A patient with high anion gap metabolic acidosis and increased serum osmolal gap

A case of a 61-year-old male who presented with ethylene glycol (EG) toxicity but experienced secondary propylene glycol (PG) toxicity from formulated medications that were administered to him has been described. At presentation EG toxicity was confirmed using gas chromatography (GC) and PG was negative. Thirteen hours after treatment was initiated, the laboratory results of this patient showed a PG peak while GC showed a negative EG. The patient’s initial treatments included emergent hemodialysis followed by continuous veno-venous hemofiltration and fomepizole as well as phenytoin and a high dose of lorazepam drip for a witnessed seizure. The two medications contained PG at 40% (v/v) and 80% (v/v), respectively, which led to the new peak of PG 13hours later while the EG was cleared. Although PG poisoning is rare, its toxicity due to excessive and rapid infusion of medications containing PG is being increasingly reported.