Lorazepam
1
Reactions 1309 - 10 Jul 2010 S Lorazepam Osmolar gap metabolic acidosis in an elderly woman associated with propylene glycol excipient: case report A 67-year-old woman developed osmolar gap metabolic acidosis during continuous sedation with lorazepam containing propylene glycol; high anion gap metabolic acidosis was also present (double gap metabolic acidosis). The woman presented with pneumonia, progressing to acute respiratory failure. To allow ventilation, she received sedation with a continuous IV infusion of lorazepam titrated to 10 mg/h. Each 2 mg/mL vial of lorazepam contained 10.9 mmol/L of propylene glycol. After five days she developed high anion gap metabolic acidosis, with blood as low as pH 7.16 and an anion gap of 21 mmol/L. Investigations also revealed a plasma osmolal gap of 89.4 mmol/kg, and a peak propylene glycol concentration of 32.9 mmol/L. Lorazepam was discontinued and replaced by midazolam, which does not contain propylene glycol. The woman received haemodialysis for 8 hours which removed the propylene glycol and eliminated the osmolal gap, but her high anion gap metabolic acidosis worsened over the following two days. After a total of two months’ hospitalisation, the woman died from ventilator-associated pneumonia. Author comment: Propylene glycol "is an important cause of high osmolal gap but not necessarily high AG [anion gap] metabolic acidosis." Yan M-T, et al. Hunting down a double gap metabolic acidosis. Annals of Clinical Biochemistry 47: 267-270, No. 3, May 2010. Available from: URL: http:// dx.doi.org/10.1258/acb.2010.009213 - Taiwan 803023613 1 Reactions 10 Jul 2010 No. 1309 0114-9954/10/1309-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Lorazepam
Reactions 1309 - 10 Jul 2010
SLorazepam
Osmolar gap metabolic acidosis in an elderlywoman associated with propylene glycolexcipient: case report
A 67-year-old woman developed osmolar gap metabolicacidosis during continuous sedation with lorazepamcontaining propylene glycol; high anion gap metabolicacidosis was also present (double gap metabolic acidosis).
The woman presented with pneumonia, progressing toacute respiratory failure. To allow ventilation, she receivedsedation with a continuous IV infusion of lorazepamtitrated to 10 mg/h. Each 2 mg/mL vial of lorazepamcontained 10.9 mmol/L of propylene glycol. After five daysshe developed high anion gap metabolic acidosis, withblood as low as pH 7.16 and an anion gap of 21 mmol/L.Investigations also revealed a plasma osmolal gap of89.4 mmol/kg, and a peak propylene glycol concentrationof 32.9 mmol/L.
Lorazepam was discontinued and replaced bymidazolam, which does not contain propylene glycol. Thewoman received haemodialysis for 8 hours which removedthe propylene glycol and eliminated the osmolal gap, buther high anion gap metabolic acidosis worsened over thefollowing two days. After a total of two months’hospitalisation, the woman died from ventilator-associatedpneumonia.
Author comment: Propylene glycol "is an important causeof high osmolal gap but not necessarily high AG [anion gap]metabolic acidosis."Yan M-T, et al. Hunting down a double gap metabolic acidosis. Annals of ClinicalBiochemistry 47: 267-270, No. 3, May 2010. Available from: URL: http://dx.doi.org/10.1258/acb.2010.009213 - Taiwan 803023613
1
Reactions 10 Jul 2010 No. 13090114-9954/10/1309-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
