title: Massive ketonuria during sedation with propofol in a 12 year old girl with severe head trauma.
abstract: Severe ketonuria developed during sedation with propofol in a 12 year old girl with brain injury. Deep sedation with propofol (5.1 mg/kg/h) was required because of agitation and severe intracranial hypertension; as a part of our management protocol, glucose intake was restricted to 5 Kcal/h. After 18 hours of propofol infusion there was intense ketonuria (8+ by Ketostix) without any evidence of metabolic acidosis (pH, HCO3- and anion gap were within normal values). At this time, indirect calorimetry (Deltatrac) confirmed that energy expenditure was principally based on fat consumption (70% of energy expenditure). Lowering the propofol infusion rate and increasing glucose intake reduced fat consumption to 39% within 8 hours: at this time, Ketostix was negative for ketone bodies. This case illustrates a potential risk of ketonuria during prolonged sedation with propofol (a 10% solution of intralipid), particularly if glucose intake is restricted. Monitoring urinary ketone bodies is recommended under these circumstances.
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Liège, Belgium.
authors.forename: J L
authors.initials: JL
authors.lastname: Canivet
authors.forename: K
authors.initials: K
authors.lastname: Gustad
authors.forename: P
authors.initials: P
authors.lastname: Leclercq
authors.forename: P
authors.initials: P
authors.lastname: Damas
authors.forename: M
authors.initials: M
authors.lastname: Lamy
mesh_terms: D001930:Brain Injuries / Q000378:metabolism / Q000503:physiopathology*; D002151:Calorimetry; D002648:Child; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D007657:Ketone Bodies / Q000652:urine*; D050356:Lipid Metabolism; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D007657:Ketone Bodies; D015742:Propofol