Intoxication with Fireball Whiskey causing severe lactic acidosis.

Propylene glycol is a viscous, colorless liquid that has been approved by the US Food and Drug Administration for use as a preservative in foods and as a solvent in pharmaceuticals. Compared with methanol and ethylene glycol, it is regarded as a relatively safe alcohol. There have been several reports of severe lactic acidosis in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam. The laboratory findings may include high metabolic acidosis and high osmolal gap. Propylene glycol is also one of the ingredients used in Fireball Whiskey. We present two cases of severe lactic acidosis in the setting of Fireball Whiskey use.

Worsening of renal function and uncontrolled hypertension from intravitreal bevacizumab injections.

Vascular endothelial growth factor (VEGF) inhibitors are used in the treatment of various cancers as well as diabetic retinopathy. The systemic use of these drugs has been associated with adverse effects such as worsening hypertension, proteinuria, and renal function. There have been some reported cases of worsening hypertension, thrombotic microangiopathy, or glomerular disease after intravitreal injections of bevacizumab, aflibercept, and ranibizumab. We present a case of a patient who was taking intravitreal bevacizumab injections for diabetic retinopathy and was hospitalized with worsening renal function, high blood pressure, and nephrotic-range proteinuria in the setting of tight glycemic control.