Propofol Infusion Syndrome — FRCA Primary MCQ
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Correct answer: C — Rhabdomyolysis, metabolic acidosis, hyperlipidaemia and rapidly progressive cardiac failure
Option C is correct. Propofol infusion syndrome is a potentially fatal constellation including otherwise unexplained metabolic, often lactic, acidosis; rhabdomyolysis; hyperkalaemia; hyperlipidaemia; ECG abnormalities or arrhythmias; and rapidly progressive cardiac failure, which may be resistant to inotropes. Renal failure and hepatomegaly may also occur. Propofol-related disruption of mitochondrial electron transport and fatty-acid oxidation causes impaired ATP production, particularly affecting cardiac and skeletal muscle. High infusion rates, prolonged administration, critical illness, catecholamines and corticosteroids increase risk, but a rigid dose-duration threshold is not required for diagnosis. The other options contain abnormalities that are not characteristic PRIS constellations: metabolic alkalosis, hypokalaemia, thrombocytosis, hypertension and isolated bradycardia do not define the syndrome.
Reference: Baxter Healthcare Ltd. Propofol 10 mg/ml Emulsion for injection/infusion, Summary of Product Characteristics, sections 4.4 and 4.8; text revised 2024, eMC updated 2025. https://www.medicines.org.uk/emc/product/11295/smpc