Brewster, Nathan, DO

Castillo, Hernando, MS

Civic, Brian, MD

Patel, Jaimin, DO

Patel, Swetangini, P3

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicinePropofol Infusion Syndrome: a SeriousComplication With a Commonly Used Drug in theICUHernando Castillo MSUSF MCOM- LVHN Campus, Hernando.Castillo@lvhn.orgJaimin Patel DOLehigh Valley Health Network, Jaimin.Patel@lvhn.orgNathan Brewster DOLehigh Valley Health Network, Nathan.Brewster@lvhn.orgSwetangini Patel P3Brian Civic MDLehigh Valley Health Network, Brian_K.Civic@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Critical Care Commons, Internal Medicine Commons, and the PulmonologyCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtCastillo, H. Patel, J. Brewster, N. Patel, S. Civic, B. (2019, May). Propofol Infusion Syndrome: a Serious Complication With a CommonlyUsed Drug in the ICU. Poster Presented at: The Pennsylvania Osteopathic Medical Association (POMA), Philadelphia, PA.LVHN.org© 2019 Lehigh Valley Health NetworkPropofol Infusion Syndrome: a Serious Complication With a Commonly Used Drug in the ICU Hernando Castillo, MS,2 Jaimin Patel, DO,1 Nathan Brewster, DO,1 Swetangini Patel, P3,3 Brian Civic, MD4 1Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA, 2Morsani College of Medicine at the University of South Florida, Tampa, FL,  3Wingate University School of Pharmacy, Wingate, NC, 4Division of Pulmonary and Critical Care Medicine, Lehigh Valley Health Network, Allentown, PAINTRODUCTIONPropofol infusion syndrome (PRIS)  is a rare and fatal syndrome that can be caused by doses of propofol that  exceed 4mg/kg/hr for more than  48 hours. Concurrent use of cate­cholamines and glucocorticoids  while  using propofol has also been linked  with PRIS.1 PRIS can present with  different symptoms including  arrhythmias, metabolic/lactic acidosis, rhabdomyolysis, renal failure, hypertri­glyceridemia, and cardiac failure. Symptoms can be  associated with variables such as the rate of infusion (cardiac failure and metabolic acidosis), the duration of the infusion (arrhythmias), or to the  cumulative amount of propofol used (rhabdomyolysis and hypertri­glyceridemia).2 These associations help  predict symptoms but are not strict rules. REFERENCES1.  Vasile, B., Rasulo, F., Candiani, A., & Latronico, N. (2003). The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Medicine, 29(9), 1417–1425. https://doi.org/10.1007/s00134-003-1905-x2.  Kraj ová, A., Waldauf, P., And l, M., & Duška, F. (2015). Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports. Critical Care, 19(1). https://doi.org/10.1186/s13054-015-1112-53.  Pandharipande, P., Hughes, & McGrane. (2012). Sedation in the intensive care setting. Clinical Pharmacology: Advances and Applications, 53. https://doi.org/10.2147/cpaa.s26582CASE DESCRIPTION55­year­old female with past medical history of type  1 diabetes presented on day 3 as a transfer from an outside hospital with worsening hypoxia and day 3 of ventilator support due to parainfluenza pneumonia. Physical exam was limited due to sedation with remarkable findings including bilateral breath sounds present with end expiratory crackles more prominent  on the right lung base. Abdominal distention was noted with 1+ pitting edema in the upper and lower extremities. The dose of propofol on admission was 50 mcg/kg/min and was slowly increased to a max dose of 80 mcg/kg/min over the next 3 days. Lab abnormalities on day  6 of hospitalization included creatinine 2.18 mg/dL, potassium 5.9 mmol/L, bicarbonate 13 mmol/L, triglyceride 2,192 mg/dL, and creatinine kinase total (CK) 1,483 U/L Based on the lab results, the patient had developed acute renal failure, severe metabolic acidosis, hyperkalemia, severe hypertriglyceridemia, and rhabdomyolysis which increased the suspicion for PRIS. The patient was promptly started on continuous renal replacement therapy (CRRT) for the acute renal failure and started on an insulin drip for the hypertriglyceridemia which resolved within 24 hours. Her CK normalized within 3 days. Thankfully the patient was subsequently taken off the CRRT and recovered fully prior to leaving the hospital. DISCUSSIONDue to its favorable pharmacological properties, propofol is one of the more commonly used agents for sedation in the ICU setting.3 PRIS is a rare but potentially fatal syndrome with mortality rates reaching as high as 66%. Due to its high mortality rates it is important for physicians to monitor for early signs of PRIS in order to decrease the risk of poor outcomes. The current mainstay of treatment is switching to a different sedative and providing supportive care to the patient. In the case presented above the cessation of propofol and management of its symptoms  and complications led to the patient’s eventual recovery from PRIS; however, it did increase the length of stay by a considerable amount.

Propofol Infusion Syndrome: a Serious Complication With a Commonly Used Drug in the ICU

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2691&context=medicine

Propofol Infusion Syndrome: a Serious Complication With a Commonly Used Drug in the ICU

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