Acute kidney injury, hyperosmolality and metabolic acidosis associated with lorazepam.
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.


METHODS
Serum chemistries, arterial blood gas analysis, and measurement of serum propylene glycol, ethylene glycol and methanol levels.


METHODS
Propylene glycol toxicity.


RESULTS
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.
Zar
Tausif
T
Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA. zarjr73@yahoo.com
Yusufzai
Irfan
I
Sullivan
Anna
A
Graeber
Charles
C
D000138:Acidosis / Q000139:chemically induced; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy*; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004339:Drug Compounding; D006801:Humans; D007262:Infusions, Intravenous; D008140:Lorazepam / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D014677:Pharmaceutical Vehicles / Q000009:adverse effects* / Q000493:pharmacokinetics; D019946:Propylene Glycol / Q000009:adverse effects* / Q000493:pharmacokinetics; D006435:Renal Dialysis
D014151:Anti-Anxiety Agents; D014677:Pharmaceutical Vehicles; D019946:Propylene Glycol; D008140:Lorazepam