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Acute kidney injury, hyperosmolality and metabolic acidosis associated with lorazepam
Tausif Zar1, Irfan Yusufzai, Anna Sullivan
1Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA. zarjr73@yahoo.com
Background:
A 54-year-old male with a history of multiple admissions for alcohol intoxication was admitted to hospital with right flank pain. He received a high-dose lorazepam infusion for alcohol withdrawal during hospitalization and developed severe hyperosmolality, high anion gap metabolic acidosis, and acute kidney injury on his eighth day of hospitalization.
Investigations:
Serum chemistries, arterial blood gas analysis, and measurement of serum propylene glycol, ethylene glycol and methanol levels.
Diagnosis:
Propylene glycol toxicity.
Management:
Discontinuation of lorazepam infusion, administration of fomepizole, hemodialysis for five consecutive days, hemodynamic support, and follow-up of serum osmolality as a measure of propylene glycol decay.
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