Determination of a lorazepam dose threshold for using the osmol gap to monitor for propylene glycol toxicity

Pharmacotherapy

Volumn 28, Issue 8, 2008, Pages 984-991

  Yahwak, Jason A ^a   Riker, Richard R ^a   Fraser, Gilles L ^a   Subak Sharpe, Sarah ^a  

^a MAINE MEDICAL CENTER   (United States)

Author keywords

Adverse drug events; Conscious sedation; Intensive care; Lorazepam; Osmol gap; Propylene glycol

Indexed keywords

DEXMEDETOMIDINE; LORAZEPAM; PROPYLENE GLYCOL;

ADULT; AGED; ARTICLE; BLOOD LEVEL; CALCULATION; CLINICAL ARTICLE; DOSE CALCULATION; DRUG DOSE COMPARISON; DRUG DOSE INCREASE; DRUG SUBSTITUTION; FEMALE; HUMAN; KIDNEY INJURY; MALE; MEASUREMENT; METABOLIC ACIDOSIS; OBSERVATIONAL STUDY; OSMOL GAP; OSMOLARITY; PREDICTION; PROSPECTIVE STUDY; SCREENING TEST; SERUM OSMOLALITY; UNITED STATES;

ACID-BASE EQUILIBRIUM; ADULT; AGED; CREATININE; FEMALE; HUMANS; HYPNOTICS AND SEDATIVES; LORAZEPAM; MALE; MIDDLE AGED; OSMOLAR CONCENTRATION; PROPYLENE GLYCOL; PROSPECTIVE STUDIES; ROC CURVE;

EID: 48249134733     PISSN: 02770008     EISSN: None     Source Type: Journal    
DOI: 10.1592/phco.28.8.984     Document Type: Article

References (32)

1. Fraser GL, Prato BS, Riker RR, Berthiaume D, Wilkins ML. Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU. Pharmacotherapy 2000;20:75-82.
2. Riker RR, Fraser GL. Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy 2005;25:S8-18.
3. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119-41.
4. Pandharipande P, Shintani A, Peterson J, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 2006;104:21-6.
5. Parker MG, Fraser GL, Watson DM, Riker RR. Removal of propylene glycol and correction of increased OG by hemodialysis in a patient on high-dose lorazepam infusion therapy. Intensive Care Med 2002;28:81-4.
6. Glover ML, Reed MD. Propylene glycol: the safe diluent that continues to cause harm. Pharmacotherapy 1996;16:690-3.
7. Yorgin PD, Theodorou AA, Al-Uzri A, Davenport K, Boyer-Hassen L, Johnson MI. Propylene glycol-induced proximal renal tubular cell injury. Am J Kidney Dis 1997;30:134-9.
8. Eisen TF, Lacouture PG, Woolf A. Serum osmolality in alcohol ingestions: differences in availability among laboratories of teaching hospitals, non-teaching hospitals, and commercial facilities. Am J Emerg Med 1989;7:256-9.
9. Arbour RB. Propylene glycol toxicity related to high-dose lorazepam infusion: case report and discussion. Am J Crit Care 1999;8:499-506.
10. Al-Khafaji AH, Dewhirst WE, Manning HL. Propylene glycol toxicity associated with lorazepam infusion in a patient receiving continuous veno-venous hemofiltration with dialysis. Anesth Analg 2002;94:1583-5.
11. Yaucher NE, Fish JT, Smith HW, Wells JA. Propylene glycol-associated renal toxicity from lorazepam infusion. Pharmacotherapy 2003;23:1094-9.
12. Barnes BJ, Gerst C, Smith JR, Terrell AR, Mullins ME. Osmol gap as a surrogate marker for serum propylene glycol concentrations in patients receiving lorazepam for sedation. Pharmacotherapy 2006;26:23-33.
13. Hayman M, Seidl EC, Anderson JA, Harchelroad F. Monitoring lorazepam induced propylene glycol toxicity in a critical care population: a prospective series [abstract]. Crit Care Med 2003;30:A157.
14. Arroliga AC, Shehab N, McCarthy K, Gonzales JP. Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Crit Care Med 2004;32:1709-14.
15. Reynolds HN, Teiken P, Regan ME, et al. Hyperlactatemia, increased osmolar gap and renal dysfunction during continuous lorazepam infusion. Crit Care Med 2000;28:1631-4.
16. Hayman M, Seidl EC, Ali M, Malik K. Acute tubular necrosis associated with propylene glycol from concomitant administration of intravenous lorazepam and trimethoprim-sulfamethoxazole. Pharmacotherapy 2003;23:1190-4.
17. D'Ambrosio JA, Borchardt-Phelps P, Nolen JG, Cerra FB. Propylene glycol induced lactic acidosis secondary to continuous infusion of lorazepam [abstract]. Pharmacotherapy 2003;13:274.
18. Arbour R, Esparis B. Osmolar gap metabolic acidosis in a 60-year-old man treated for hypoxemic respiratory failure. Chest 2000;118:545-6.
19. Cawley MJ. Short-term lorazepam infusion and concerns for propylene glycol toxicity: case report and review. Pharmacotherapy 2001;21:1140-4.
20. Wilson KC, Reardon C, Theodore AC, Farber HW. Propylene glycol toxicity: a severe iatrogenic illness in ICU patients receiving IV benzodiazepines - a case series and prospective, observational pilot study. Chest 2005;128:1674-81.
21. Chicella M, Jansen P, Parthiban A, et al. Propylene glycol accumulation associated with continuous infusion of lorazepam in pediatric intensive care patients. Crit Care Med 2002;30:2752-6.
22. Erstad BL. Osmolality and osmolarity: narrowing the terminology gap. Pharmacotherapy 2003;23:1085-6.
23. Oster JR, Singer I. Hyponatremia, hyposmolality, and hypotonicity: tables and fables. Arch Intern Med 1999;159:333-6.
24. McQuillen KK, Andersen AC. Osmol gaps in the pediatric population. Acad Emerg Med 1999;6:27-30.
25. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.
26. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, for the Acute Dialysis Quality Initiative Workgroup. Acute renal failure: definition, outcome measures, animal models, fluid therapy, and information technology needs. The second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care 2004;8:R204-12.
27. Thomson Micromedex. Propylene glycol. In: POISINDEX System [intranet database]. Greenwood Village, CO: Thomson Micromedex. Updated periodically. Accessed May 28, 2008.
28. Speth PA, Vree TB, Neilen NF, et al. Propylene glycol pharmacokinetics and effects after intravenous infusion in humans. Ther Drug Monit 1987;9:255-8.
29. Jacobi J. Medication vehicle injury: using the proper restraint? Crit Care Med 2004;32:1800-1.
30. Joint FAO/WHO Expert Committee on Food Additives. Toxicological evaluation of certain food additives with a review of general principles and of specifications: 17th report of the joint FAO/WHO expert committee on food additives (1974). Technical report series no. 539. Geneva, Switzerland: World Health Organization; 1974.
31. Seay RE, Graves PJ, Wilkin MK. Comment: possible toxicity from propylene glycol in lorazepam infusion [letter]. Ann Pharmacother 1997;31:647-8. (Erratum in Ann Pharmacother 1997;31:1413.)
32. Tayar J, Jabbour G, Saggi SJ. Severe hyperosmolar metabolic acidosis due to a large dose of intravenous lorazepam [letter]. N Engl J Med 2002;346:1253-4.