A client receiving a prolonged high-dose propofol infusion develops severe metabolic acidosis, hyperkalemia, rhabdomyolysis, acute kidney injury, and new ECG changes. Which action is the priority?
1Stop propofol, notify the critical care team, switch sedation, and treat the metabolic and organ complications.✓ Correct answer
2Increase propofol to deepen sedation and treat the acidosis with bicarbonate while continuing the current infusion.
3Treat malignant hyperthermia with dantrolene and active cooling while maintaining propofol at the same dose.
4Reduce propofol gradually and observe for 24 hours because abrupt discontinuation can worsen the electrolyte abnormalities.
Explanation
The combination of severe metabolic acidosis, hyperkalemia, rhabdomyolysis, renal failure, and ECG changes during a prolonged high-dose propofol infusion is characteristic of propofol infusion syndrome. The propofol label directs clinicians to discontinue the infusion immediately when these findings develop and to use alternative sedation and supportive critical care. Increasing, continuing, or slowly tapering the infusion prolongs exposure, and this pattern is not malignant hyperthermia.
Clinical reasoning Propofol infusion syndrome is a potentially fatal cluster of metabolic and organ failures associated with prolonged or high-dose exposure. Acidosis, hyperkalemia, rhabdomyolysis, renal failure, ECG changes, and cardiac failure are key signals.
Decision rule When this cluster appears, stop propofol immediately, switch sedation, and treat the hemodynamic, electrolyte, renal, and acid-base consequences.
Scenario 28-year-old male in ICU on propofol 80 mcg/kg/min × 60 hours for ARDS sedation. New metabolic acidosis, CK 18000, K+ 6.0, arrhythmias.