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Propylene glycol accumulation associated with continuous infusion of lorazepam in pediatric intensive care patients

Michael Chicella1, Paul Jansen, Anitha Parthiban

  • 1Clinical Pharmacy Practice, Auburn University, Auburn, AL, USA.

Critical Care Medicine
|December 17, 2002
PubMed

Insights

Propylene glycol accumulates in children receiving continuous lorazepam infusions. However, this accumulation did not lead to significant laboratory abnormalities in pediatric intensive care patients.

Area of Science:

  • Pediatric intensive care
  • Pharmacokinetics
  • Clinical toxicology

Background:

  • Continuous lorazepam infusions are used for sedation in pediatric intensive care units (PICUs).
  • Lorazepam formulations contain propylene glycol, a potential toxin.
  • The accumulation and effects of propylene glycol in pediatric patients require investigation.

Purpose of the Study:

  • To assess propylene glycol accumulation in pediatric patients receiving continuous lorazepam infusions.
  • To determine if propylene glycol accumulation is associated with laboratory abnormalities.

Main Methods:

  • Prospective study in a tertiary care PICU.
  • Eleven intubated pediatric patients receiving continuous lorazepam infusion.
  • Propylene glycol concentrations, serum lactate, and osmolar gap were measured at baseline, 48 hours, and end of therapy.

Main Results:

  • Propylene glycol significantly accumulated, increasing from 86 ± 93 µg/mL at baseline to 763 ± 660 µg/mL at study end (p=.038).
  • A significant correlation was found between cumulative lorazepam dose and propylene glycol concentration (r²=.65, p<.005).
  • No significant laboratory abnormalities (serum lactate or osmolar gap) were observed.

Conclusions:

  • Propylene glycol accumulates significantly in pediatric patients on continuous lorazepam infusions.
  • The degree of accumulation correlates with the cumulative lorazepam dose.
  • Observed propylene glycol accumulation did not result in significant laboratory abnormalities in this cohort.
Abstract

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