Friday February 16, 2007
Propylene Glycol and Ativan

Being an intensivist it is imperative to understand the dangers of propylene glycol with Lorazepam drip - particularly if it is continued beyond 48 hours and require higher dose. Any unexplained high anion gap metabolic acidosis with elevated osmol gap, should prompt the diagnosis of propylene gylcol toxicity. It may also cause CNS depression, arrhythmias and renal dysfuntion. Propylene glycol is a viscous, colorless liquid solvent used for many drugs with poor aqueous solubility including lorazepoam, diazepam, esmolol, nitroglycerin, pentobarbital, phenytoin, Bactrim and others.

References: click to get abstract/article

1. Propylene Glycol-Induced Lactic Acidosis in a Patient with Normal Renal Function: A Proposed Mechanism and Monitoring Recommendations - The Annals of Pharmacotherapy: Vol. 39, No. 10, pp. 1732-1735., 2005

2. Propylene Glycol Toxicity: A Severe Iatrogenic Illness in ICU Patients Receiving IV Benzodiazepines Chest. 2005;128:1674-1681.

3. Hyperosmolar Metabolic Acidosis and Intravenous Lorazepam - Volume 347:857-858, Number 11 NEJM, sept. 12, 2002.