Hyperosmolality induced by propylene glycol. A complication of silver sulfadiazine therapy

JAMA. 1985 Mar 15;253(11):1606-9.


An 8-month-old male infant was treated with topical silver sulfadiazine for a burn and complicating toxic epidermal necrolysis involving 78% of his total body surface area. Transdermal absorption of propylene glycol from the silver sulfadiazine produced hyperosmolality with an increased osmolal gap. A peak propylene glycol concentration of 1,059 mg/dL was documented, and its osmotic effect was that predicted from its concentration. Our data support either zero-order elimination at a rate of 13.5 mg/dL/hr or first-order elimination with a half-life of 16.9 hours. Elevated concentrations of propylene glycol may have contributed to the patient's cardiorespiratory arrest. The osmolal gap may be used as a screen for suspected propylene glycol intoxication in selected clinical settings.

Publication types

  • Case Reports

MeSH terms

  • Administration, Topical
  • Burns / drug therapy
  • Heart Arrest / chemically induced
  • Humans
  • Infant
  • Male
  • Ointment Bases
  • Osmolar Concentration
  • Propylene Glycol
  • Propylene Glycols / adverse effects*
  • Propylene Glycols / blood
  • Propylene Glycols / metabolism
  • Silver Sulfadiazine / administration & dosage*
  • Skin Absorption*
  • Stevens-Johnson Syndrome / drug therapy
  • Sulfadiazine / administration & dosage*
  • Water-Electrolyte Imbalance / blood
  • Water-Electrolyte Imbalance / chemically induced*


  • Ointment Bases
  • Propylene Glycols
  • Sulfadiazine
  • Propylene Glycol
  • Silver Sulfadiazine