Propofol infusion syndrome (PRIS) occurs most commonly with high-dose, prolonged infusions. Which metabolic abnormality is the hallmark of PRIS that distinguishes it from simple propofol toxicity?
- A Hypoglycaemia with raised insulin levels
- B Hypernatraemia with central diabetes insipidus
- C Metabolic acidosis with elevated lactate, lipemic plasma, and cardiac dysfunction ✓
- D Acute liver failure with coagulopathy
Correct answer: C. Metabolic acidosis with elevated lactate, lipemic plasma, and cardiac dysfunction
Explanation
PRIS is characterised by metabolic (lactic) acidosis, lipemic plasma (propofol is a lipid emulsion), rhabdomyolysis, hepatomegaly, and refractory cardiac arrhythmias/failure — often fatal. The pathophysiology involves impairment of mitochondrial respiratory chain complex II and fatty acid oxidation, leading to anaerobic metabolism. Risk factors include doses >4 mg/kg/hr for >48 hours, young age, low carbohydrate intake, and high-fat diet. Triglyceride levels and lactate must be monitored.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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