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Unusual case of propofol-related infusion syndrome complicating severe COVID-19 ARDS
  1. Vedesh Kumar Babu,
  2. Pedro Rojas,
  3. Genesis Perez Del Nogal and
  4. Alejandra Garcia-Fernandez
  1. Internal Medicine Residency, Texas Tech University Health Sciences Center School of Medicine, Odessa, Texas, USA
  1. Correspondence to Dr Vedesh Kumar Babu; vebabu{at}


An elderly man presenting with shortness of breath and hypoxaemia was admitted with acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Due to worsening hypoxaemia, he was transferred to the intensive care unit and required mechanical ventilation. Propofol was infused at 1.5–4 mg/kg/hour. Within 48 hours of initiation, we noticed worsening metabolic acidosis, acute kidney injury, hyperkalaemia, hyperphosphataemia, hypertriglyceridaemia, elevated creatine kinase and elevated myoglobin levels. Suspecting propofol-related infusion syndrome (PRIS), we discontinued his propofol infusion immediately and initiated supportive measures. In 48 hours, there was a significant improvement in metabolic acidosis, hypertriglyceridaemia, rhabdomyolysis and renal function. The propofol infusion rate and cumulative propofol dosage (under 140 mg/kg) were well below levels associated with PRIS. COVID-19’s pathogenesis, still under investigation, may have contributed to this presentation. It is imperative for clinicians to maintain a high degree of suspicion once propofol is initiated, regardless of the cumulative dose or rate of infusion.

  • COVID-19
  • Drugs and medicines
  • Adult intensive care
  • Unwanted effects / adverse reactions
  • Acute renal failure

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  • Contributors VKB will remain the guarantor, he contributed to the conceptualisation, drafting of the case presentation and final proofreading of the manuscript. PR and GPDN have contributed to drafting the introduction and case discussion. AG-F and GPDN have contributed to the final proofreading of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.