Prolonged use of which intravenous agent may lead to lactic acidosis?

Prolonged use of which intravenous agent may lead to lactic acidosis?

• A. Thiopental
• B. Diazepam
• C. Etomidate
• D. Propofol

Answer: (D)

Prolonged high-dose infusion of propofol can cause a syndrome known as Propofol Infusion Syndrome, which includes metabolic acidosis with elevated lactate. The reason this happens is that propofol at sustained, large doses impairs mitochondrial function, specifically oxidative phosphorylation and fatty acid oxidation. When the mitochondria aren’t producing energy efficiently, tissues rely more on anaerobic metabolism, producing lactate and leading to lactic acidosis. This risk rises with prolonged infusions (for example, extended ICU sedation or high-dose maintenance) and is more likely in critically ill patients. Other intravenous agents listed do not have this same mitochondria-focused risk profile, so they are not typically associated with this pattern of lactic acidosis.

Prolonged high-dose infusion of propofol can cause a syndrome known as Propofol Infusion Syndrome, which includes metabolic acidosis with elevated lactate. The reason this happens is that propofol at sustained, large doses impairs mitochondrial function, specifically oxidative phosphorylation and fatty acid oxidation. When the mitochondria aren’t producing energy efficiently, tissues rely more on anaerobic metabolism, producing lactate and leading to lactic acidosis. This risk rises with prolonged infusions (for example, extended ICU sedation or high-dose maintenance) and is more likely in critically ill patients. Other intravenous agents listed do not have this same mitochondria-focused risk profile, so they are not typically associated with this pattern of lactic acidosis.