# A critically ill client on prolonged propofol infusion develops metabolic acidosis, rhabdomyolysis, hyperkalemia, and arrhythmias. Which is the nurse's priority interpretation?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391880&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A critically ill client on prolonged propofol infusion develops metabolic acidosis, rhabdomyolysis, hyperkalemia, and arrhythmias. Which is the nurse's priority interpretation?

## Option

1. Expected drug effect
2. Increase propofol for better sedation
3. Propofol infusion syndrome (PRIS) — stop the infusion, switch to alternative sedation (midazolam/dexmedetomidine), supportive care including hemodialysis if needed **✔ Correct answer**
4. Add albuterol for hyperkalemia only

**Correct answer: 3**

## Explanation

Correct (2): Propofol infusion syndrome (PRIS) — rare but fatal complication of prolonged high-dose propofol (>48 hours, >4 mg/kg/hr). Mitochondrial dysfunction → metabolic acidosis, rhabdomyolysis, hyperkalemia, AKI, cardiac failure. STOP propofol, switch sedation (midazolam, dexmedetomidine), supportive care (renal replacement, vasopressors). Also screen for egg/soy allergy before starting propofol. (1,3,4) Worsen.

## In-depth explanation

Memory Tip Propofol = "White drink of forgetfulness." Watch egg/soy allergy + prolonged high-dose = PRIS. Lipid emulsion → check TG levels. Quick-onset/offset for procedures.

## Clinical scenario

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.

## Key concepts

- **Propofol** — Lipid emulsion sedative-anesthetic; rapid onset/offset; egg/soy allergy precaution.
- **Propofol infusion syndrome (PRIS)** — Rare fatal syndrome from prolonged high-dose propofol; mitochondrial dysfunction.
- **Propofol triglyceride monitoring** — Lipid emulsion can cause hypertriglyceridemia and pancreatitis; check TG with prolonged use.

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