SHM Converge Scientific Abstract ePoster Gallery-Propylene Glycol Nephrotoxicity Linked to Electronic Cigarette Consumption

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This case report describes a 37-year-old woman with polysubstance use disorder, diabetes, hypothyroidism, hepatitis C, and depression who was found unresponsive and brought to the emergency department. On arrival, she was obtunded with diminished right-sided lung sounds. Initial workup showed severe metabolic derangements, including hyperkalemia, leukocytosis, high anion gap metabolic acidosis with lactic acidosis, acute kidney injury, and marked rhabdomyolysis. Imaging suggested aspiration pneumonia, and she was transferred to the ICU for profound acidosis (pH 6.99), intubation, and treatment for presumed diabetic ketoacidosis and septic shock.<br /><br />Her kidney injury worsened due to acute tubular necrosis, rhabdomyolysis, and shock, prompting continuous renal replacement therapy for oliguria and refractory acidosis. Toxicology evaluation later revealed daily e-cigarette use with a recent switch to a new vaping product. An elevated osmolar gap and toxicology screening supported propylene glycol (PG) exposure from vaping. She was treated with fomepizole, and dialysis was continued, transitioning from CRRT to intermittent hemodialysis. Despite treatment, renal recovery was poor, and she was discharged dialysis-dependent.<br /><br />The report highlights that e-cigarettes commonly contain propylene glycol and vegetable glycerin, and that inhaled PG can cause systemic toxicity, including hyperosmolar states, high anion gap metabolic acidosis, lactic acidosis, and acute kidney injury. Renal injury may result from direct tubular toxicity, metabolic injury, and secondary complications such as rhabdomyolysis or hypoperfusion. Because symptoms are nonspecific, clinicians should consider PG toxicity when unexplained metabolic acidosis and elevated osmolar gap are present. Early recognition, toxicology testing, fomepizole, and renal replacement therapy may be necessary.

Asset Subtitle

Elaine Ognjanovski

Meta Tag

Author List David Leroy, Elaine Ognjanovski, Mindy Raminick, Muhammad Ismail, Niketh Chopra

Category Clinical Vignettes

Concept E-cigarette Liquid

Concept Propylene Glycol

Concept Propylene Glycol Toxicity

Concept E-Cigarette Use

Concept Osmolar Gap

Distinguished Non-Finalist

Presenter Organization Henry Ford Warren Internal Medicine

Presenting Author Elaine Ognjanovski

Track Adult

Keywords

propylene glycol toxicity

vaping

e-cigarette

metabolic acidosis

osmolar gap

acute kidney injury

rhabdomyolysis

fomepizole

hemodialysis

aspiration pneumonia

E-cigarette Liquid

Propylene Glycol

Propylene Glycol Toxicity

E-Cigarette Use

Osmolar Gap