Syndrome of the week

This week's syndrome comes from the realm of critical care:
"The propofol infusion syndrome".
The propofol infusion syndrome is a rare and often fatal syndrome originally described in critically ill children undergoing long-term propofol infusion at high doses. Recently several cases have been reported in adults, too. These adult cases were mostly patients with acute neurologic illnesses or acute inflammatory diseases complicated by severe infections or even sepsis, and receiving catecholamines and/or corticosteroids in addition to propofol.
The main features of the syndrome consist of cardiac failure, rhabdomyolysis, severe metabolic acidosis and renal failure associated with hyperkalemia. Central nervous system activation with production of catecholamines and glucocorticoids, and systemic inflammation with cytokine production are priming factors for cardiac and peripheral muscle dysfunction. High-dose propofol, but also supportive treatments with catecholamines and corticosteroids, act as triggering factors.
At the subcellular level, propofol impairs free fatty acid utilization and mitochondrial activity. Imbalance between energy demand and utilization is a key pathogenetic mechanism, which may lead to cardiac and peripheral muscle necrosis. The syndrome can be lethal if not identified early, and caution should be exercised when using prolonged (>48 h) propofol sedation at doses higher than 75 μg/kg/min, particularly in patients with acute neurologic or inflammatory illnesses.

see also this link for a related abstract:
http://www.theannals.com/cgi/content/abstract/36/9/1453

Ref:MKSAP14

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