MED-5. An unusual cause of poisoning.
The ingestion of excessive amounts of medication can cause toxicity from both the active drug and the inactive ingredients. A careful analysis of laboratory abnormalities should suggest the diagnosis. Recently, a 32-year-old female presented to the Emergency Department with the chief complaint of not wanting to live. Her family reported that she may have swallowed up to 300 tablets of Tylenol. Her physical exam was unremarkable, and her mental status was unchanged from baseline. Initial laboratory values were significant for bicarbonate level of 23 mmol/L, anion gap of 13, glucose 137 mg/dl, and acetaminophen level of 719 [micro]g/ml. Within 2 hours, she became obtunded obtunded Neurology adjective Mentally dulled; “out of it”. See Comatose. and she was intubated for airway protection. Four hours later, an arterial blood gas arterial blood gas Critical care Analysis of arterial blood for O2, CO2, bicarbonate content, and pH, which reflects the functional effectiveness of lung function and to monitor respiratory therapy Ref range pO2 revealed a metabolic acidosis with a pH of 7.13 and pC[O.sub.2] of 31 mm/Hg. Her bicarbonate level decreased to 6 mmol/L, glucose increased to 437 mg/dl, and lactic acid was elevated at 10 mmol/L. Both the anion gap and osmolar gap were increased, and propylene glycol was measured at 40 mg/dl. The cause of her lactic acidosis, hyperglycemia hyperglycemia: see diabetes. , and hyperosmolarity was determined to be propylene glycol poisoning. Propylene glycol, a relatively non-toxic alcohol, is one of the most commonly used vehicles in hydrophobic compounds. It is used as a preservative in many different medication tablets and in certain benzodiazepine benzodiazepine (bĕn'zōdīăz`əpēn'), any of a class of drugs prescribed for their tranquilizing, antianxiety, sedative, and muscle-relaxing effects. Benzodiazepines are also prescribed for epilepsy and alcohol withdrawal. and anti-convulsant intravenous solutions. It is also found in household cleaners, hair products, and skin lotions. When administered in very large quantities, it can cause lactic acidosis, hyperglycemia, and increased serum osmolarity osmolarity /os·mo·lar·i·ty/ (oz?mo-lar´i-te) the concentration of a solution in terms of osmoles of solutes per liter of solution.
n. . Potentially fatal effects include stupor, seizures, and brady-asystolic arrests. Though it may produce striking lab abnormalities, deaths attributed to oral ingestion of propylene glycol have not been reported.
Alan Redding, MD. Medical University of South Carolina “MUSC” redirects here. For Abel Santa María airport in Santa Clara, Cuba (ICAO code MUSC), see Abel Santa María Airport.
The Medical University of South Carolina , Charleston, SC.