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.