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In most people with malignant hyperthermia susceptibility, they have few or no symptoms unless they are exposed to a triggering agent. The most common triggering agents are volatile anesthetic gases, such as halothane , sevoflurane , desflurane , isoflurane , enflurane or the depolarizing muscle relaxants suxamethonium and decamethonium used ...
Succinylcholine may also trigger malignant hyperthermia in rare cases in patients who may be susceptible. In depolarizing the musculature, suxamethonium may trigger a transient release of large amounts of potassium from muscle fibers. This puts the patient at risk for life-threatening complications, such as hyperkalemia and cardiac arrhythmias.
Like all the potent inhalational anaesthetic agents, it is a potent trigger for malignant hyperthermia. [5] Similarly, in common with the other potent inhalational agents, it relaxes uterine smooth muscle and this may increase blood loss during delivery or termination of pregnancy. [26]
RyR1 mutations are associated with malignant hyperthermia and central core disease. [17] Mutant-type RyR1 receptors exposed to volatile anesthetics or other triggering agents can display an increased affinity for cytoplasmic Ca 2+ at activating sites as well as a decreased cytoplasmic Ca 2+ affinity at inhibitory sites. [18]
Dantrolene may interact with the following drugs: [15] Calcium channel blockers of the diltiazem/verapamil type: Intravenous treatment with dantrolene and concomitant calcium channel blocker treatment may lead to severe cardiovascular collapse, abnormal heart rhythms, myocardial depressions, and high blood potassium.
The primary treatment strategy is to eliminate or discontinue the offensive agent. Supportive therapy, such as ice packs, may be provided to get the body temperature within physiologic range. In severe cases, when the fever is high enough (generally at or above ~104°F or 40°C), aggressive cooling such as an ice bath and pharmacologic therapy ...
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The diagnosis is suggested on patients with a history of drug exposure to the most common inducing agents such as strong antidopaminergic medications. [6] [40] The differential diagnosis includes serotonin syndrome, [41] encephalitis, toxic encephalopathy, status epilepticus, heat stroke, catatonia and malignant hyperthermia.