Propylene Glycol‐Associated Renal Toxicity from Lorazepam Infusion

  title={Propylene Glycol‐Associated Renal Toxicity from Lorazepam Infusion},
  author={Ndidi E. Yaucher and Jeffrey T. Fish and Heidi Smith and Jeffrey A Wells},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
Objectives. Using data from patients who developed elevations in serum creatinine concentrations while receiving continuous‐infusion lorazepam, we sought to determine the correlations between the magnitude of serum creatinine concentration rise and each of the following variables: serum propylene glycol level, cumulative lorazepam dose, and duration of lorazepam administration. An additional objective was to identify clinical markers for propylene glycol toxicity. 

Osmol Gap as a Surrogate Marker for Serum Propylene Glycol Concentrations in Patients Receiving Lorazepam for Sedation

The prevalence of hyperosmolality and range of serum propylene glycol concentrations in this patient population is characterized and the amount of propylene Glycol administered to mechanically ventilated patients receiving continuous infusions of lorazepam is characterized.

Determination of a Lorazepam Dose Threshold for Using the Osmol Gap to Monitor for Propylene Glycol Toxicity

Study Objective. To determine a threshold dose for parenteral lorazepam when screening for propylene glycol toxicity with the osmol gap, and to characterize which osmol gap values are more predictive

Assessing Propylene Glycol Toxicity in Alcohol Withdrawal Patients Receiving Intravenous Benzodiazepines: A One-Compartment Pharmacokinetic Model

It does not appear that intermittent bolus administration of intravenous benzodiazepines for alcohol withdrawal influenced renal function or anion gap regardless of number of administered doses, amount of PG received, or the estimated PG concentration.

A Prospective Evaluation of Propylene Glycol Clearance and Accumulation During Continuous-Infusion Lorazepam in Critically Ill Patients

Fifty critically ill patients receiving continuous-infusion lorazepam for a minimum of 36 hours were prospectively evaluated to determine the extent of propylene glycol accumulation over time, characterize propylene Glycol clearance in the presence of critical illness, and develop a pharmacokinetic model that would predict clearance based on patient-specific clinical, laboratory, and demographic factors.

Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults*

It is suggested that in critically ill adults with normal renal function, serum propylene glycol concentrations may be predicted by the high-dose lorazepam infusion rate and osmol gap, as reflected by a hyperosmolar anion gap metabolic acidosis.

Propylene Glycol Accumulation in Critically III Patients Receiving Continuous Intravenous Lorazepam Infusions

The continuous infusion rate and cumulative 24-hour lorazepam dose are strongly associated with and independently predict propylene glycol concentrations, and clinicians should be aware that propylene Glycol accumulation may occur with continuous-infusion lorzepam.

Acute kidney injury, hyperosmolality and metabolic acidosis associated with lorazepam

A 54-year-old male with a history of multiple admissions for alcohol intoxication received a high-dose lorazepam infusion for alcohol withdrawal during hospitalization and developed severe hyperosmolality, high anion gap metabolic acidosis, and acute kidney injury on his eighth day of hospitalization.

Propylene glycol toxicity in children.

  • T. LimR. PooleN. Pageler
  • Medicine
    The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG
  • 2014
L Laboratory monitoring of PG levels, osmolarity, lactate, pyruvate, bicarbonate, creatinine, and anion gap can assist practitioners in making the diagnosis of PG toxicity.

Acute Tubular Necrosis Associated with Propylene Glycol from Concomitant Administration of Intravenous Lorazepam and Trimethoprim‐Sulfamethoxazole

Patients in the intensive care setting who require high doses of intravenous lorazepam for sedation, as well as antimicrobial therapy with trimethoprim‐sulfamethoxazole for treatment of either Stenotrophomonas maltophilia or Pneumocystis carinii pneumonia, may be at increased risk for propylene glycol toxicity and should be monitored closely.

Pharmacoeconomic Modeling of Lorazepam, Midazolam, and Propofol for Continuous Sedation in Critically Ill Patients

To compare the expected costs of short‐, intermediate‐, and long‐term sedation with propofol, lorazepam, and midazolam in an intensive care unit, a large number of patients with severe sedation problems are admitted to intensive care.



Propylene glycol toxicity associated with lorazepam infusion in a patient receiving continuous veno-venous hemofiltration with dialysis.

A case of toxicity from the drug solvent propylene glycol resulting from prolonged, large-dose lorazepam infusion is reported, unusual in that toxicity developed during continuous veno-venous hemofiltration with dialysis.

Propylene glycol accumulation associated with continuous infusion of lorazepam in pediatric intensive care patients

Propylene glycol accumulated significantly in pediatric intensive care patients receiving continuous lorazepam infusion, and propylene gly col concentration correlated with the cumulative lorzepam dose the patient received, however, significant laboratory abnormalities were not observed.

Short‐Term Lorazepam Infusion and Concern for Propylene Glycol Toxicity: Case Report and Review

The large PG exposure associated with long‐term cocaine‐induced renal insufficiency produced a toxic metabolic state and agents containing PG should be avoided in patients with compromised renal function induced by cocaine use.

Propylene glycol toxicity following continuous etomidate infusion for the control of refractory cerebral edema.

Etomidate, when administered by continuous infusion, has been shown to decrease cerebral metabolism resulting in a secondary decrease in cerebral blood flow with minimal changes in cerebral perfusion pressure, which decreased Intracranial pressure and cardiac parameters remained unchanged.

Comment: Possible Toxicity from Propylene Glycol in Lorazepam Infusion

Clinicians should be aware of the potential for this interaction and monitor INRs or consider alternative therapy until more is known.

Propylene glycol toxicity in a patient receiving intravenous diazepam.

To the Editor: Alcohol withdrawal is a common problem among hospitalized patients and is frequently treated with intravenous diazepam. Propylene glycol is a solvent in which diazepam is often disso...

Hyperlactatemia, increased osmolar gap, and renal dysfunction during continuous lorazepam infusion

The vehicle of lorazepam, propylene glycol, can cause hyperlactatemia and elevated osmolar gaps, however, prophene glycol may also interfere with renal tubular function and may blunt renal compensation for respiratory acidosis.

A case of propylene glycol toxic reaction associated with etomidate infusion.

For the treatment of postoperative seizures and prevention of brain edema, an etomidate drip was used in conjunction with phenytoin, diazepam, pentobarbital, and phenobarbital in a 70-year-old woman.

Propylene glycol as a cause of an elevated serum osmolality.

Prophylene glycol, in concentrations which were high enough to account for the difference between calculated and measured osmolality, was demonstrated in the sera of these patients by gas chromatography.

Propylene glycol-induced proximal renal tubular cell injury.