Propylene glycol toxicity complicating use of barbiturate coma.

INTRODUCTION: Barbiturate coma is a necessary medical therapy in certain instances, such as the treatment of refractory status epilepticus or severe intracranial hypertension, but its use is often wrought with serious complications. Potential complications include hemodynamic instability, respiratory depression, and immunosuppression with frequent nosocomial infections. High doses of barbiturates may also lead to the accumulation of propylene glycol, the vehicle used in the intravenous formulations of both pentobarbital and phenobarbital, thereby yielding another less-recognized complication of therapy.

RESULTS: We present a case of propylene glycol toxicity associated with the use of high-dose intravenous pentobarbital and phenobarbital during the treatment of refractory status epilepticus.