Introduction 
Propofol infusion syndrome (PRIS) is a rare and fatal complication of high dose administration of propofol. We introduce a case report of a critically-ill patient who received high-dose intravenous (IV) pushes of propofol that resulted in rhabdomyolysis, metabolic acidosis, shock, multi-organ failure, and death. 

Patient Course 
A 48-year-old male diagnosed with acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia was intubated and sedated with propofol and fentanyl. He initially improved on the ventilator, but began to suffer emesis. Ileus was suspected. Imaging was not consistent with aspiration. Patient began to require large propofol boluses for adequate sedation and ventilation, greater than 4mg/kg/hr for several hours. The patient declined with progressive renal failure and increasing creatine kinase (CK). Due to elevation of CK and concern for PRIS, sedative medication was changed to midazolam. Patient soon required continuous renal replacement therapy (CRRT) due to oliguria/hyperkalemia. Evidence of shock liver became apparent. Patient required progressive amounts of vasopressors. Family decided to pursue comfort measures due to poor prognosis. 

Discussion 
PRIS is related to impaired free fatty acid metabolism and mitochondrial activity disruption causing an imbalance between energy production and utilization leading to peripheral and cardiac muscle necrosis. Typically, doses greater than 4-5mg/kg/hr are used in PRIS cases. Other hallmarks of PRIS include metabolic acidosis, kidney and cardiac failure, and hypertriglyceridemia. Treatment is generally supportive. Immediate withdrawal of propofol is recommended on suspicion. Other risk factors for PRIS include mitochondrial disease, exogenous catecholamine or glucocorticoid administration, inadequate carbohydrate intake, or critical illness. 

Our patient’s history fits with PRIS, due to his treatment with steroids and vasopressors, along with large doses of propofol. Carbohydrate rich diet may slow the progression of PRIS. Our patient worsened after cessation of tube feeds, potentially contributing to this patient’s syndrome. After our presented patient’s clinical picture became more evident for PRIS, sedation was transitioned to a non-propofol regimen, utilizing midazolam. In retrospect, a cardiac workup may have benefited diagnosis, as the literature seems to demonstrate that cardiac involvement is common. Triglyceride surveillance may aid in detection of impending complications of propofol, due to correlation with iatrogenic pancreatitis. 

Conclusion 
PRIS is a rare, lethal syndrome that has the best prognosis with early detection; our case demonstrates need for high index of suspicion for PRIS, and utilization of early interventions such as recognition of laboratory excursions, withdrawal of propofol, utilization of fluids, and a carbohydrate rich diet.

A Rare Case of Propofol Related Infusion Syndrome

Clinical Vignettes | Pulmonology / Critical Care Medicine / Sleep Medicine

poster

Welcome to the largest national, multi-specialty research event **featuring research from 750 medical students, residents and fellows, and international medical graduates.**


#### Event Details
The 2022 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. Log in at any time throughout the event to:
* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with participants** and provide feedback to help advance their research

At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges and compete to win a $10,000 grand prize sponsored by Laurel Road.
 

#### Attend Live Forums
**Oct. 20, 6 — 7 p.m. Central**
 **How to plan a career in academic medicine** 
 Learn how to plan a career in academic medicine and get your questions answered. [Access Here](https://underline.io/events/363/lounge)
 
 **Speakers**
![](https://assets.underline.io/uploads/markdown_image/1/image/d5adb133dfc58eb0a6d469e9cedcd5d4.jpg)
Ricardo Correa, MD, EdD
![](https://assets.underline.io/uploads/markdown_image/1/image/5f9437ab87861538bf02b9ca7c0d926e.jpg)
Stuart M. Greenstein, MD
![](https://assets.underline.io/uploads/markdown_image/1/image/05b1b637c99286d558c371f8e8b185ce.jpg)
Stephanie Strohbeen, MD
 
 **Oct. 22, 11 a.m. — Noon Central**
 **How to get published**
 Learn tips to get your research published and get your questions answered. [Access Here](https://underline.io/events/363/lounge)
 
 **Speakers**
![](https://assets.underline.io/uploads/markdown_image/1/image/8ce6235e957d31cb5e6f9097cc6f6972.jpg)
Jessica Li, MD/PhD Candidate
![](https://assets.underline.io/uploads/markdown_image/1/image/9950ef2e0237f54cb3d8280334d42491.jpg)
Charles Lopresto, DO

### Sponsor
AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on Dec. 7 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)

**There is no registration fee for this event! **

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals.

**Please use the link below to register for free if you have not already done so:**

https://www.ama-assn.org/about/events/ama-research-challenge

Registration Is Required

AMA Research Challenge 2022

Welcome to the largest national, multi-specialty research event featuring research from 750 medical students, residents and fellows, and international medical graduates.


Daniel Heck

1

SHORT BIO

Presentations

A Rare Case of Propofol Related Infusion Syndrome

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES