PROPYLENE-GLYCOL TOXICITY CAUSED BY PROLONGED INFUSION OF ETOMIDATE

We describe a case of propylene glycol toxicity due to intravenous adm inistration of etomidate for cerebral protection. A continuous etomida te infusion was titrated to burst suppression of the electroencephalog ram during surgical resection of a large intracranial arteriovenous ma lformation. The etomidate formulation used (Amidate, Abbot) contains e tomidate 2mg/ml in a 35% propylene glycol vehicle. A total of 5 g/kg o f the solvent was given during 12 h. Adverse effects of propylene glyc ol were observed including hyperosmolality with an increased osmolal g ap, hemolysis, hemoglobinuria, and metabolic acidosis. Normalization o f these metabolic and ionic alterations occurred after 12 h of discont inuation of the infusion. The potential toxicity of the solvent should be considered during long-term administration of etomidate.