Propofol
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Mitochondrial cytopathy: case report A 32-year-old man developed mitochondrial cytopathy during treatment with propofol and unspecified steroids. The man presented with fatigue and tachycardia following a workout. The initial examination showed sinus tachycardia and chest, abdomen and pelvis CT imaging was found to be unremarkable. Subsequently, he was admitted to the hospital and overnight became increasingly agitated. His lactate level was increased to 11 from 2. Then he was desaturated on the floor and subsequently intubated and transferred to the ICU. Following intubation, he received propofol for sedation [route and dosage not stated]. In the ICU, his lactate remained elevated at 11. Therefore, he was initiated with unspecified broad spectrum antibiotics. A central line was placed with central venous oxygen saturation (CVO2)>90%. Subsequent CSF examination following a lumbar puncture was negative for infection and EEG was found to be negative for seizure. On ICU admission day 2 , propofol therapy was stopped because of his elevated lactate level. He was noted to have fever (104°F), which continued till day 5. On ICU admission day 5, an acute worsening of his BP was noted along with a decrease in CVO2 to 45%. Subsequently, trans-thoracic echo-cardiogram revealed bi-ventricular hypokinesis with an ejection fraction of 15%. Due to his worsening cardiac function and poor mental status, he received unspecified steroids. Following steroid initiation, he developed acute onset of rhabdomyolysis with creatine kinase>88000. Subsequent muscle biopsy for mitochondrial disorders revealed lack of cytochrome oxidase staining, suggesting a defect in the complex IV of the electron transport chain. He was diagnosed with mitochondrial cytopathy [durations of treatments to reaction onset not stated]. Thereafter, he developed bilateral blindness and acute renal failure. The man therefore started treatment with biotin, thiamine, riboflavin, levocarnitine, ubidecarenone [CoQ10], acetylcysteine [Nacetylcysteine], folinic acid [leucovorin], pyridoxine and vitamin E [outcome not stated]. McNeill JN. The case of the unexplained lactate: The role of mitochondria. American Journal of Respiratory and Critical Care Medicine 199: no pagination abstr. A1736, No. 803446882 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1736 [abstract]
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Reactions 18 Jan 2020 No. 1787
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