Citation Information :
Khandelwal A. Recurrent Metabolic Acidosis During High-dose Midazolam Therapy for Refractory Status Epilepticus. Indian J Crit Care Med 2018; 22 (2):119-121.
High-dose continuous midazolam therapy has been used successfully for control of refractory status epilepticus. However, normal anion gap (AG) metabolic acidosis, a deleterious complication of this therapy is underrecognized. Even though previously reported in an isolated case report in a pediatric patient, we observed similar complication in an adult patient. Stereotyped normal AG metabolic acidosis along with hypotension developed on two occasions during high-dose continuous midazolam hydrochloride infusion that reverted rapidly following cessation of the infusion.
Wilson KC, Reardon C, Theodore AC, Farber HW. Propylene glycol toxicity: A severe iatrogenic illness in ICU patients receiving IV benzodiazepines: A case series and prospective, observational pilot study. Chest 2005;128:1674-81.
Federman MD, Kelly R, Harrison RE. Refractory metabolic acidosis as a complication of high-dose midazolam infusion for pediatric status epilepticus. Clin Neuropharmacol 2009;32:340-1.
Ulvi H, Yoldas T, Müngen B, Yigiter R. Continuous infusion of midazolam in the treatment of refractory generalized convulsive status epilepticus. Neurol Sci 2002;23:177-82.
Brown WJ, Buist NR, Gipson HT, Huston RK, Kennaway NG. Fatal benzyl alcohol poisoning in a neonatal Intensive Care Unit. Lancet 1982;1:1250.
Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M, et al. Association between a chloride-liberal vs. chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012;308:1566-72.
McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS, et al. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: A propensity-matched cohort study. Anesth Analg 2013;117:412-21.
