Propofol Infusion Syndrome Full Presentation — FRCA Final MCQ

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HardIntensive Care MedicinePropofol Infusion Syndrome Full PresentationFRCA Final

A 65-year-old man (ASA IV) in ICU has refractory status epilepticus treated with propofol infusion for burst suppression for 48 hours. His triglycerides are 8.5 mmol/L. He now develops metabolic acidosis (pH 7.18), cardiac failure, rhabdomyolysis (CK 85000), and a Brugada-type ECG pattern. What is the unifying diagnosis?

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Correct answer: D — Propofol infusion syndrome

Propofol infusion syndrome (PRIS) is characterised by: metabolic acidosis (lactic), rhabdomyolysis (elevated CK), hyperkalaemia, cardiac failure (Brugada-type ECG – coved ST elevation in V1-V3), lipaemia (elevated triglycerides from propofol lipid formulation), and renal failure. It typically occurs with propofol infusions >4 mg/kg/hr for >48 hours. The mechanism involves impaired mitochondrial fatty acid oxidation. Risk factors: high-dose propofol, prolonged infusion, critical illness, catecholamine use, and low carbohydrate intake. Treatment: STOP propofol immediately, supportive care (haemofiltration, inotropic support, bicarbonate).

Reference: MHRA – 2014 – Propofol infusion syndrome; RCOA – 2023 – ICM pharmacology