Reviews: Recognition, Treatment, and Prevention of Propylene Glycol Toxicity

@article{Zar2007ReviewsRT,
  title={Reviews: Recognition, Treatment, and Prevention of Propylene Glycol Toxicity},
  author={Tausif Zar and Charles W. Graeber and Mark A Perazella},
  journal={Seminars in Dialysis},
  year={2007},
  volume={20}
}
Propylene glycol is a commonly used solvent for oral, intravenous, and topical pharmaceutical preparations. Although it is considered safe, large intravenous doses given over a short period of time can be toxic. Underlying renal insufficiency and hepatic dysfunction raise risk for toxicity. Toxic effects include hyperosmolality, increased anion gap metabolic acidosis (due to lactic acidosis), acute kidney injury, and sepsis‐like syndrome. Treatment of toxicity includes hemodialysis to… 
Propylene glycol toxicity in children.
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L Laboratory monitoring of PG levels, osmolarity, lactate, pyruvate, bicarbonate, creatinine, and anion gap can assist practitioners in making the diagnosis of PG toxicity.
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TLDR
The data on PG disposition and tolerance suggest that there is a lower limit of safe short term exposure to PG in neonates and that a safer level of exposure should finally be based on clearance estimates and level of tolerated exposure.
Iatrogenic Propylene Glycol Intoxication Due to High-Dose Pentobarbital for Refractory Intracranial Hypertension: A Case Report
TLDR
This case of iatrogenic propylene glycol toxicity secondary to a high-dose pentobarbital infusion for the treatment of refractory intracranial hypertension due to cerebral venous sinus thrombosis is presented.
Propylene Glycol in Neonates: Never Prescribed, Frequently Administered, Hardly Evaluated
TLDR
Overall PG clearance is in part explained by primary renal elimination (glomerular filtration rate), in part by hepatic metabolism (alcohol dehydrogenase, 55%) to lactate and pyruvate, but this does not linearly apply in neonates, commonly exposed to PG.
Severe Propylene Glycol Toxicity Secondary to Use of Anti-Epileptics
TLDR
A novel case of propylene glycol toxicity secondary to phenobarbital and phenytoin infusion in a patient with refractory status epilepticus is reported, and it is thought that end-stage renal disease could have been an important precipitating factor for the toxicity.
Propylene glycol neurotoxicity due to sodium citrate therapy in an infant with renal tubular acidosis
TLDR
The first case of propylene glycol neurotoxicity in a 6-week-old infant with renal tubular acidosis treated with sodium citrate is reported, indicating increased risk of toxicity in pediatric patients due to high Sodium citrate requirement and low propylene Glycol metabolism capacity.
Propylene Glycol Toxicity Complicating Use of Barbiturate Coma
TLDR
A case of propylene glycol toxicity associated with the use of high-dose intravenous pentobarbital and phenobarbitals during the treatment of refractory status epilepticus is presented.
Toxic Alcohols.
  • M. Mycyk
  • Medicine
    The New England journal of medicine
  • 2019
TLDR
In this review, the mechanisms of toxicity, methods available for diagnosis, and current recommendations for therapy are discussed.
Toxic Alcohols
TLDR
In this review, the mechanisms of toxicity, methods available for diagnosis, and current recommendations for therapy are discussed.
Propylene Glycol Toxicity in Adolescent with Refractory Myoclonic Status Epilepticus
TLDR
Clinicians should have a high index of suspicion for propylene glycol toxicity in patients treated with PG-containing medications even when the total PG exposure is lower than currently accepted limits.
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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.
Propylene Glycol Pharmacokinetics and Effects after Intravenous Infusion in Humans
TLDR
A rapid gas chromatographic assay method is described for PG and the plasma pharmacokinetics after intravenous administration to six patients on nine occasions, finding no evidence of lactic acidosis, hemolysis, or increase in osmolality at 3–15 g/m2 PG infused over periods of 4 h.
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TLDR
The findings suggest the development of a mild, subacute toxicity in normally proliferating HPT cells at concentrations that could be achieved in human plasma when PD is used as a drug vehicle.
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TLDR
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.
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TLDR
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.
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TLDR
A 24-year-old female with community-acquired pneumonia presented with severe acute respiratory distress syndrome and propylene glycol was determined to be the probable cause of lactic acidosis, which later deteriorated and she ultimately died.
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TLDR
Using data from patients who developed elevations in serum creatinine concentrations while receiving continuous‐infusion lorazepam, the correlations between the magnitude of serum creat inine concentration rise and each of the following variables were determined: serum propylene glycol level, cumulative lorZepam dose, and duration of lorAZepam administration.
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TLDR
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.
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TLDR
The cause of this high 'calcium gap' appeared to be binding of calcium by dicarboxylic acid metabolites of polyethylene glycol, similar to the more common poisoning with ethylene glycol but also included an increased serum calcium with a concomitant decrease in the ionized calcium.
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TLDR
Propylene glycol toxicity is a potentially life-threatening iatrogenic complication that is common and preventable and should be considered whenever a patient has an unexplained anion gap, unexplained metabolic acidosis, hyperosmolality, and/or clinical deterioration.
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