MALIGNANT HYPERTHERMIA

Malignant hyperthermia (MH) is a life-threatening, hypermetabolic clinical condition affecting the skeletal muscle. It is caused by volatile inhalation of anesthetic agents and muscle relaxant succinylcholine in susceptible individuals mainly, although other medications have also been involved as potential triggers. MH is not an allergy but is an acquired condition found in humans and swine alike.

Malignant hyperthermia (MH) is a primarily acquired skeletal muscle disease predisposing individuals to a deadly adverse reaction (fulminant MH event) to potent volatile anesthetics (halothane, isoflurane, sevoflurane, desflurane, etc.) and succinylcholine.

One of many genetic mutations is causing muscle abnormality, which can lead to malignant hyperthermia. Around half of all cases are caused by the most frequent mutation. An individual with this mutation has one in two opportunities to pass the gene on to either of his or her offspring.

Family members may have different levels of medication sensitivity, which causes the issue. Reactions are, in some situations, mild. Until having an identifiable response, a person may be exposed to high-risk drugs many times.

This disorder often happens in people with muscular dystrophy, too. It also exists in many genetic mutation-associated muscle diseases.

TYPES

The most common triggering agents widely used in general anesthesia are explosive anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane, enflurane, or the depolarizing muscle relaxants suxamethonium and decamethonium. In some cases, the cause can be the biological stresses of physical activity or heat.

There is increasing evidence that some individuals with vulnerability to malignant hyperthermia may develop MH with workouts and immersion in environments with extremely high temperatures.

 

SYMPTOMS

Signs of malignant hyperthermia and its symptoms include:

  • An increase in body temperature, often as high as 113 degrees Fahrenheit
  • Muscles are tight or sore, particularly in the jaw
  • Rapid breathing or painful breathing
  • Black or brown urine
  • Dramatically low blood pressure (which leads to shock)
  • Disorientation
  • Muscle fatigue or after-event swelling

Most people with a malignant hyperthermia-type of a gene will never show symptoms.

DIAGNOSIS

Most patients with malignant hyperthermia are not diagnosed until they experience a severe reaction to general anesthesia. Doctors typically assume this condition when there are usual symptoms in a patient, particularly high fever and stiff muscles.

Blood tests that indicate body chemistry changes are indicative of malignant hyperthermia. Those involve elevated levels of CPK (creatine phosphokinase) muscle enzyme and increases in an electrolytes. Blood tests may also include indications of signs of kidney failure. If malignant hyperthermia is not quickly identified and treated, the heart of the individual may stop during surgery.

Many approaches to help validate malignant hyperthermia diagnosis include genetic testing and a muscle biopsy.

TREATMENT

The first and most necessary step is to stop giving the causing drug instantly and postpone the operation. Doctors then prescribe dantrolene to the patient.

Dantrolene makes the muscles relax. It prevents muscle metabolism from increasing rapidly.

Supplemental interventions may include:

Decrease body temperature with:

  • Cooled steam and blowers
  • Cooling wraps/sleeves
  • Cooled intravenous fluid infusions
  • Giving therapeutic amounts of oxygen

Use of medicines to:

  • Regulate pulse
  • Maintain blood pressure’s stabilization
  • Correct electrolyte irregularities including potassium

Blood pressure monitoring, heart rhythm, acid, and kidney function in an intensive care unit

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