Propylene Glycol‐Associated Renal Toxicity from Lorazepam Infusion

@article{Yaucher2003PropyleneGR,
  title={Propylene Glycol‐Associated Renal Toxicity from Lorazepam Infusion},
  author={Ndidi E. Yaucher and J. Fish and Heidi W. Smith and Jeffrey A. Wells},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  year={2003},
  volume={23}
}
  • Ndidi E. Yaucher, J. Fish, +1 author Jeffrey A. Wells
  • Published 2003
  • Medicine
  • 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. 
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TLDR
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. Expand
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… Expand
Propylene Glycol Accumulation After High-Dose Lorazepam: What Have We Learned?
TLDR
The primary objective was to document the relationship between continuous infusion of high-dose lorazepam (HD-LZ) and serum propylene glycol (PG) concentrations 48 hrs into HD- LZ. Expand
Assessing Propylene Glycol Toxicity in Alcohol Withdrawal Patients Receiving Intravenous Benzodiazepines: A One-Compartment Pharmacokinetic Model
TLDR
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. Expand
A Prospective Evaluation of Propylene Glycol Clearance and Accumulation During Continuous-Infusion Lorazepam in Critically Ill Patients
TLDR
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. Expand
Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults*
TLDR
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. Expand
Propylene Glycol Accumulation in Critically III Patients Receiving Continuous Intravenous Lorazepam Infusions
TLDR
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. Expand
Acute kidney injury, hyperosmolality and metabolic acidosis associated with lorazepam
TLDR
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. Expand
Propylene glycol toxicity in children.
TLDR
L Laboratory monitoring of PG levels, osmolarity, lactate, pyruvate, bicarbonate, creatinine, and anion gap can assist practitioners in making the diagnosis of PG toxicity. Expand
Removal of propylene glycol and correction of increased osmolar gap by hemodialysis in a patient on high dose lorazepam infusion therapy
TLDR
Hemodialysis may be a useful component of therapy for critically ill patients exhibiting propylene glycol toxicity in the context of multiple organ dysfunction. Expand
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TLDR
Hemodialysis may be a useful component of therapy for critically ill patients exhibiting propylene glycol toxicity in the context of multiple organ dysfunction. Expand
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