Episode 92: PRIS and propylene glycol toxicity, with Jerry Snow

Propofol Infusion Syndrome (PRIS) and propylene glycol toxicity represent rare but critical iatrogenic complications in intensive care settings. PRIS, linked to high-dose and prolonged propofol administration, stems from mitochondrial dysfunction, manifesting as a triad of elevated lactate, metabolic acidosis, and cardiac dysfunction. Similarly, propylene glycol toxicity—a byproduct of lorazepam infusions—mimics toxic alcohol poisoning, characterized by an elevated osmolar gap and lactic acidosis. Medical toxicologist Dr. Jerry Snow emphasizes that these conditions are primarily clinical diagnoses requiring a high index of suspicion, especially when patients on long-term, high-dose sedation exhibit unexplained organ dysfunction. Management centers on early recognition, immediate cessation of the offending agent, and supportive care, with potential interventions like fomepizole or renal replacement therapy for severe cases. Avoiding these toxicities requires careful dose monitoring and, when possible, utilizing alternative sedative agents.