Case
Published · Updated · 2 min read
Severe propofol infusion syndrome: recovery after drug withdrawal and multimodal organ support
What it means for practice
Sudden cardiovascular collapse with severe metabolic derangement during propofol infusion should prompt suspicion of propofol infusion syndrome, immediate drug withdrawal, and rapid organ support.
Summary
A case of severe propofol infusion syndrome (PRIS) was reported in a 21-year-old man with previous traumatic brain injury. Refractory status epilepticus required mechanical ventilation and prolonged propofol sedation.
Clinical course and treatment
After four days of infusion, he abruptly developed bradycardia, cardiogenic shock, severe high-anion-gap metabolic acidosis, rhabdomyolysis, acute kidney injury, hypertriglyceridemia, and significant left ventricular dysfunction. The authors considered the combination of prolonged propofol exposure and rapidly evolving multiorgan failure consistent with PRIS.
Propofol was discontinued immediately. Treatment included multiple vasoactive infusions, sodium bicarbonate, calcium chloride, high-effluent continuous renal replacement therapy through two dialysis circuits, high-dose euglycemic insulin, and enteral L-carnitine.
Outcome and limitations
Hemodynamic improvement occurred within approximately six hours, followed by recovery of cardiac and renal function. The patient was discharged from the intensive care unit on day 30 and returned home after rehabilitation without dialysis dependence.
The authors emphasize early recognition of PRIS and rapid escalation of individualized organ support in severe presentations. However, a single case cannot establish the contribution of individual adjunctive treatments to the patient's recovery.
Case analysis
- Likely mechanism
- Generally accepted pharmacological explanation, not provided in the abstract: propofol can impair mitochondrial energy production, including fatty acid oxidation, causing an energy deficit in cardiac and skeletal muscle.
- Causality assessment
- Editorial WHO-UMC assessment: possible. The temporal relationship with propofol exposure and the clinical presentation support suspected PRIS, but the abstract does not allow adequate assessment of alternative causes. Improvement after withdrawal occurred alongside several simultaneous interventions; rechallenge is not described. The authors do not report a formal causality category.
- Take-home lesson
- During prolonged propofol infusion, a sudden combination of cardiovascular collapse, acidosis, and muscle or kidney injury should prompt early recognition of PRIS, immediate propofol withdrawal, and rapid organ support. This case does not establish the efficacy of any individual adjunctive intervention.
Source
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Power R, El Katan M, Wibrow B, et al. Severe Propofol Infusion Syndrome Managed With Multimodal Critical Care: A Case Report. Cureus. 2026;18(10):e118902. doi:10.7759/cureus.118902
PubMed 42968967 DOI 10.7759/cureus.118902 Original: pubmed.ncbi.nlm.nih.gov
Reviewed by: DrugCard editorial team ·
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