and a subsequent high-dose lorazepam infusion, both which contained PG, led to the positive PG result. This substance is less toxic than EG; however, poisoning cases associated with overdose of medications with PG as diluent have been described (3)(4)(5) …”

Propylene Glycol Toxicity Complicating Use of Barbiturate Coma

“…Early manifestations of propylene glycol toxicity include hyperosmolarity and lactic acidosis [16,19,20], but patients may progress to develop refractory hypotension [23], arrhythmias [27], hemolysis [22], renal dysfunction [26,28], and multi-organ failure. These features may erroneously be attributed to the direct effects of the drug or the systemic inflammatory response syndrome.…”

“…However, the serum osmolar gap has been demonstrated to correlate with propylene glycol concentration in a linear fashion, such that it can be used as a surrogate [19,28]. Elevated propylene glycol levels may develop after only 48 h of high-dose lorazepam infusion, and careful monitoring of the osmolar gap has been recommended [19,20].…”

Hyperosmolar, increased-anion-gap metabolic acidosis and hyperglycemia after etomidate infusion

“…Hepatic and renal insufficiency may accelerate the development of propylene glycol toxicity. An association also has been observed between increase in serum creatinine concentration and duration of lorazepam therapy [11], and it may be due to proximal renal tubular injury caused by propylene glycol [6]. Accumulation of lactic acid is the cause of the increasedanion-gap acidosis.…”