Propylene glycol-induced side effects during intravenous nitroglycerin therapy

Intensive Care Medicine - Tập 14 - Trang 221-226 - 1988
H. E. Demey1, R. A. Daelemans2, G. A. Verpooten2, M. E. De Broe2, Ch. M. Van Campenhout3, F. V. Lakiere4, P. J. Schepens4, L. L. Bossaert1
1Department of Intensive Care, University of Antwerp U.I.A., University Hospital, Edegem, Belgium
2Department of Nephrology, University of Antwerp U.I.A., University Hospital, Edegem, Belgium
3Department of Clinical Chemistry, University of Antwerp U.I.A., University Hospital, Edegem, Belgium
4Department of Toxicology, University of Antwerp U.I.A., University Hospital, Edegem, Belgium

Tóm tắt

Propylene glycol, an alcohol frequently used as a solvent in medical preparations, is considered non-toxic. We found that this solvent, used in a commercially available IV nitroglycerin solution, may cause hyperosmolality, hemolysis and lactic acidosis. The influence of kidney function as the main determinant in causing accumulation of this solvent and consequently hyperosmolality is emphasized. A review of the literature dealing with propylene glycol is given. The possible mechanisms of neurological disturbances occurring during IV nitroglycerin therapy are discussed.

Tài liệu tham khảo

Wade A, Reynolds JEF (eds) (1977) Martindale the extra pharmacopoeia. Pharmaceutical Press, London, p 629 Shook TL, Kirshenbaum JM, Hundley R, Shorey JM, Lamas GA (1984) Ethanol intoxication complicating intravenous nitroglycerin therapy. Ann Intern Med 101:498 Korn SH, Comer JB (1985) Intravenous nitroglycerin and ethanol intoxication. Ann Intern Med 102:274 Daly TJ, Camann WR, Dawley D, O'Rourke ME (1984) “Cocktail”-coronary care. N Engl J Med 310:1123 Bismuth C (1983) Management of specific poisonings. In: Tinker J, Rapin M (eds) Care of the critically ill patient. Springer, Berlin Heidelberg New York, p 829 Klaassen CD (1980) Propylene glycol. In: Goodman LS, Gilman A (eds) Goodman and Gilman's the pharmacological basis of therapeutics. MacMillan, New York, p 1647 Kaplan K, Reed MT, Davison R (1985) Intravenous nitroglycerin in unstable angina. Cardiovasc Rev Reports 6:279 Bekeris I, Baker C, Fenton J, Kimball D, Bermes E (1979) Propylene glycol as a cause of an elevated serum osmolality. Am J Clin Pathol 72:633 Kulick MI, Lewis NS, Bansal V, Warpeha R (1980) Hyperosmolality in the burn patient: analysis of an osmolal discrepancy. J Trauma 20:223 Fligner CL, Jack R, Twiggs GA, Ralays VA (1985) Hyperosmolality induced by propylene glycol. JAMA 253:1606 Glasgow AM, Boeckx RL, Miller MK, McDonald MG, August GP (1983) Hyperosmolality in small infants due to propylene glycol. Pediatrics 72:353 Morizono T, Johnstone BM (1975) Ototoxicity of chloramphenicol ear drops with propylene glycol as solvent. Med J Aust 2:634 Andersen KE, Storrs FJ (1982) Skin irritation caused by propylene glycol. Hautarzt 33:12 Cate JC, Hedrick R (1980) Propylene glycol intoxication and lactic acidosis. N Engl J Med 303:1237 Kelner MJ, Bailey DN (1985) Propylene glycol as a cause of lactic acidosis. J Anal Toxicol 9:40 Martin G, Finberg L (1970) Propylene glycol: a potentially toxic vehicle in liquid dosage form. J Pediatr 77:877 Arulanantham K, Genel M (1978) Central nervous system toxicity associated with ingestion of propylene glycol. J Pediatr 93:515 Demey H, Daelemans R, De Broe ME, Bossaert L (1984) Propylene glycol intoxication due to intravenous nitroglycerin. Lancet 1:1360 Dorwart WV, Chalmers L (1975) Comparison of methods for calculating serum osmolality from chemical concentrations, and the prognostic values of such calculations. Clin Chem 21:190 Weisberg HF (1975) Osmolality-calculated, “delta”, and more formulas. Clin Chem 21:1182 Glasser L, Sternglanz PD, Combie J, Robinson A (1973) Serum osmolality and its applicability to drug overdose. Am J Clin Pathol 60:695 Gennari FJ (1984) Serum osmolality. Uses and limitations. N Engl J Med 310:102 Yu DK, Sawchuk RJ (1983) Gas-liquid chromatographic determination of propylene glycol in plasma and urine. Clin Chem 29:2088 Yu DK, Elmquist WF and Sawchuk RJ (1985) Pharmacokinetics of propylene glycol in humans during multiple dosage regimens. J Pharm Sci 74:876 Ruddick JA (1972) Toxicology, metabolism and biochemistry of 1,2 propanediol. Toxicol Appl Pharmacol 21:102 Brittain RT, D'Arcy PF (1962) Hematologic effects following the intravenous injection of propylene glycol in the rabbit. Toxicol Appl Pharmacol 4:738 Cadwallader DE (1963) Behaviour of erythrocytes in various solvent systems. J Pharm Sci 52:1175 Potter BJ (1958) Haemoglobinuria caused by propylene glycol. Br J Pharmacol 13:385 Randolph TG, Mallery OT (1944) The effect of propylene glycol on erythrocytes. J Lab Clin Med 29:197 Varriale P, Kwa R, Vyas P (1984) Intravenous nitroglycerin in transfusion therapy for severe anemia. Arch Intern Med 144:401 Col J, Col-Debeys C, Lavenne-Pardonge E, Meert PH, Hericks L, Broze MC, Moriau M (1985) Propylene glycol-induced heparin resistance during nitroglycerin infusion. Am Heart J 110:171 Telford AM, Wilson C (1981) Trial of heparin versus atenolol in prevention of myocardial infarction in intermediate coronary syndrome. Lancet 1:1225 Wood P (1961) Acute and subacute coronary insufficiency. Br Med J 1:1779 Shorey J, Bhardwaj N, Loscalzo J (1984) Acute Wernicke's encephalopathy after intravenous infusion of high-dose nitroglycerin. Ann Intern Med 101:500 Ohar JM, Fowler AA, Selhorst JB, Glauser FL (1985) Intravenous nitroglycerin administration and ethanol. Ann Intern Med 102:558 Alexander J, Kaplan K, Davison R, Blonsky ER, Gilbert J (1983) Intravenous nitroglycerin-induced abducens nerve palsy. Am Heart J 106:1159 Gagnon RL, Marsh ML, Smith RW, Shapiro HM (1979) Intracranial hypertension caused by nitroglycerin. Anesthesiology 51:86 Cottrell JE, Gupta B, Rappaport H, Turndorf H, Ransohoff J, Flamm ES (1980) Intracranial pressure during nitroglycerin-induced hypotension. J Neurosurg 53:309 Ghani GA, Sung YF, Weinstein MS, Tindall GT, Fleischer AS (1983) Effects of intravenous nitroglycerin on the intracranial pressure and volume-pressure response. J Neurosurg 58:562 Ohar JM, Fowler AA, Selhorst JB, Glauser FL (1985) Intravenous nitroglycerin-induced intracranial hypertension. Crit Care Med 13:867