Propylene glycol
Summary
Propylene glycol is a pharmaceutical solvent that can cause high anion gap metabolic acidosis, hyperosmolality, and neurologic symptoms in toxicity. Occurs with large IV doses or renal impairment.
Detail
Propylene glycol is metabolized to lactic acid and methylglyoxal. Toxicity occurs with high doses or impaired clearance, manifesting as high anion gap metabolic acidosis, elevated osmolar gap, and encephalopathy. Particularly problematic with continuous infusions of PG-containing drugs (lorazepam, TMP-SMX IV) in ICU patients with renal failure. Treatment is supportive: discontinue offending drug, fluids, correct acidosis.
Sources
- First Aid for the USMLE Step 1
- Goldfrank's Toxicologic Emergencies
- Harrison's Principles of Internal Medicine
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