Abstract: TH-PO167
An Unexpected Complication After a Motor Vehicle Accident: Propofol Infusion Syndrome
Session Information
- Drug Events Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1800 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Rodriguez, Yamiris, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Marquez Pantoja, Mariela, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Lopez vega, Keysha, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Ocasio Melendez, Ileana E., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Cintron-Rosa, Fatima B., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
Introduction
Propofol is the most commonly used parenteral anesthetic in the United States due to its rapid onset and reversal of action. Propofol infusion syndrome (PRIS) is a serious complication associated with multiorgan failure. An incidence of less than 1% have been reported for this life-threatening complication, making its early recognition critical for a favorable outcome.
Case Description
A 59-year-old woman was admitted due to multiple body trauma after a motor vehicle accident. She was intubated for airway protection and propofol was used for sedation. Hospitalization complicated with acute kidney injury (AKI) and Nephrology service was consulted. Examination revealed a critically ill patient sedated with an intravenous infusion of propofol at a 0.83 mg/kg/hr rate and norepinephrine for hemodynamic support. Propofol drip was infused for more than 48 hours. Physical exam revealed adequate urine output, clear lungs and no edema. Laboratory tests with increased lactate levels from 37.4 to 54.8 mg/dl, bicarbonate 13.6 mEq/L and pH of 7.24. Anion gap (AG) was 17.9. Creatinine worsened from 0.55 to 1.12 mg/dl. Creatinine phosphokinase level of 3,421 U/L was observed. Triglyceride levels increased from 171 to 372 mg/dl. Laboratory findings were consistent with high AG metabolic acidosis, AKI, rhabdomyolysis and hypertriglyceridemia. Based on clinical course and risk factors for PRIS including critical illness, prolonged sedation and catecholamine infusion; propofol was discontinued and altered laboratories showed marked improvement.
Discussion
Our patient received a prolonged infusion of propofol and exhibited risk factors previously stated for developing this rare complication. He had a worsening metabolic acidosis with additional findings not explained by other causes of acidosis. Moreover, improvement of parameters after discontinuation of propofol infusion supports our diagnosis of PRIS. This syndrome should be suspected in any patient with prolonged infusion of propofol and the cardinal features of this syndrome, including cardiovascular collapse, lactic acidosis, AKI, rhabdomyolysis and hypertriglyceridemia. PRIS suspicion should prompt immediate propofol weaning, since this complication carries a high mortality risk. In our case, early recognition and proper management lead to a satisfactory outcome.