Metabolic consequences of a sorbitol overdose during neurosurgery

The authors present a case of severe electrolyte and acid-base disturbances after administration of sorbitol. The rate of sorbitol infusion was in excess of the stated maximum safe infusion rate in parenteral nutrition. Sorbitol was used for treating raised intracranial pressure. The mechanisms of sorbitol metabolism leading to hyperlactacemia, lactic acidosis, hyperuricemia, depletion of intracellular ATP and ADP and depletion of inorganic phosphates are described.