Abstracts

Rationale: Propofol (Diprivan) is a widely used anesthetic drug which is generally considered to be safe and effective. Recently it has been used as an agent in refractory status epilepticus. We report a case of marked fatty liver from the multiday use of propofol in status epilepticus in a 16 year female that was evaluated by liver biopsy. Methods: A patient with new onset status epilepticus was treated with various anticonvulsants. It was refractory to all medications tried and one point propofol was infused for 6 days. Propofol chemcially is 2,6-diisopropylphenol and is only very slightly soluble in water and is thus is formulated in a white oil-in-water emulison that also contains soybean oil and glycerol. A 1 mL of profopol emulsion contains 0.1 g of fat. Results: During the multiday infusion of propofol the patient developed a markedly enlarged liver with elevation of liver enzymes. The patient had no prior history of liver troubles. Serology for infectious hepatitis was negative. A liver ultrasound was performed. The liver was biopsied and it demonstrated macrofascicular fatty deposits. The status epilepticus was refractroy to propofol. Propofol, which is metabolized by the liver by conjucation, was discontinued and the liver enzyme abnormalites and liver size normalized. Review of the literature for liver complications from propofol emulison is uniumpressive with the PDR citing caution should be used in patients with disorders of lipid metabolism. There is a note that with prolonged use there may be possible elevations in serum triglyceride. In dogs it can cause hemosiderin deposits and in another report of discoloring the liver to a greenish color. Discussion: Propofol as an anesthetic is a medication intended for short term use but with increasing prolonged use in sedation or in status the lipid emulsion may cause liver abnormalties. Propofol delivered with a high fat emulsion probably contributed to the markedly enlarged fatty liver and possible liver function abnormalites which in this patient was reversible. Fatty liver and possible liver function abnormalties needs to be kept in mind when using propofol for status epilepticus especially in prolonged use.