Does lorazepam cause metabolic acidosis?

Does lorazepam cause metabolic acidosis?

Hyperosmolality, metabolic acidosis and AKI are classic signs of propylene glycol toxicity in patients receiving high-dose lorazepam.

Can Ativan cause lactic acidosis?

After 18 days of high-dose continuous infusion of lorazepam (maximum dose 50 mg/h), the patient developed severe lactic acidosis secondary to propylene glycol toxicity, the main diluent of lorazepam. The acidosis temporarily resolved with bicarbonate administration and discontinuation of lorazepam.

What are the symptoms of lactic acidosis?

The symptoms of lactic acidosis include abdominal or stomach discomfort, decreased appetite, diarrhea, fast, shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness.

What drugs cause lactic acidosis?

Drugs such as metformin, linezolid, propofol, intravenous epinephrine, inhaled beta agonists (eg, albuterol), and nucleoside reverse transcriptase inhibitors (NRTIs), which are used for treatment of human immunodeficiency virus (HIV), have been linked to lactic acidosis.

What medications affect anion gap?

The most common drugs and chemicals that induce the anion gap type of acidosis are biguanides, alcohols, polyhydric sugars, salicylates, cyanide and carbon monoxide.

What is propylene glycol toxicity?

How Toxic Is Propylene Glycol? The toxicity of propylene glycol is very low. It has not been found to cause cancer, damage genes or interfere with fertility or reproduction. Moreover, there are no reported deaths on record ( 1 , 9 ).

What is lactate acidosis?

Lactic acidosis occurs when lactic acid production exceeds lactic acid clearance. The increase in lactate production is usually caused by impaired tissue oxygenation, either from decreased oxygen delivery or a defect in mitochondrial oxygen utilization. (See “Approach to the adult with metabolic acidosis”.)

What are the symptoms of acidosis?

People with metabolic acidosis often have nausea, vomiting, and fatigue and may breathe faster and deeper than normal. People with respiratory acidosis often have headache and confusion, and breathing may appear shallow, slow, or both. Tests on blood samples typically show pH below the normal range.

What medications can cause metabolic acidosis?

All could lead to acidosis.

• CA inhibitors (e.g. acetazolamide) 25.
• Anti-viral/HIV drugs (e.g. lamivudine, stavudine 75 and tenofovir 121– 124).
• Platinum-containing agents (e.g. cisplatin 126, 127) and DNA alkylating agents (e.g. ifosfamide 128– 130) are common proximal tubule toxins.
• Valproic acids (VPAs) 131– 133

What drugs can cause metabolic acidosis?

What drugs cause Hyperchloremic metabolic acidosis?

Angiotensin-converting enzyme inhibitors (ACEIs), aldosterone receptor blockers (ARBs), and renin inhibitors all interfere with the renin-angiotensin-aldosterone system (RAAS), causing hyperkalemia with hyperchloremic metabolic acidosis 102– 104.

Does lorazepam contain propylene glycol?

Intravenous lorazepam contains propylene glycol, which has been associated with toxicity when high doses of lorazepam are administered.

How does propylene glycol cause lactic acidosis?

Propylene glycol is a diluent found in many IV and oral medications, including phenytoin, diazepam and lorazepam. Propylene glycol is eliminated from the body by oxidation through alcohol dehydrogenase to form lactic acid (Figure 1).

How do you reverse lactic acidosis?

Thiamine is a water-soluble vitamin that plays a pivotal role in carbohydrate metabolism. In acute deficiency, pyruvate accumulates and is metabolized to lactate, and chronic deficiency may cause polyneuropathy and Wernicke encephalopathy.

What drugs cause metabolic acidosis?

What is metabolic acidosis and its signs and symptoms?

Causes include accumulation of ketones and lactic acid, renal failure, and drug or toxin ingestion (high anion gap) and gastrointestinal or renal HCO3− loss (normal anion gap). Symptoms and signs in severe cases include nausea and vomiting, lethargy, and hyperpnea.

What is the most common cause of metabolic acidosis?

The most common causes of hyperchloremic metabolic acidosis are gastrointestinal bicarbonate loss, renal tubular acidosis, drugs-induced hyperkalemia, early renal failure and administration of acids.

What are three 3 causes of metabolic acidosis?

Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body’s acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids.

What are three causes of metabolic acidosis?

It can be caused by:

• Cancer.
• Carbon monoxide poisoning.
• Drinking too much alcohol.
• Exercising vigorously for a very long time.
• Liver failure.
• Low blood sugar (hypoglycemia)
• Medicines, such as salicylates, metformin, anti-retrovirals.
• MELAS (a very rare genetic mitochondrial disorder that affects energy production)