Lorazepam propylene glycol toxicity

Cawley MJ. Short-term lorazepam infusion and concern for propylene glycol toxicity case report and review. Pharmacotherapy 2001 21(9) 1140-4. 

Yahwak JA, Riker RR, Fraser GL, Subak-Sharpe S. Determination of a lorazepam dose threshold for using the osmol gap to monitor for propylene glycol toxicity. Pharmacotherapy 2008 28(8) 984—91. 

Refractory GCSE has also been treated with large-dose continuous infusion lorazepam or diazepam. Lorazepam contains propylene glycol, which can accumulate and cause marked osmolar gap, metabolic acidosis, and renal toxicity. 

Yaucher NE, Fish JT, Smith HW, Wells JA. Propylene glycol-associated renal toxicity from lorazepam infusion. Pharmacotherapy 2003 23(9) 1094-9. 

Pentobarbital contains 40% v/v propylene glycol, which was thought to have caused this patient s metabolic derangements. Reports of toxicity with drugs containing propylene glycol, particularly intravenous lorazepam, have been well described, but this is one of few reports involving intravenous pentobarbital. 

---