Propylene Glycol Poisoning From Excess Whiskey Ingestion: A Case of High Osmolal Gap Metabolic Acidosis.

Courtney A Cunningham,Gloria R Sue,Kevin Ku

doi:10.1177/2324709615603722

Abstract

In this report, we describe a case of high anion gap metabolic acidosis with a significant osmolal gap attributed to the ingestion of liquor containing propylene glycol. Recently, several reports have characterized severe lactic acidosis occurring in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam. To date, no studies have explored potential effects of excess propylene glycol in the setting of alcohol intoxication. Our patient endorsed drinking large volumes of cinnamon flavored whiskey, which was likely Fireball Cinnamon Whisky. To our knowledge, this is the first case of propylene glycol toxicity from an intentional ingestion of liquor containing propylene glycol.

Highlights

Propylene glycol is a widely used organic compound that is approved by the US Food and Drug Administration for use as a preservative in foods and as a solvent in pharmaceuticals.[1]
We describe a case of high anion gap metabolic acidosis with a significant osmolal gap attributed to the ingestion of liquor containing propylene glycol
We present an interesting case of metabolic acidosis and a large osmolal gap from the excess ingestion of liquor containing propylene glycol

Summary

Introduction

Propylene glycol is a widely used organic compound that is approved by the US Food and Drug Administration for use as a preservative in foods and as a solvent in pharmaceuticals.[1]. Several reports have characterized severe lactic acidosis occurring in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam.[3,4] To date, no studies have explored potential effects of excess propylene glycol in the setting of alcohol intoxication. We describe a case of high anion gap metabolic acidosis with a significant osmolal gap attributed to the ingestion of liquor containing propylene glycol.

Results

Conclusion