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Lorazepam Infusions
- There is some literature that propofol may be better for sedation in the mechanically ventilated patient, yet many emergency physicians still do not have access to the medication
- Lorazepam infusions are frequently used in many EDs for sedation of the mechanically ventilated patient
- Patients receiving continuous infusions of lorazepam are at risk for propylene glycol toxicity
- Propylene glycol toxicity primarily causes a metabolic acidosis and acute tubular necrosis
- Critically ill patients with renal or hepatic dysfunction are at increased risk of toxicity
- Monitoring propylene glycol levels are impractical
- Rather, check the osmol gap: a gap > 10 - 15 reflects significany propylene glycol accumulation
- Hemodialysis effectively removes propylene glycol
References
Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Crit Care Clin 2009;25:431-49.