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Acute kidney injury, hyperosmolality and metabolic acidosis associated with lorazepam

Nature Clinical Practice Nephrology volume 3, pages 515–520 (2007)Cite this article

Abstract

Background A 54-year-old male with a history of multiple admissions for alcohol intoxication was admitted to hospital with right flank pain. He received a high-dose lorazepam infusion for alcohol withdrawal during hospitalization and developed severe hyperosmolality, high anion gap metabolic acidosis, and acute kidney injury on his eighth day of hospitalization.

Investigations Serum chemistries, arterial blood gas analysis, and measurement of serum propylene glycol, ethylene glycol and methanol levels.

Diagnosis Propylene glycol toxicity.

Management Discontinuation of lorazepam infusion, administration of fomepizole, hemodialysis for five consecutive days, hemodynamic support, and follow-up of serum osmolality as a measure of propylene glycol decay.

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Figure 1: Correlation between rate of infusion of high-dose lorazepam and serum propylene glycol concentrations at 48 hours
Figure 2: Correlation between serum propylene glycol concentration and osmolal gap at 48 hours

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Authors and Affiliations

  1. T Zar is a Senior Fellow in Nephrology in the Division of Nephrology and I Yusufzai is a Chief Medical Resident in the Department of Medicine at the University of Connecticut School of Medicine, Farmington, CT, USA.,

    Tausif Zar & Irfan Yusufzai

  2. A Sullivan is an Intensive Care Nurse Practitioner at the Hospital of Central Connecticut, and C Graeber is an Associate Professor of Medicine at the University of Connecticut School of Medicine and Associate Chief of Nephrology at the Hospital of Central Connecticut, New Britain, CT, USA.,

    Anna Sullivan & Charles Graeber

Authors
  1. Tausif Zar
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  2. Irfan Yusufzai
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  3. Anna Sullivan
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  4. Charles Graeber
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Correspondence to Tausif Zar.

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The authors declare no competing financial interests.

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Zar, T., Yusufzai, I., Sullivan, A. et al. Acute kidney injury, hyperosmolality and metabolic acidosis associated with lorazepam. Nat Rev Nephrol 3, 515–520 (2007). https://doi.org/10.1038/ncpneph0573

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  • DOI: https://doi.org/10.1038/ncpneph0573

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