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ACUTE EXPOSURE INFORMATION

1. USES: Propylene glycol has many uses. It is an ingredient in antifreeze and deicing fluids, foods, drugs, cosmetics, liquid detergents, paints and coatings, inks, and polyester resins. Some examples of medications that include propylene glycol as an intravenous diluent/solvent include: etomidate, lorazepam, diazepam, esmolol, phenytoin, nitroglycerin, pentobarbital, phenobarbital, hydrocortisone, digoxin, and trimethoprim/sulfamethoxazole. Most significant human toxicity results from exposure to large does of intravenous medications that contain propylene glycol as a solvent/diluent.

2. TOXICOLOGY: In general, propylene glycol is considered nontoxic; however, patients receiving large doses (especially by intravenous administration) can become acidotic, as it is metabolized to lactic acid. Reported renal toxicity from chronic exposure is thought secondary to proximal renal tubular injury, with excessive dilation of the proximal renal tubules and disrupted brush borders.

3. EPIDEMIOLOGY: Significant toxicity is extremely rare, with case reports described in the literature developing after rapid intravenous administration or prolonged intravenous infusion of drugs with propylene glycol as a diluent.

4. WITH THERAPEUTIC USE
   1. No adverse effects are expected from propylene glycol when administered in therapeutic doses to healthy individuals.

5. WITH POISONING/EXPOSURE
   1. MILD TO MODERATE TOXICITY: Most exposures will be asymptomatic. In patients with chronic exposure secondary to medication administration, there are reports of metabolic acidosis, hyperosmolality, and hyperglycemia. There are also concerns of prolonged intravenous administration causing proximal renal tubular toxicity. Finally, otic suspensions in animal studies have been linked to hearing impairment.
   2. SEVERE TOXICITY: Rapid administration of propylene glycol during intravenous phenytoin infusion has been reported to cause cardiotoxicity, including hypotension, bradycardia, increased QRS intervals, increased T wave amplitudes, and transient ST elevations, ventricular dysrhythmias, and even death. Severe metabolic acidosis, decreased level of consciousness, and seizures have been reported after large acute ingestions, prolonged intravenous infusion of high doses and rarely after prolonged ingestion or topical use of normal therapeutic doses. Intravenous infusion of drugs with high concentrations of propylene glycol (more than 30%) can cause hemolysis.

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