Propylene Glycol Toxicity And Treatment

Propylene glycol is a clear,colorless and viscous liquid with a faintly sweet taste. Its chemical structure is CH3CH[OH]CH3OH.

Propylene glycol and ethylene glycol have similar physical properties and uses. Their chemical structures differ by only one methyl group (ethylene glycol = HOCH2CH2OH; propylene glycol = CH3CH[OH]CH2OH).

Humans are susceptible to acute poisoning from ethylene glycol. Contrarily, propylene glycol is a food and pharmaceutical component that is "generally recognized as safe".
Although propylene glycol is frequently used as a solvent for intravenous drugs, it has the potential to be hazardous when given in high concentrations quickly. The toxicity of propylene glycol often does not affect exposures in the workplace or environment. The most frequent cause of propylene glycol toxicity is iatrogenic propylene glycol overdose.
An iatrogenic overdose of propylene glycol can result in the following:

Anion gap metabolic acidosis and hyperosmolality, which are frequently accompanied with acute kidney damage and the possibility of multisystem organ failure, as well as refractory hypotension, arrhythmias or emolysis, renal dysfunction or seizures, and coma. Pediatric patients may experience convulsions and CNS depression.
The use of propylene glycol as a diluent for the intravenous administration of benzodiazepines has been responsible for the majority of recorded cases of propylene glycol poisoning.
Hyperosmolality, increased lactate, refractory hypotension, arrhythmias, hemolysis, and renal failure are some of the main toxicological outcomes of propylene glycol intoxication.

Patients in intensive care, for example, might experience toxicity from either of the following:

Excessively large or rapidly infused intravenous injections of propylene glycol-containing medications;prolonged dermal contact during treatment of burns ;patients at risk for propylene glycol toxicity include the following:

Patients with underlying kidney disease;Patients with less effective or impaired alcohol dehydrogenase enzyme systems (e.g., children younger than 4 years, pregnant women, patients with hepatic disease, and patients treated with disulfiram or metronidazole);Patients with epilepsy;Burn patients who receive extensive dermal applications of propylene glycol.

Because this disorder is iatrogenic, prevention by limiting the dosage of propylene glycol given to patients in the intensive care unit might be the best treatment. Healthcare providers should consider a 50% reduction in the maximum daily dose for patients with underlying risk factors. The maximum daily dose of drug for a pediatric patient can be extrapolated from the adult data (based on a 70-kg patient) .

Anion gap metabolic acidosis and hyperosmolality, which are frequently accompanied with acute kidney damage and the possibility of multisystem organ failure, as well as refractory hypotension, arrhythmias or emolysis, renal dysfunction or seizures, and coma. Pediatric patients may experience convulsions and CNS depression.
The use of propylene glycol as a diluent for the intravenous administration of benzodiazepines has been responsible for the majority of recorded cases of propylene glycol poisoning.
Hyperosmolality, increased lactate, refractory hypotension, arrhythmias, hemolysis, and renal failure are some of the main toxicological outcomes of propylene glycol intoxication.