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This study provides the first quantitative estimate of the incidence of mild metabolic acidosis during prolonged propofol infusion in non-critically ill patients, where there is no apparent cause of the acidosis except propofol: 24%, significantly greater than the 8% incidence of metabolic acidosis in the nonpropofol comparator group. This surprisingly high incidence is not an indication of the number of patients at risk for serious injury from the fulminant form of propofol infusion syndrome, because the study criterion (BE ≤ -2) was designed to detect early, mild, reversible cases. Indeed, none of the patients in this study showed evidence of permanent injury from their mild metabolic acidosis. However, our data do support the hypothesis that clinically significant propofol infusion syndrome is an extreme manifestation of a more common, initially reversible syndrome, rather than an extremely rare, idiosyncratic drug reaction.

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