Hyperosmolar metabolic acidosis in burn patients exposed to glycol based topical antimicrobials—A systematic review

Tom Leibson, Paige Davies, Cheri Nickel, Gideon Koren

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

Background: The well documented susceptibility of burn patients to acquired infections via damaged skin mandates application of antimicrobial agents. These agents are dissolved in various vehicles that augment skin absorption thus allowing greater efficacy. Polyethylene glycol (PEG) and Propylene glycol (PropG) are among the most commonly used vehicles, and both have been used in numerous medications and cosmetic products over the past few decades. Rarely, burn patients treated with agents containing these glycols present with a life threatening systemic toxidrome of hyperosmolar metabolic acidosis. We present a systematic review of outcomes in burn patients treated with similar agents. Methods: Relevant studies were identified through systematic searches conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Thomson Reuters), from database inception to August 4th, 2016. All publications of clinical burn patient studies included at least one arm receiving a glycol based topical therapy. Results: A total of 61 studies involving 10,282 patients and 4 different antimicrobial medications fulfilled the inclusion criteria. Nine burn patients (0.09%) were documented to present with hyperosmolar metabolic acidosis during topical silver sulfadiazine treatment. Propylene glycol isolated from their blood accounted for the high osmole gap. Conclusion: This first systematic review found very few cases of documented hyperosmolar metabolic acidosis, all within one study that had set to specifically explore this toxidrome. High index of suspicion with frequent osmolar gap monitoring may help identify future toxicities in a timely manner.

Original languageEnglish
Pages (from-to)776-783
Number of pages8
JournalBurns
Volume44
Issue number4
DOIs
StatePublished - Jun 2018
Externally publishedYes

Keywords

  • Burn patients
  • Glycol-based topical antimicrobials
  • Hyperosmolar metabolic acidosis
  • Polyethylene glycol
  • Propylene glycol

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