ID/CC A 16-year-old female patient undergoes surgery to remove an inflamed appendix and has a rare anesthesia complication.
HPI The father states that the patient's paternal uncle died of an anesthetic complication. The patient has had no prior surgery and received general anesthesia in the form of halothane and succinylcholine.
PE VS: very high fever (39.8°C); hypertension (BP 150/95). PE: generalized muscular rigidity with difficulty breathing, anxiety, and marked sweating.
Labs CBC: leukocytosis with neutrophilia. Lytes: hyperkalemia. ABGs: metabolic acidosis. Elevated CK.
Treatment Immediate treatment to lower body temperature, control acidosis, and restore electrolyte balance is critical to survival. IV dantrolene relaxes skeletal muscle by inhibiting release of calcium from sarcoplasmic reticulum. This allows muscle to relax and limits hyperthermia from muscle hyperactivity.
Discussion Malignant hyperthermia is a highly lethal, genetically determined myopathy (autosomal-dominant trait). It is triggered by inhalation anesthetics (more commonly halothane), particularly those coupled writh succinylcholine. The syndrome includes tachycardia, hypertension, acidosis, hyperkalemia, and muscle rigidity, and it appears to be related to excess myoplasmic calcium.
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