Propylene glycol toxicity complicating use of barbiturate coma.
BACKGROUND
Barbiturate coma is a necessary medical therapy in certain instances, such as the treatment of refractory status epilepticus or severe intracranial hypertension, but its use is often wrought with serious complications. Potential complications include hemodynamic instability, respiratory depression, and immunosuppression with frequent nosocomial infections. High doses of barbiturates may also lead to the accumulation of propylene glycol, the vehicle used in the intravenous formulations of both pentobarbital and phenobarbital, thereby yielding another less-recognized complication of therapy.


RESULTS
We present a case of propylene glycol toxicity associated with the use of high-dose intravenous pentobarbital and phenobarbital during the treatment of refractory status epilepticus.
Bledsoe
Kathleen A
KA
Department of Pharmacy, University of Virginia Health System, PO Box 800674, Charlottesville, VA 22908-0674, USA. kv9k@virginia.edu
Kramer
Andreas H
AH
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage*; D001463:Barbiturates / Q000008:administration & dosage*; D003128:Coma / Q000139:chemically induced; D003422:Critical Care; D017809:Fatal Outcome; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D014677:Pharmaceutical Vehicles / Q000008:administration & dosage / Q000009:adverse effects; D019946:Propylene Glycol / Q000008:administration & dosage / Q000009:adverse effects*; D012772:Shock, Septic; D012997:Solvents / Q000008:administration & dosage / Q000009:adverse effects*; D013226:Status Epilepticus / Q000188:drug therapy*
D000927:Anticonvulsants; D001463:Barbiturates; D014677:Pharmaceutical Vehicles; D012997:Solvents; D019946:Propylene Glycol