Propofol infusion syndrome as a cause for CRRT circuit malfunction: a case report with literature review

Renal Replacement Therapy

Case Report

Marcela de Almeida Lopes¹  Marjorie Gosdal Zambon²  Isadora Schwaab Guerini³  Luana Caroline Miantti Ghellere Bonfim⁴ 

[1] Hospital da Cidade, Salvador, Brazil;Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil;State University of Western Parana, Francisco Beltrão, Paraná, Brazil;University of South Santa Catarina, Florianópolis, Brazil;

关键词: Acute kidney injury;    Continuous renal replacement therapy;    Dialysis;    CRRT;    Propofol;    Propofol infusion syndrome;    Hypertriglyceridemia;    Case report;   

DOI  :  10.1186/s41100-023-00496-x

 received in 2022-11-16, accepted in 2023-08-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPropofol is commonly used for sedation in the Intensive Care Unit (ICU). When administered in high doses and for a prolonged time, it can cause a rare but hazardous complication: Propofol Infusion Syndrome (PRIS). Along with other findings, PRIS can cause lipemia and clotting of the Continuous Renal Replacement Therapy (CRRT) circuit.Case presentationA 62-year-old woman admitted to the ICU after an acute ischemic stroke was sedated with Propofol for neuroprotection. On the sixteenth day of infusion (mean daily dose: 4 mg/kg/h), she presented with hyperlactatemia (7.7 mg/dL), acute kidney injury, metabolic acidosis (pH: 7.23 / HCO3–: 12.2 mEq/L), hyperkalemia (6.9 mEq/L), and hypotension requiring high doses of norepinephrine. CRRT and corticosteroids were initiated. After 15 min of CRRT, the blood in the circuit had a milky color, and the therapy was interrupted because of high transmembrane pressure, despite adequate anticoagulation with heparin. Laboratory tests showed hypertriglyceridemia (782 mg/dL), increased transaminases, and creatine phosphokinase (5008 U/L), suggesting the rare and fatal PRIS.ConclusionThere is no established guideline for treating PRIS other than early discontinuation of Propofol and supportive care. Although CRRT is an important tool in managing PRIS, hypertriglyceridemia can cause circuit malfunction. Clinical hypervigilance and serial monitoring in at-risk patients are advised to minimize potentially lethal complications.

【 授权许可】

CC BY   
© The Japanese Society for Dialysis Therapy and BioMed Central Ltd. 2023

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