A number of factors may contribute to an elevated blood lactate concentration following therapy with a drug containing propylene glycol.
Patient selection: infusion of a drug containing propylene glycol
Risk factors for hyperlactatemia:
(1) large amount of propylene glycol (high dose of a drug using a large amount of propylene glycol in its formulation)
(2) renal impairment
(3) small distribution volume (infant or small child)
Sufficient propylene glycol can be delivered when lorazepam is infused at a rate greater than 4 mg/h.
Manifestations:
(1) elevated osmolar gap
(2) elevated serum lactate concentration
(3) elevated serum propylene glycol concentration
