Which of the following, in combination with progressive myocardial failure, is most likely to be present in a patient with propofol infusion syndrome?

In 1998, propofol infusion syndrome was initially described in children and later recognized in the adult population. Criteria proposed by Cremer in 2001 included progressive myocardial failure with dysrhythmias and two of the following:

Early signs have included unexplained acidosis, lipemic serum, cardiac dysfunction or Brugada-like electrocardiographic changes.

Propofol infusion syndrome has been described primarily in critically ill, intensive care unit patients undergoing long-term infusions, although case reports have described development of a metabolic acidosis after shorter intraoperative (4-6 hours) routine infusions (125-130 µg • kg–1 • min–1), which may indicate an early stage of this condition. In those patients who survive, the metabolic acidosis reportedly resolves with discontinuation of the propofol infusion....

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