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A life-threatening double gap metabolic acidosis
Yu-Tzu Tsao1, Wei-Chi Tsai, Shih-Ping Yang
1Department of Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu 114, Taipei, Taiwan.
The American Journal of Emergency Medicine
|March 25, 2008
Summary
Lorazepam can cause propylene glycol (PG) intoxication, leading to double gap metabolic acidosis. Prompt hemodialysis is crucial for treating this severe condition.
Area of Science:
- Nephrology
- Toxicology
- Critical Care Medicine
Background:
- Double gap metabolic acidosis is characterized by high anion and osmolal gaps, indicating unmeasured osmole retention.
- Propylene glycol (PG) intoxication is a rare but serious cause of this condition.
Observation:
- A 62-year-old man with community-acquired pneumonia developed severe bradyarrhythmia due to high anion and osmolal gaps.
- Laboratory results revealed D-Lactic acidosis and elevated serum PG levels, confirming lorazepam-induced PG intoxication.
Findings:
- Discontinuation of lorazepam and emergent hemodialysis effectively resolved the metabolic derangement and bradyarrhythmia.
- Serum osmolal gap serves as a valuable tool for early detection and monitoring treatment efficacy in PG intoxication.
Implications:
- Propylene glycol intoxication should be a key consideration in the differential diagnosis of double gap metabolic acidosis.
- Early recognition and prompt hemodialysis can prevent life-threatening complications associated with PG intoxication.
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