Materiały źródłowe

• #1 Malignant Hyperthermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430828/

  Malignant hyperthermia (MH) is a hereditary disorder of skeletal muscle that classically presents as a hypermetabolic response to halogenated anesthetic gasses and/or the depolarizing muscle relaxant succinylcholine. […] Signs and symptoms of malignant hyperthermia include tachycardia, tachypnea, hypoxemia, hypercarbia, metabolic and respiratory acidosis, hyperkalemia, cardiac dysrhythmias, hypotension, skeletal muscle rigidity, and hyperthermia. The earliest signs of malignant hyperthermia are usually hypercarbia and tachycardia due to elevated carbon dioxide production. […] Complete recovery can occur if the signs and symptoms of malignant hyperthermia are recognized early and proper treatment is started. Multiple organ failure and death can still occur, however, even with prompt treatment. The mortality rate is less than 5%.

• #1 Malignant hyperthermia Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/malignant-hyperthermia.html

  Symptoms of malignant hyperthermia usually occur within the first hour after exposure to the trigger medication. However, the symptoms can be delayed for up to 12 hours. […] Symptoms and signs of malignant hyperthermia include: a dramatic rise in body temperature, sometimes as high as 113 degrees Fahrenheit; rigid or painful muscles, especially in the jaw; flushed skin; sweating; an abnormally rapid or irregular heartbeat; rapid breathing or uncomfortable breathing; brown or cola-colored urine; very low blood pressure (shock); confusion; muscle weakness or swelling after the event. […] With prompt treatment, symptoms should resolve within 12 to 24 hours. However, if a severe reaction develops before treatment is started, complications may develop. These can include respiratory or kidney failure. These complications may not improve for days or weeks. Some damage may be permanent. […] An episode of hyperthermia can be life threatening. However, early treatment at onset of symptoms is usually successful. Once recognized and diagnosed, future episodes can almost always be prevented by avoiding known triggers.

• #1 Malignant Hyperthermia: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17945-malignant-hyperthermia

  Symptoms of malignant hyperthermia may vary and can happen during your procedure or shortly after surgery while you’re recovering. If your symptoms start while you’re under the effects of anesthesia asleep or sedated you won’t know you’re experiencing these symptoms. But your anesthesiologist or nurse anesthetist will. They always carefully monitor people when they’re under anesthesia and will do the same for you. Once they see these signs, they’ll respond quickly with treatment for malignant hyperthermia. […] Early signs of malignant hyperthermia include unexplained increase in heart rate (tachycardia), unexplained increase in carbon dioxide produced by your body, rapid breathing (tachypnea), muscle rigidity, and rapid elevation in temperature. […] Later signs of malignant hyperthermia include increase in body temperature beyond what is normally seen with fever, dark pee, muscle breakdown showing up on blood tests, heart rhythm problems, bleeding, and seizures.

• #1 RYANODEX® | What is malignant hyperthermia (MH)?

  https://www.ryanodex.com/about-mh/

  Malignant hyperthermia (MH) is a pharmacogenetic disease that causes hypermetabolism, a fast rise in body temperature and severe muscle contractions when an affected person receives general anesthesia using volatile anesthetics or the paralytic succinylcholine. […] The signs and symptoms of MH include hypercarbia, muscle rigidity, fast-rising body temperature, tachycardia, myolysis, increased ETCO2, hyperkalemia, and acidosis. […] There are multiple signs that may prompt a diagnosis of MH by anesthesia practitioners. […] Hypercarbia is often the first clinical sign of MH. Other early signs include sinus tachycardia and masseter spasm. […] Every delay in treatment increases the risk of further complication during an MH crisis. […] The risk of complications may increase to 30% with a 20-minute delay in treating MH from its first symptom.

• #1 Quick Reference: Malignant Hyperthermia – Perfusion.com

  https://perfusion.com/quick-reference-malignant-hyperthermia/

  Malignant hyperthermia (MH) is triggered by certain types of anesthetic agents, typically succinylcholine, sevoflurane, desflurane, isoflurane and halothane. The earliest sign and symptom that will present is an increase in end-tidal carbon dioxide. Other additional early signs include tachycardia, tachypnea, and rigidity of the masseter muscle called trismus. As an MH crisis progresses, other signs and symptoms are unstable blood pressure, cyanosis and/or mottling of the skin, diaphoresis, cardiac dysrhythmia and a dramatic increase in the body temperature. […] As an MH crisis progresses, other signs and symptoms are unstable blood pressure, cyanosis and/or mottling of the skin, diaphoresis, cardiac dysrhythmia and a dramatic increase in the body temperature.

• #1 Malignant Hyperthermia: An Overview

  https://www.uspharmacist.com/article/malignant-hyperthermia-an-overview

  In a patient experiencing MH, the reaction causes increased carbon dioxide production, metabolic and respiratory acidosis, accelerated oxygen consumption, heat production, sympathetic nervous system activation, hyperkalemia, and disseminated intravascular coagulation (DIC), all of which result in multisystem organ failure. Early clinical signs of MH are hypercapnia (elevated carbon dioxide levels in the blood), tachypnea, tachycardia, and muscle rigidity. Later signs may include hyperthermia, ECG changes related to hyperkalemia, and myoglobinuria. […] The presentation of MH varies, and most patients do not develop all of the signs. In a review of 255 MH events, the order of appearance of clinical signs, from earliest to latest, was as follows: masseter spasm, hypercarbia, sinus tachycardia, muscle rigidity, tachypnea, cyanosis, skin mottling, rapidly increasing temperature, elevated temperature, sweating, ventricular tachycardia, cola-colored urine, ventricular fibrillation, and excessive bleeding. […] It is a misconception that hyperthermia is the initial presenting sign of MH. Hyperthermia typically occurs later and is absent when the condition is first suspected. In the review of 255 MH cases, hyperthermia was one of the first signs in just 8.2% of crises and was the only initial sign in 3.9%.

• #1 Malignant Hyperthermia – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/heat-disorders/malignant-hyperthermia

  Malignant hyperthermia is a rare, life-threatening rise in body temperature that occurs in susceptible people who are given certain muscle-relaxing drugs plus an anesthetic gas for surgery. […] Malignant hyperthermia can occur when the anesthesia is given or during or soon after surgery. […] Symptoms include muscle rigidity, rapid heart rate, and rapid breathing. […] Malignant hyperthermia may develop during anesthesia or shortly after surgery. Often, the first signs are rapid breathing, a fast heart rate, and muscle rigidity, especially in the jaw. Temperature usually becomes extremely high (usually over 104 [40 C] and sometimes higher than 109 F [43 C]). Abnormal heart rhythms, nausea, and vomiting may occur. Urine may appear brown or bloody. […] Many people with malignant hyperthermia die even when they receive early and intensive treatment.

• #1 Malignant hyperthermia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/malignant-hyperthermia/symptoms-causes/syc-20353750

  Malignant hyperthermia is a severe reaction to certain drugs used for anesthesia. This severe reaction typically includes a dangerously high body temperature, rigid muscles or spasms, a rapid heart rate, and other symptoms. Without prompt treatment, the complications caused by malignant hyperthermia can be fatal. […] Signs and symptoms of malignant hyperthermia may vary and can occur during anesthesia or during recovery shortly after surgery. They can include: […] Severe muscle rigidity or spasms […] Rapid, shallow breathing and problems with low oxygen and high carbon dioxide […] Rapid heart rate […] Irregular heart rhythm […] Dangerously high body temperature […] Excessive sweating […] Patchy, irregular skin color (mottled skin). […] In rare cases, people at risk of malignant hyperthermia have shown signs of a reaction after intense physical activity during excessive heat or humidity, during a viral illness, or when taking statin medication used to lower cholesterol.

• #1 Management of malignant hyperthermia: diagnosis and treatment | TCRM

  https://www.dovepress.com/management-of-malignant-hyperthermia-diagnosis-and-treatment-peer-reviewed-fulltext-article-TCRM

  Malignant hyperthermia is a potentially lethal inherited disorder characterized by disturbance of calcium homeostasis in skeletal muscle. […] Clinical symptoms of malignant hyperthermia, diagnostic criteria, and current therapeutic guidelines, as well as adequate management of anesthesia in patients susceptible to malignant hyperthermia, are discussed in this review. […] Clinical symptoms of MH are highly variable, and range from abortive courses with mild or moderate symptoms to fulminant MH crises with severe skeletal muscle hypermetabolism and rhabdomyolysis. Excessive CO2 production presenting with an increase in end tidal CO2 concentration or hyperventilation while breathing spontaneously is a sensitive and specific early sign of imminent MH. […] Further early symptoms of an MH crisis may include tachycardia, supraventricular or ventricular arrhythmia, and isolated masseter spasm or generalized muscular rigidity.

• #1 Malignant hyperthermia: a review | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-015-0310-1

  The earliest signs are tachycardia, rise in end-expired carbon dioxide concentration despite increased minute ventilation, accompanied by muscle rigidity, especially following succinylcholine administration. Body temperature elevation can be a dramatic sign of MH. […] Hyperthermia can be marked, with an increase in core temperature at a rate of 12 C every five minutes. Severe hyperthermia (core temperature greater than 44 C) may occur, and lead to a marked increase in oxygen consumption, CO2 production, widespread vital organ dysfunction, and disseminated intravascular coagulation (DIC). […] Uncontrolled hypermetabolism leads to respiratory and in most cases metabolic acidosis due to rapid consumption of energy stores and ATP. If untreated, continuing myocyte death and rhabdomyolysis result in life-threatening hyperkalemia; myoglobinuria may lead to acute renal failure. […] The progression of the syndrome may be rapid and dramatic, particularly if precipitated by succinylcholine, or more slowly and not become manifest until after several hours after induction of anesthesia.

• #1 Malignant Hyperthermia and Related Conditions – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/critical-care-medicine/malignant-hyperthermia-and-related-conditions/

  MH is a rare pharmacogenetic sensitivity of skeletal muscle to volatile anesthetics and depolarizing muscle relaxants such as succinylcholine that results in autonomic activation, hypermetabolism that results in a mixed respiratory-metabolic acidosis, truncal or total body rigidity in a significant number of patients, masseter muscle spasm (trismus = jaws of steel) in some patients in response to the depolarizing effects of succinylcholine, hyperthermia (may be a late sign) and rhabdomyolysis. […] The hallmark of a full blown episode of MH is runaway metabolism and a rate of production of CO2 that is difficult if not impossible to control with increasing minute ventilation. In the awake patient this will manifest as severe hyperventilation, with the breaths rapid and deep. In the mechanically ventilated patient, MH will result in the physician or respiratory therapist constantly increasing minute ventilation that is unable to compensate for the continuing rise in end-tidal CO2. The combination of extremely high temperatures (as high as 42-43C), severe acidosis (pH7), and the hyperkalemia that results both from acid buffering and rhabdomyolysis, results in autonomic and cardiovascular instability and arrhythmias, renal failure from myoglobin precipitation in proximal tubules, and eventual death in virtually all untreated patients.

• #1 Nursing Guide to Malignant Hyperthermia – Straight A Nursing

  https://straightanursingstudent.com/malignant-hyperthermia/

  Malignant hyperthermia is a hypermetabolic crisis that is fatal if left untreated. It occurs in individuals with a specific genetic condition when they are exposed to certain anesthetic gasses or the medication succinylcholine. […] The result is ATP depletion, oxygen depletion, carbon dioxide production, and the development of acidosis. This pathological process is responsible for the early signs of malignant hyperthermia, which are tachycardia, hypercapnia and muscle rigidity. […] While in this hypermetabolic state, the body generates more heat than it is able to dissipate. This leads to hyperthermia which can occur early or later as the condition progresses. […] Studies show that in some cases, body temperature can increase by as much as 1 to 2 degrees Celsius every five minutes. Organ dysfunction sets in once the temperature reaches dangerously high levels above 41.5-degree Celsius (106.7-degrees Fahrenheit).

• #1 Delayed-onset malignant hyperthermia in the postanesthetic care unit: a case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8485277/

  Malignant hyperthermia (MH) is a potentially fatal hypermetabolic syndrome that occurs when susceptible individuals are exposed to triggering agents. […] A 77-year-old man awoke from anesthesia and was transferred to the recovery room. Ten minutes after his arrival, his mental status became stuporous and he developed masseter muscle rigidity, hyperventilation, and a body temperature of 39.8C. […] The principal diagnostic features of MH are unexplained elevation of the end-tidal carbon dioxide (EtCO2) concentration, hyperthermia, tachycardia, muscle rigidity, and rhabdomyolysis. […] Symptoms of MH appeared 95 minutes after exposure to the trigger factor. […] In this case, sevoflurane was suspected to be a trigger factor for MH. […] The patient’s MH clinical classification score was 53 points

• #1 Malignant hyperthermia: Diagnosis and management of acute crisis – UpToDate

  https://www.uptodate.com/contents/malignant-hyperthermia-diagnosis-and-management-of-acute-crisis

  Malignant hyperthermia (MH) manifests clinically as a hypermetabolic crisis when an MH-susceptible (MHS) individual is exposed to a volatile anesthetic (eg, halothane, isoflurane, sevoflurane, desflurane) or succinylcholine. […] Clinical signs include hypercarbia, generalized muscle rigidity, masseter muscle rigidity, arrhythmias, hyperthermia, and myoglobinuria. […] An MH event does not necessarily occur every time an MH susceptible individual is exposed to an anesthetic triggering agent. Approximately one-half of patients who develop acute MH have had one or two uneventful exposures to triggering agents.

• #1 Malignant Hyperthermia: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17945-malignant-hyperthermia

  Complete recovery from malignant hyperthermia is possible if your anesthesiologist and surgery team recognize the signs and symptoms of malignant hyperthermia early and properly treat it. But multiple organ failure and death can still occur even with prompt treatment. […] If untreated, malignant hyperthermia is almost always fatal. The death rate is 3% to 5%, even when the condition is properly treated.

• #1 Malignant hyperthermia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/malignant-hyperthermia/

  In rare cases, people at risk of malignant hyperthermia have shown signs of a reaction after intense physical activity during excessive heat or humidity, during a viral illness, or when taking statin medication used to lower cholesterol. […] If not treated promptly, malignant hyperthermia can result in major complications, such as: A rare condition that causes muscle cells to break down (rhabdomyolysis), Kidney damage or failure, Problems with clotting and bleeding, Death. […] Immediate treatment of malignant hyperthermia includes: A drug called dantrolene (Dantrium, Revonto, Ryanodex) is used to treat the reaction by stopping the release of calcium into muscles. Other medications may be given to correct problems with a balance of the body’s chemicals (metabolic imbalance) and treat complications. […] With treatment, malignant hyperthermia usually resolves within a few days.

• #1 Delayed-onset malignant hyperthermia in the postanesthetic care unit: a case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8485277/

  After 10 minutes, the patient was suspected to have MH with an increased body temperature (39.8C) and worsening of masseter muscle rigidity. […] The rapid increase in body temperature and oxygen consumption provided strong evidence for suspected MH. […] This case illustrates that delayed-onset MH may also occur in the postoperative period when the patient is not immediately exposed to the trigger factor. […] Rapid diagnosis and treatment are crucial to ensure a good prognosis for patients with MH. […] The diagnosis was particularly suspicious based on the rapid relief of symptoms immediately after administration of dantrolene sodium.

• #1 Malignant hyperthermia: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/malignant-hyperthermia/

  Affected individuals may be at increased risk for „awake” malignant hyperthermia, in which the severe reaction occurs in response to physical activity, often while sick, rather than in reaction to exposure to a triggering drug. […] While malignant hyperthermia often occurs in people without other serious medical problems, certain inherited muscle diseases (including central core disease, multiminicore disease, and STAC3 disorder) are associated with malignant hyperthermia susceptibility.

• #1 Malignant Hyperthermia May Develop in People with Heat or Exercise – MHAUS

  https://www.mhaus.org/about/press-releases/malignant-hyperthermia-may-develop-in-people-with-heat-or-exercise/

  There is mounting evidence that some people who are susceptible to Malignant hyperthermia (MH) will develop MH when exposed to hot environments or with exercise. […] Six year-old Vincent Groetzner died June 14, 2010, after he started to complain of leg cramps and rapid heart rate and a developing fever that soared to 108 degrees while playing at a friend’s house. The medical examiner reported the cause to be Malignant Hyperthermia (MH). […] The signs of MH include muscle rigidity, rapid heart rate, high body temperature, muscle breakdown and increased acid content. […] MH is inherited genetic disorder found in an estimated 1 out of 2,000 people. MH is triggered by certain anesthesia and most often experienced in individuals undergoing routine surgery but in rare cases MH can happen without anesthesia. Symptoms include body temperature of up to 107 degrees, muscle rigidity, system-wide organ failure, and possible death.

• #1 Malignant hyperthermia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/malignant-hyperthermia/

  Malignant hyperthermia (MH) is a subclinical myopathy in which general anesthesia triggers an uncontrollable contraction of skeletal muscle that leads to a life-threatening hypercatabolic state and an increase in body temperature. […] In the acute setting, diagnosis is based mainly on clinical presentation and end-tidal capnography, which reveals an increase in end-tidal CO2. […] MH is a lethal disease and has a high mortality rate if left untreated. […] Early signs of malignant hyperthermia include tachycardia, tachypnea, cyanosis, and generalized rigidity, including masseter rigidity. […] Late signs include elevated body temperature (up to 45C/113F) and signs of secondary organ damage such as complex arrhythmias, oliguria (acute kidney injury), seizures, bleeding and/or thrombosis (disseminated intravascular coagulation), and myoglobinuria, muscle pain, swelling, and weakness of the affected muscles (rhabdomyolysis).

• #1 Malignant Hyperthermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/heat-illness/malignant-hyperthermia

  Malignant hyperthermia may develop during anesthesia or the early postoperative period. Clinical presentation varies depending on the drugs used and the patients susceptibility. Muscular rigidity, especially in the jaw, is often the first sign, followed by tachycardia, other arrhythmias, tachypnea, acidosis, shock, and hyperthermia. Hypercapnia (detected by increased end-tidal carbon dioxide [CO2]) may be an early sign. Temperature is usually 40 C and may be extremely high (ie, 43 C). Urine may appear brown or bloody if rhabdomyolysis and myoglobinuria have occurred. […] The diagnosis is suspected by the appearance of typical symptoms and signs within 10 minutes to, occasionally, several hours after inhalational anesthesia is begun. Early diagnosis can be facilitated by prompt recognition of jaw rigidity, tachypnea, tachycardia, and increased end-tidal CO2. […] Malignant hyperthermia develops in genetically susceptible patients who have been exposed (usually more than once) simultaneously to a depolarizing muscle relaxant and a potent, volatile inhalational general anesthetic.

• #1 Malignant Hyperthermia and Related Conditions – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/critical-care-medicine/malignant-hyperthermia-and-related-conditions/

  The management of an episode of MH should include the following: Stop the offending agent (remove the vaporizers) and ventilate with 100% O2. […] If treated early, most patients recover uneventfully, but a significant proportion complain of muscle pain or discomfort. Indeed, a delay as short as 20 minutes from presenting signs to diagnosis and institution of dantrolene therapy may greatly increase morbidity. […] If this is true MH, and you have made the diagnosis early enough, the response to dantrolene is in the range of minutes to tens of minutes. The temperature, PaCO2 and heart rate all will begin to improve rather dramatically, and in parallel. The acidosis will correct itself and the hyperkalemia will correct due to symptomatic treatment and to the reduction in acidosis.

• #1 Malignant hyperthermia: a review | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-015-0310-1

  Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stressors such as vigorous exercise and heat. The classic signs of MH include hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, hyperkalaemia, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. An increase in end-tidal carbon dioxide despite increased minute ventilation provides an early diagnostic clue. […] The key clinical features include an unexplained elevation of expired carbon dioxide, despite increased minute ventilation, muscle rigidity and rhabdomyolysis, hyperthermia, tachycardia, acidosis and hyperkalemia.

• #1 Management of malignant hyperthermia: diagnosis and treatment | TCRM

  https://www.dovepress.com/management-of-malignant-hyperthermia-diagnosis-and-treatment-peer-reviewed-fulltext-article-TCRM

  A rapid increase in temperature (to 38.8C) is a relatively late sign. […] As the MH episode progresses, rhabdomyolysis leads to hyperkalemia, increased creatine phosphokinase, and myoglobinemia, and might result in acute renal failure. […] The end stage of a fulminant MH crisis is characterized by multiorgan failure and circulatory collapse. […] Because of the variable clinical presentation of MH, ranging from abortive courses with only mild or moderate symptoms to fulminate MH crises, patient survival depends on early recognition of symptoms of MH and prompt action on the part of the attending anesthesiologist.

• #1 Malignant Hyperthermia in PICU—From Diagnosis to Treatment in the Light of Up-to-Date Knowledge

  https://www.mdpi.com/2227-9067/9/11/1692

  Malignant Hyperthermia (MH) is a rare, hereditary, life-threatening disease triggered by volatile anesthetics and succinylcholine. […] The most typical symptoms of MH are hypercapnia, tachycardia, hyperthermia, and muscle rigidity. […] The clinical presentation reflects disturbed calcium homeostasis due to genetic defects and MH triggers. […] Hypercapnia, due to inappropriately elevated CO2 production, is known to be the earliest sign of the MH crisis. […] Hyperthermia might be pathognomonic, but it develops quite late. […] The cornerstone of successful treatment is to start as soon as possible, the sooner, the better patient outcomes. […] Malignant hyperthermia crisis is usually taken only as an anesthesia complication, but in fact, the triggers of MH are quite often used within intensive care as well.

• #2 Malignant hyperthermia: a review | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-015-0310-1

  Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stressors such as vigorous exercise and heat. The classic signs of MH include hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, hyperkalaemia, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. An increase in end-tidal carbon dioxide despite increased minute ventilation provides an early diagnostic clue. […] The key clinical features include an unexplained elevation of expired carbon dioxide, despite increased minute ventilation, muscle rigidity and rhabdomyolysis, hyperthermia, tachycardia, acidosis and hyperkalemia.

• #2 Malignant Hyperthermia and Related Conditions – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/critical-care-medicine/malignant-hyperthermia-and-related-conditions/

  Not all the signs and symptoms of MH enumerated above have to occur in the patient experiencing an MH episode. Hence, the symptomatic expression of the syndrome is variable. […] While not pathognomonic, the sine qua non of a full blown MH episode, however, is the mixed respiratory-metabolic acidosis in the setting of general anesthesia with volatile anesthetics, whether succinylcholine is used or not, and in the presence a rising end-tidal CO2 that cannot be controlled with increasing minute ventilation. MH may occur intraoperatively and for some undetermined time that is generally thought to be less than 12 hours postoperatively, though the vast majority of cases occur within an hour postoperatively. […] In this instance, incomplete penetrance means that just because you have the genetic trait does not mean you will get MH on the first exposure to volatile anesthetics; variable expressivity means that a susceptible individual may present with a symptom pattern varying from smoldering to explosive.

• #2 ‘It’s Getting Hot in Here’: A Discussion on Malignant Hyperthermia – AACN

  https://www.aacn.org/blog/its-getting-hot-in-here-a-discussion-on-malignant-hyperthermia

  Malignant hyperthermia (MH) is a rare but life-threatening condition triggered by certain medications. […] Identifying MH early is a crucial component of MH management and prevention of complications. Hence, nurses need to be knowledgeable about the signs and symptoms of MH, which include: […] Initial: Unexplained tachycardia, tachypnea, muscle rigidity, masseter muscle rigidity, a sudden increase in end-tidal carbon dioxide (ETCO2) and metabolic acidosis […] Late: Fever, rhabdomyolysis, mottled skin and myoglobinuria. […] After the patient experiences an MH crisis, they are transferred to the ICU for close monitoring for at least 24 hours. […] The patients heart rate, respiratory rate, temperature, ETCO2, oxygen saturation, muscle tone and urine output should be monitored at least hourly for 24 hours. […] CK levels may not peak for up to 24 hours after an MH event.

• #2 Malignant Hyperthermia: An Overview

  https://www.uspharmacist.com/article/malignant-hyperthermia-an-overview

  In a patient experiencing MH, the reaction causes increased carbon dioxide production, metabolic and respiratory acidosis, accelerated oxygen consumption, heat production, sympathetic nervous system activation, hyperkalemia, and disseminated intravascular coagulation (DIC), all of which result in multisystem organ failure. Early clinical signs of MH are hypercapnia (elevated carbon dioxide levels in the blood), tachypnea, tachycardia, and muscle rigidity. Later signs may include hyperthermia, ECG changes related to hyperkalemia, and myoglobinuria. […] The presentation of MH varies, and most patients do not develop all of the signs. In a review of 255 MH events, the order of appearance of clinical signs, from earliest to latest, was as follows: masseter spasm, hypercarbia, sinus tachycardia, muscle rigidity, tachypnea, cyanosis, skin mottling, rapidly increasing temperature, elevated temperature, sweating, ventricular tachycardia, cola-colored urine, ventricular fibrillation, and excessive bleeding. […] It is a misconception that hyperthermia is the initial presenting sign of MH. Hyperthermia typically occurs later and is absent when the condition is first suspected. In the review of 255 MH cases, hyperthermia was one of the first signs in just 8.2% of crises and was the only initial sign in 3.9%.

• #2 Malignant Hyperthermia – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/heat-disorders/malignant-hyperthermia

  Malignant hyperthermia is a rare, life-threatening rise in body temperature that occurs in susceptible people who are given certain muscle-relaxing drugs plus an anesthetic gas for surgery. […] Malignant hyperthermia can occur when the anesthesia is given or during or soon after surgery. […] Symptoms include muscle rigidity, rapid heart rate, and rapid breathing. […] Malignant hyperthermia may develop during anesthesia or shortly after surgery. Often, the first signs are rapid breathing, a fast heart rate, and muscle rigidity, especially in the jaw. Temperature usually becomes extremely high (usually over 104 [40 C] and sometimes higher than 109 F [43 C]). Abnormal heart rhythms, nausea, and vomiting may occur. Urine may appear brown or bloody. […] Many people with malignant hyperthermia die even when they receive early and intensive treatment.

• #2 Malignant hyperthermia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/malignant-hyperthermia/symptoms-causes/syc-20353750

  Malignant hyperthermia is a severe reaction to certain drugs used for anesthesia. This severe reaction typically includes a dangerously high body temperature, rigid muscles or spasms, a rapid heart rate, and other symptoms. Without prompt treatment, the complications caused by malignant hyperthermia can be fatal. […] Signs and symptoms of malignant hyperthermia may vary and can occur during anesthesia or during recovery shortly after surgery. They can include: […] Severe muscle rigidity or spasms […] Rapid, shallow breathing and problems with low oxygen and high carbon dioxide […] Rapid heart rate […] Irregular heart rhythm […] Dangerously high body temperature […] Excessive sweating […] Patchy, irregular skin color (mottled skin). […] In rare cases, people at risk of malignant hyperthermia have shown signs of a reaction after intense physical activity during excessive heat or humidity, during a viral illness, or when taking statin medication used to lower cholesterol.

• #2 Malignant Hyperthermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/heat-illness/malignant-hyperthermia

  Malignant hyperthermia may develop during anesthesia or the early postoperative period. Clinical presentation varies depending on the drugs used and the patients susceptibility. Muscular rigidity, especially in the jaw, is often the first sign, followed by tachycardia, other arrhythmias, tachypnea, acidosis, shock, and hyperthermia. Hypercapnia (detected by increased end-tidal carbon dioxide [CO2]) may be an early sign. Temperature is usually 40 C and may be extremely high (ie, 43 C). Urine may appear brown or bloody if rhabdomyolysis and myoglobinuria have occurred. […] The diagnosis is suspected by the appearance of typical symptoms and signs within 10 minutes to, occasionally, several hours after inhalational anesthesia is begun. Early diagnosis can be facilitated by prompt recognition of jaw rigidity, tachypnea, tachycardia, and increased end-tidal CO2. […] Malignant hyperthermia develops in genetically susceptible patients who have been exposed (usually more than once) simultaneously to a depolarizing muscle relaxant and a potent, volatile inhalational general anesthetic.

• #2 Quick Reference: Malignant Hyperthermia – Perfusion.com

  https://perfusion.com/quick-reference-malignant-hyperthermia/

  Malignant hyperthermia (MH) is triggered by certain types of anesthetic agents, typically succinylcholine, sevoflurane, desflurane, isoflurane and halothane. The earliest sign and symptom that will present is an increase in end-tidal carbon dioxide. Other additional early signs include tachycardia, tachypnea, and rigidity of the masseter muscle called trismus. As an MH crisis progresses, other signs and symptoms are unstable blood pressure, cyanosis and/or mottling of the skin, diaphoresis, cardiac dysrhythmia and a dramatic increase in the body temperature. […] As an MH crisis progresses, other signs and symptoms are unstable blood pressure, cyanosis and/or mottling of the skin, diaphoresis, cardiac dysrhythmia and a dramatic increase in the body temperature.

• #2 Malignant Hyperthermia. Malignany Hyperpyrexia information

  https://patient.info/doctor/malignant-hyperthermia

  Spasm of the masseter muscle is often first noted. […] There is muscular rigidity despite a paralysing agent. If breathing is still spontaneous there is tachypnoea. […] There is tachycardia and the skin is flushed. […] There is hypoxia, hypercapnoea and a metabolic acidosis. […] Temperature may rise above 40 but normothermia does not exclude the condition. A rise in temperature tends to be a late feature. […] There is myoglobinuria. […] Specific early changes are a rise of the end expiratory CO2 together with the metabolic acidosis. […] Later signs include complex arrhythmias, cyanosis, hypoxia, hypotension, electrolyte abnormalities, rhabdomyolysis and severe hyperthermia. Hyperthermia is a late sign. […] Rhabdomyolysis is a sign of the severity of the condition.

• #2 Malignant hyperthermia: a review | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-015-0310-1

  The earliest signs are tachycardia, rise in end-expired carbon dioxide concentration despite increased minute ventilation, accompanied by muscle rigidity, especially following succinylcholine administration. Body temperature elevation can be a dramatic sign of MH. […] Hyperthermia can be marked, with an increase in core temperature at a rate of 12 C every five minutes. Severe hyperthermia (core temperature greater than 44 C) may occur, and lead to a marked increase in oxygen consumption, CO2 production, widespread vital organ dysfunction, and disseminated intravascular coagulation (DIC). […] Uncontrolled hypermetabolism leads to respiratory and in most cases metabolic acidosis due to rapid consumption of energy stores and ATP. If untreated, continuing myocyte death and rhabdomyolysis result in life-threatening hyperkalemia; myoglobinuria may lead to acute renal failure. […] The progression of the syndrome may be rapid and dramatic, particularly if precipitated by succinylcholine, or more slowly and not become manifest until after several hours after induction of anesthesia.

• #2 Nursing Guide to Malignant Hyperthermia – Straight A Nursing

  https://straightanursingstudent.com/malignant-hyperthermia/

  Malignant hyperthermia is a hypermetabolic crisis that is fatal if left untreated. It occurs in individuals with a specific genetic condition when they are exposed to certain anesthetic gasses or the medication succinylcholine. […] The result is ATP depletion, oxygen depletion, carbon dioxide production, and the development of acidosis. This pathological process is responsible for the early signs of malignant hyperthermia, which are tachycardia, hypercapnia and muscle rigidity. […] While in this hypermetabolic state, the body generates more heat than it is able to dissipate. This leads to hyperthermia which can occur early or later as the condition progresses. […] Studies show that in some cases, body temperature can increase by as much as 1 to 2 degrees Celsius every five minutes. Organ dysfunction sets in once the temperature reaches dangerously high levels above 41.5-degree Celsius (106.7-degrees Fahrenheit).

• #2 Malignant hyperthermia: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/malignant-hyperthermia/

  Affected individuals may be at increased risk for „awake” malignant hyperthermia, in which the severe reaction occurs in response to physical activity, often while sick, rather than in reaction to exposure to a triggering drug. […] While malignant hyperthermia often occurs in people without other serious medical problems, certain inherited muscle diseases (including central core disease, multiminicore disease, and STAC3 disorder) are associated with malignant hyperthermia susceptibility.

• #2 Malignant hyperthermia: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/malignant-hyperthermia/

  Malignant hyperthermia is a severe reaction to particular anesthetic drugs that are often used during surgery and other invasive procedures. If given these drugs, people at risk of malignant hyperthermia may experience a rapid increase in heart rate and body temperature (hyperthermia), abnormally fast breathing, muscle rigidity, breakdown of muscle fibers (rhabdomyolysis), and increased acid levels in the blood and other tissues (acidosis). Without prompt treatment and cessation of the drugs, the body’s reaction can cause multiple organs to be unable to function, including the heart (cardiac arrest) and kidneys (renal failure), and it can cause a blood clotting abnormality called disseminated intravascular coagulation. These complications may be life-threatening. […] Affected individuals may never know they have the condition unless they have a severe reaction to anesthesia during a surgical procedure or they undergo testing (for instance, if susceptibility is suspected because a family member had a severe reaction). Malignant hyperthermia may not occur every time anesthesia is used. Many individuals who develop a severe reaction have previously been exposed to a triggering drug and not had a reaction.

• #2 Malignant Hyperthermia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2231150-overview

  If an MH reaction is treated early in the process, complete recovery can be expected. Multiple organ failure and death can occur, however, and one or two deaths are reported to the MH hotline each year. Before the approval of dantrolene by the US Food and Drug Administration (FDA) in the late 1970s for use in the treatment of MH, the mortality of an acute MH reaction was greater than 70%. Currently, the mortality of acute MH is less than 5%.

• #2 Treating Malignant Hyperthermia: What You Should Know

  https://www.healthline.com/health/malignant-hyperthermia-treatment

  Malignant hyperthermia is a condition thats often triggered by certain anesthesia drugs and can be life threatening. […] The condition impacts an estimated 1 in every 100,000 adult surgeries and 1 in 30,000 childrens surgeries, and requires immediate treatment from a team of medical professionals. […] As soon as signs of malignant hyperthermia like elevated temperature, increased heart rate, rapid production of carbon dioxide, and muscle or jaw rigidity are noticed, the surgeon is notified so that they should end the surgery as soon as possible. […] Malignant hyperthermia is a life threatening condition that needs to be treated immediately. If left untreated, it can lead to: cardiac arrest, brain damage, internal bleeding, failure of other body systems, including the kidneys and liver, muscle damage, seizures, coma.

• #2 Malignant Hyperthermia and Related Conditions – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/critical-care-medicine/malignant-hyperthermia-and-related-conditions/

  The management of an episode of MH should include the following: Stop the offending agent (remove the vaporizers) and ventilate with 100% O2. […] If treated early, most patients recover uneventfully, but a significant proportion complain of muscle pain or discomfort. Indeed, a delay as short as 20 minutes from presenting signs to diagnosis and institution of dantrolene therapy may greatly increase morbidity. […] If this is true MH, and you have made the diagnosis early enough, the response to dantrolene is in the range of minutes to tens of minutes. The temperature, PaCO2 and heart rate all will begin to improve rather dramatically, and in parallel. The acidosis will correct itself and the hyperkalemia will correct due to symptomatic treatment and to the reduction in acidosis.

• #2 Malignant Hyperthermia May Develop in People with Heat or Exercise – MHAUS

  https://www.mhaus.org/about/press-releases/malignant-hyperthermia-may-develop-in-people-with-heat-or-exercise/

  There is mounting evidence that some people who are susceptible to Malignant hyperthermia (MH) will develop MH when exposed to hot environments or with exercise. […] Six year-old Vincent Groetzner died June 14, 2010, after he started to complain of leg cramps and rapid heart rate and a developing fever that soared to 108 degrees while playing at a friend’s house. The medical examiner reported the cause to be Malignant Hyperthermia (MH). […] The signs of MH include muscle rigidity, rapid heart rate, high body temperature, muscle breakdown and increased acid content. […] MH is inherited genetic disorder found in an estimated 1 out of 2,000 people. MH is triggered by certain anesthesia and most often experienced in individuals undergoing routine surgery but in rare cases MH can happen without anesthesia. Symptoms include body temperature of up to 107 degrees, muscle rigidity, system-wide organ failure, and possible death.

• #2 Delayed-onset malignant hyperthermia in the postanesthetic care unit: a case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8485277/

  Malignant hyperthermia (MH) is a potentially fatal hypermetabolic syndrome that occurs when susceptible individuals are exposed to triggering agents. […] A 77-year-old man awoke from anesthesia and was transferred to the recovery room. Ten minutes after his arrival, his mental status became stuporous and he developed masseter muscle rigidity, hyperventilation, and a body temperature of 39.8C. […] The principal diagnostic features of MH are unexplained elevation of the end-tidal carbon dioxide (EtCO2) concentration, hyperthermia, tachycardia, muscle rigidity, and rhabdomyolysis. […] Symptoms of MH appeared 95 minutes after exposure to the trigger factor. […] In this case, sevoflurane was suspected to be a trigger factor for MH. […] The patient’s MH clinical classification score was 53 points

• #3 Management of malignant hyperthermia: diagnosis and treatment | TCRM

  https://www.dovepress.com/management-of-malignant-hyperthermia-diagnosis-and-treatment-peer-reviewed-fulltext-article-TCRM

  Malignant hyperthermia is a potentially lethal inherited disorder characterized by disturbance of calcium homeostasis in skeletal muscle. […] Clinical symptoms of malignant hyperthermia, diagnostic criteria, and current therapeutic guidelines, as well as adequate management of anesthesia in patients susceptible to malignant hyperthermia, are discussed in this review. […] Clinical symptoms of MH are highly variable, and range from abortive courses with mild or moderate symptoms to fulminant MH crises with severe skeletal muscle hypermetabolism and rhabdomyolysis. Excessive CO2 production presenting with an increase in end tidal CO2 concentration or hyperventilation while breathing spontaneously is a sensitive and specific early sign of imminent MH. […] Further early symptoms of an MH crisis may include tachycardia, supraventricular or ventricular arrhythmia, and isolated masseter spasm or generalized muscular rigidity.

• #3 Malignant Hyperthermia: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17945-malignant-hyperthermia

  Symptoms of malignant hyperthermia may vary and can happen during your procedure or shortly after surgery while you’re recovering. If your symptoms start while you’re under the effects of anesthesia asleep or sedated you won’t know you’re experiencing these symptoms. But your anesthesiologist or nurse anesthetist will. They always carefully monitor people when they’re under anesthesia and will do the same for you. Once they see these signs, they’ll respond quickly with treatment for malignant hyperthermia. […] Early signs of malignant hyperthermia include unexplained increase in heart rate (tachycardia), unexplained increase in carbon dioxide produced by your body, rapid breathing (tachypnea), muscle rigidity, and rapid elevation in temperature. […] Later signs of malignant hyperthermia include increase in body temperature beyond what is normally seen with fever, dark pee, muscle breakdown showing up on blood tests, heart rhythm problems, bleeding, and seizures.

• #3 RYANODEX® | What is malignant hyperthermia (MH)?

  https://www.ryanodex.com/about-mh/

  Malignant hyperthermia (MH) is a pharmacogenetic disease that causes hypermetabolism, a fast rise in body temperature and severe muscle contractions when an affected person receives general anesthesia using volatile anesthetics or the paralytic succinylcholine. […] The signs and symptoms of MH include hypercarbia, muscle rigidity, fast-rising body temperature, tachycardia, myolysis, increased ETCO2, hyperkalemia, and acidosis. […] There are multiple signs that may prompt a diagnosis of MH by anesthesia practitioners. […] Hypercarbia is often the first clinical sign of MH. Other early signs include sinus tachycardia and masseter spasm. […] Every delay in treatment increases the risk of further complication during an MH crisis. […] The risk of complications may increase to 30% with a 20-minute delay in treating MH from its first symptom.

• #3 Malignant Hyperthermia. Malignany Hyperpyrexia information

  https://patient.info/doctor/malignant-hyperthermia

  Spasm of the masseter muscle is often first noted. […] There is muscular rigidity despite a paralysing agent. If breathing is still spontaneous there is tachypnoea. […] There is tachycardia and the skin is flushed. […] There is hypoxia, hypercapnoea and a metabolic acidosis. […] Temperature may rise above 40 but normothermia does not exclude the condition. A rise in temperature tends to be a late feature. […] There is myoglobinuria. […] Specific early changes are a rise of the end expiratory CO2 together with the metabolic acidosis. […] Later signs include complex arrhythmias, cyanosis, hypoxia, hypotension, electrolyte abnormalities, rhabdomyolysis and severe hyperthermia. Hyperthermia is a late sign. […] Rhabdomyolysis is a sign of the severity of the condition.

• #3 Malignant hyperthermia | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/malignant-hyperthermia/

  In rare cases, people at risk of malignant hyperthermia have shown signs of a reaction after intense physical activity during excessive heat or humidity, during a viral illness, or when taking statin medication used to lower cholesterol. […] If not treated promptly, malignant hyperthermia can result in major complications, such as: A rare condition that causes muscle cells to break down (rhabdomyolysis), Kidney damage or failure, Problems with clotting and bleeding, Death. […] Immediate treatment of malignant hyperthermia includes: A drug called dantrolene (Dantrium, Revonto, Ryanodex) is used to treat the reaction by stopping the release of calcium into muscles. Other medications may be given to correct problems with a balance of the body’s chemicals (metabolic imbalance) and treat complications. […] With treatment, malignant hyperthermia usually resolves within a few days.

• #4 Malignant hyperthermia – NYSORA

  https://www.nysora.com/anesthesia/malignant-hyperthermia-2/

  Malignant hyperthermia (MH) is caused by genetic defects, most commonly in the RYR1 gene (more rarely affected genes include CACNA1S and STAC3) […] Symptoms of malignant hyperthermia include unexplained, unexpected increase in ETCO2, unexplained, unexpected increase in heart rate, unexplained, unexpected increase in temperature, decreased urine output, muscle spasms, and masseter muscle rigidity.

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