Hyperosmolality induced by propylene glycol. A complication of silver sulfadiazine therapy.
An 8-month-old male infant was treated with topical silver sulfadiazine for a burn and complicating toxic epidermal necrolysis involving 78% of his total body surface area. Transdermal absorption of propylene glycol from the silver sulfadiazine produced hyperosmolality with an increased osmolal gap. A peak propylene glycol concentration of 1,059 mg/dL was documented, and its osmotic effect was that predicted from its concentration. Our data support either zero-order elimination at a rate of 13.5 mg/dL/hr or first-order elimination with a half-life of 16.9 hours. Elevated concentrations of propylene glycol may have contributed to the patient's cardiorespiratory arrest. The osmolal gap may be used as a screen for suspected propylene glycol intoxication in selected clinical settings.
D000287:Administration, Topical; D002056:Burns / Q000188:drug therapy; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D007223:Infant; D008297:Male; D009823:Ointment Bases; D009994:Osmolar Concentration; D019946:Propylene Glycol; D011409:Propylene Glycols / Q000009:adverse effects* / Q000097:blood / Q000378:metabolism; D012837:Silver Sulfadiazine / Q000008:administration & dosage*; D012869:Skin Absorption; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy; D013411:Sulfadiazine / Q000008:administration & dosage*; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000139:chemically induced*
D009823:Ointment Bases; D011409:Propylene Glycols; D013411:Sulfadiazine; D019946:Propylene Glycol; D012837:Silver Sulfadiazine