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Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS

An elderly man presenting with shortness of breath and hypoxaemia was admitted with acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Due to worsening hypoxaemia, he was transferred to the intensive care unit and required mechanical ventilation. Propofol was infused at 1.5–4 mg/kg/h...

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Autores principales: Babu, Vedesh Kumar, Rojas, Pedro, Perez Del Nogal, Genesis, Garcia-Fernandez, Alejandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906275/
https://www.ncbi.nlm.nih.gov/pubmed/36750301
http://dx.doi.org/10.1136/bcr-2022-249456
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author Babu, Vedesh Kumar
Rojas, Pedro
Perez Del Nogal, Genesis
Garcia-Fernandez, Alejandra
author_facet Babu, Vedesh Kumar
Rojas, Pedro
Perez Del Nogal, Genesis
Garcia-Fernandez, Alejandra
author_sort Babu, Vedesh Kumar
collection PubMed
description An elderly man presenting with shortness of breath and hypoxaemia was admitted with acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Due to worsening hypoxaemia, he was transferred to the intensive care unit and required mechanical ventilation. Propofol was infused at 1.5–4 mg/kg/hour. Within 48 hours of initiation, we noticed worsening metabolic acidosis, acute kidney injury, hyperkalaemia, hyperphosphataemia, hypertriglyceridaemia, elevated creatine kinase and elevated myoglobin levels. Suspecting propofol-related infusion syndrome (PRIS), we discontinued his propofol infusion immediately and initiated supportive measures. In 48 hours, there was a significant improvement in metabolic acidosis, hypertriglyceridaemia, rhabdomyolysis and renal function. The propofol infusion rate and cumulative propofol dosage (under 140 mg/kg) were well below levels associated with PRIS. COVID-19’s pathogenesis, still under investigation, may have contributed to this presentation. It is imperative for clinicians to maintain a high degree of suspicion once propofol is initiated, regardless of the cumulative dose or rate of infusion.
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spelling pubmed-99062752023-02-08 Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS Babu, Vedesh Kumar Rojas, Pedro Perez Del Nogal, Genesis Garcia-Fernandez, Alejandra BMJ Case Rep Case Reports: Adverse drug reactions and complications An elderly man presenting with shortness of breath and hypoxaemia was admitted with acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Due to worsening hypoxaemia, he was transferred to the intensive care unit and required mechanical ventilation. Propofol was infused at 1.5–4 mg/kg/hour. Within 48 hours of initiation, we noticed worsening metabolic acidosis, acute kidney injury, hyperkalaemia, hyperphosphataemia, hypertriglyceridaemia, elevated creatine kinase and elevated myoglobin levels. Suspecting propofol-related infusion syndrome (PRIS), we discontinued his propofol infusion immediately and initiated supportive measures. In 48 hours, there was a significant improvement in metabolic acidosis, hypertriglyceridaemia, rhabdomyolysis and renal function. The propofol infusion rate and cumulative propofol dosage (under 140 mg/kg) were well below levels associated with PRIS. COVID-19’s pathogenesis, still under investigation, may have contributed to this presentation. It is imperative for clinicians to maintain a high degree of suspicion once propofol is initiated, regardless of the cumulative dose or rate of infusion. BMJ Publishing Group 2023-02-07 /pmc/articles/PMC9906275/ /pubmed/36750301 http://dx.doi.org/10.1136/bcr-2022-249456 Text en © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.
spellingShingle Case Reports: Adverse drug reactions and complications
Babu, Vedesh Kumar
Rojas, Pedro
Perez Del Nogal, Genesis
Garcia-Fernandez, Alejandra
Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS
title Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS
title_full Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS
title_fullStr Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS
title_full_unstemmed Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS
title_short Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS
title_sort unusual case of propofol-related infusion syndrome complicating severe covid-19 ards
topic Case Reports: Adverse drug reactions and complications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906275/
https://www.ncbi.nlm.nih.gov/pubmed/36750301
http://dx.doi.org/10.1136/bcr-2022-249456
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