Reactions 1083 - 7 Jan 2006

24 hours. S Wilson KC, et al. Propylene glycol toxicity: a severe iatrogenic illness in ICUDiazepam/lorazepam/propylene glycol

patients receiving IV benzodiazepines: a case series and prospective, observationalpilot study. Chest 128: 1674-1681, No. 3, Sep 2005 - USA 800992470Metabolic disorders associated with propylene

glycol toxicity: 9 case reportsSix men and three women developed metabolic disorders

associated with propylene glycol toxicity while receivingpropylene glycol-containing IV diazepam or IV lorazepaminfusions for sedation during ventilation or alcohol withdrawal[see table for patient details].

Patient characteristics and treatment detailsPatient Age Drug/total dose Duration Total

(years)/ of propyleneSex treatment glycol

(days) dose (g)

1 48/M Lorazepam 7 4441070mg

2 61/M Diazepam 5 9704850mg

3 41/M Lorazepam 11g 25 45654 30/F Lorazepam 9 1273

3068mg5 53/M Lorazepam 7 899

2166mg6 34/M Diazepam 20mg 2 306

Lorazepam730mg

7 60/F Diazepam 290mg 3 511 Lorazepam

1092mg8 35/F Lorazepam 68mg 2 289 35/M Diazepam 2 490

2450mg

Patient 1’s anion gap and creatinine level increased ontreatment days 6 and 7, and his serum bicarbonate level andpH decreased. Despite treatment with antibacterials, hismetabolic disorders continued to worsen. Lorazepam wasswitched to midazolam and his metabolic parametersnormalised within 24 hours.

Patient 2’s anion gap increased on day 6, and his serumbicarbonate level and pH decreased. Diazepam was switchedto midazolam and his metabolic disorders resolved within24 hours.

Patient 3’s anion gap and creatinine level increased onday 23 and he developed hypotension. His metabolicdisorders worsened over the next 2 days. Lorazepam wasswitched to midazolam and his metabolic disorders improvedover the next 24 hours.

Patient 4’s anion gap increased over the first 3 days and shedeveloped acute renal failure. Her metabolic disordersworsened over the next 6 days despite initiation ofhaemodialysis and antibacterial therapy. Lorazepam wasdiscontinued and her metabolic parameters and renal functionnormalised within 24 hours.

Patient 5’s serum bicarbonate level decreased and hiscreatinine level increased during the lorazepam infusion.Lorazepam was discontinued and his metabolic disordersresolved within 72 hours.

Patient 6’s bicarbonate level decreased progressively over3 days. Lorazepam and diazepam were switched to midazolamand his metabolic parameters normalised within 24 hours.

Patient 7’s bicarbonate level decreased on day 4, anddiazepam and lorazepam were switched to midazolam. Hermetabolic parameters normalised within 48 hours.

Patient 8’s anion gap increased on day 3, and lorazepam wasswitched to midazolam. Her metabolic disorder resolvedwithin 24 hours.

Patient 9’s bicarbonate level decreased progressively over3 days and her anion gap increased. Diazepam was switchedto midazolam and her metabolic disorders resolved within

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