A patient in the ICU is started on Propofol infusion for sedation at 50 text mcg/kg/min . After 48 hours, the patient develops metabolic acidosis, elevated triglycerides, elevated CK, and kidney failure. What is the MOST likely complication?

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Nursing QUESTION #9246

Question 1

A patient in the ICU is started on Propofol infusion for sedation at \(50 \text{ mcg/kg/min}\). After 48 hours, the patient develops metabolic acidosis, elevated triglycerides, elevated CK, and kidney failure. What is the MOST likely complication?

Propofol-induced hepatotoxicity
Propofol Infusion Syndrome (PRIS)✔️
Opioid-induced hyperalgesia
Benzodiazepine withdrawal syndrome

Correct Answer Explanation

Correct Answer: B — Propofol Infusion Syndrome (PRIS)

Propofol Infusion Syndrome (PRIS) is a rare but life-threatening complication of prolonged high-dose propofol infusion.

Risk factors:

Dose \(> 5 \text{ mg/kg/hr}\) (or \(> 83 \text{ mcg/kg/min}\)) for \(> 48\) hours
Concomitant use of catecholamines or corticosteroids
Low carbohydrate intake
Children (higher risk)

Clinical features of PRIS (PRIS mnemonic):

Pink/lipemic plasma, rhabdomyolysis
Renal failure (AKI)
Increase in CK, triglycerides
Severe metabolic acidosis, cardiac failure

Management:

Immediately stop propofol infusion
Switch to alternative sedation (midazolam, dexmedetomidine)
Supportive care (CRRT for renal failure)
Treat metabolic acidosis

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