Propofol-associated hypertriglyceridemia and pancreatitis in the intensive care unit: an analysis of frequency and risk factors.
OBJECTIVE
To characterize the frequency, severity, risk factors, and clinician response to propofol-associated hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis.


METHODS
Retrospective analysis.


METHODS
Medical and surgical intensive care units.


METHODS
One hundred fifty-nine adult intensive care patients administered propofol for 24 hours or longer and who had at least one serum triglyceride concentration.


RESULTS
Patient records were reviewed to identify the frequency of hypertriglyceridemia (serum triglyceride concentration > or = 400 mg/dl) and pancreatitis (amylase concentration > or = 125 IU/L, lipase concentration > or = 60 IU/L, and abdominal computed tomography scan or clinical examination findings consistent with pancreatitis). Of the 159 patients, 29 (18%) developed hypertriglyceridemia; six (21%) of the 29 had a serum triglyceride concentration of 1000 mg/dl or greater. The median maximum serum triglyceride concentration was 696 mg/dl (range 403-1737 mg/dl). At the time when hypertriglyceridemia was detected, the median infusion rate of propofol was 50 microg/kg/minute (range 5-110 microg/kg/min). The median time from the start of propofol therapy to identification of hypertriglyceridemia was 54 hours (range 14-319 hrs). Propofol was discontinued within 24 hours of detecting the hypertriglyceridemia 84% of the time. Compared with those who did not develop hypertriglyceridemia, patients who developed hypertriglyceridemia were older, had a longer intensive care unit stay, and received propofol for a longer duration; they were also more likely to be admitted to the medical versus the surgical intensive care unit. Pancreatitis developed in three (10%) of the 29 patients with hypertriglyceridemia.


CONCLUSIONS
Hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis are often seen in intensive care patients receiving propofol. Serum triglyceride concentrations should be routinely monitored in these patients. In addition, alternative sedation strategies should be considered when hypertriglyceridemia is detected.
Devlin
John W
JW
School of Pharmacy, Northeastern University, and the Department of Pharmacy, Tufts-New England Medical Center, Boston, Massachusetts 02115, USA. j.devlin@neu.edu
Lau
Adah K
AK
Tanios
Maged A
MA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000139:chemically induced* / Q000453:epidemiology; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000139:chemically induced* / Q000453:epidemiology; D015742:Propofol / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
D006993:Hypnotics and Sedatives; D015742:Propofol