Nursing - Lorazepam caution
TOXIC EFFECT
A patient in the ICU who required mechanical ventilation was sedated with the anxiolytic lorazepam at doses up to 25 mg/hour. When his condition improved and attempts were made to wean him from the ventilator, he developed metabolic acidosis and a hyperosmolar state. Administering sodium bicarbonate didn’t resolve the problem. The lorazepam infusion was discontinued and midazolam was started, and the patient improved.
A patient who’s receiving mechanical ventilation may require sedation to prevent agitation. However, propylene glycol, a common vehicle for lorazepam injection, can become toxic when the drug is administered aggressively. It can trigger metabolic acidosis and hyperosmolality when lorazepam is given in high doses, over an extended period, or to a patient with severe renal impairment.
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If your patient is at risk for propylene glycol toxicity, frequently assess his acid-base status, serum osmolality, electrolyte levels, and osmolar gap. If he has signs of toxicity, administering lorazepam via the gastrointestinal tract or substituting an I.V. benzodiazepine that doesn’t use propylene glycol enables rapid weaning from the I.V. lorazepam yet sedates without triggering withdrawal.
Source: “Propylene Glycol Toxicity Related to High Dose Lorazepam Infusion: Case Report and Discussion,” American Journal of Critical Care, Arbour, R., January 1999.
Copyright Springhouse Corporation Jun 2000
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