Propylene glycol accumulation in critically ill patients receiving continuous intravenous lorazepam infusions

The Annals of Pharmacotherapy
Erica L HorinekRobert MacLaren

Abstract

Lorazepam is recommended by the Society of Critical Care Medicine as the preferred agent for sedation of critically ill patients. Intravenous lorazepam contains propylene glycol, which has been associated with toxicity when high doses of lorazepam are administered. To evaluate the accumulation of propylene glycol in critically ill patients receiving lorazepam by continuous infusion and determine factors associated with propylene glycol concentration. A 6-month, retrospective, safety assessment was conducted of adults admitted to the medical intensive care unit who were receiving lorazepam by continuous infusion for 12 hours or more. Propylene glycol serum concentrations were obtained 24-48 hours after continuous-infusion lorazepam was initiated and every 3-5 days thereafter. Propylene glycol accumulation was defined as concentrations of 25 mg/dL or more. Groups with and without propylene glycol accumulation were compared and factors associated with propylene glycol concentration were determined using multivariate correlation regression analyses. Forty-eight propylene glycol serum samples were obtained from 33 patients. Fourteen (42%) patients had propylene glycol accumulation, representing 23 (48%) serum samples. Univariate ana...Continue Reading

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Citations

Oct 9, 2014·The New England Journal of Medicine·Kenrick BerendRijk O B Gans
Sep 24, 2013·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Aswani AlavalaHarold M Szerlip
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