key: cord-0900138-6s5adzro
authors: Samal, Subhankar; Singhania, Namrata; Adl, Dima; Afzal, Omer; Singhania, Girish
title: Chocolate milk in CRRT Circuit: Propofol Induced Hypertriglyceridemia
date: 2020-08-07
journal: Am J Med Sci
DOI: 10.1016/j.amjms.2020.08.003
sha: 568a51984ad7c45cf68dca0c7b3d1271a821939b
doc_id: 900138
cord_uid: 6s5adzro

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disease on hemodialysis, type 2 diabetes mellitus and anemia presented to emergency with fever and cough for 3 days. Physician examination was positive for crackles in bilateral lung fields. Chest radiograph showed bilateral interstitial infiltrates. He was diagnosed with coronavirus disease-2019 (COVID-19) after positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction. Patient was admitted to the intensive care unit due to severe hypoxemia. He was intubated and started on propofol and fentanyl drip for sedation and analgesia. Multiple vasopressors (norepinephrine, vasopressin, and epinephrine) were started due to septic shock. The patient developed multiorgan failure and continuous renal replacement therapy (CRRT) was initiated. On day 3, CRRT started to alarm negative pressure for the return line. Upon inspection of the machine, it was noted that the filter had a chocolate milk color on the top and the tubing had chocolate milk colored plasma in it ( Figure 1 ). Serum triglyceride (TG) level was significantly elevated (930 mg/dL; normal range, 3 149 mg/dL). Propofol infusion was discontinued. Follow-up TG level dropped promptly to 321 mg/dL the following day and to 288 mg/dL two days later. No further clotting was reported in the dialysis circuit afterwards.

Several factors influence the patency of CRRT circuit such as catheter size, location, anticoagulant use, blood flow rate, replacement fluid flow rate, hematocrit, and platelet count (viscosity of blood) and ultrafiltration rates (filtration fraction). 1 Elevated serum TG as a cause of CRRT circuit malfunction is sparsely reported. 2 It can occur due to propofol infusion in critically ill intubated patients. Propofol has many beneficial effects, including rapid emergence and onset, antiemetic properties, and neurophysiologic benefits such as decreased cerebral metabolic demand, anticonvulsive properties, and possible neuroprotective effects. Periodic triglyceride level monitoring can identify the potential adverse effects associated with this drug. 

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