Background Malignant hyperthermia (MH) is an inherited autosomal‐dominant disorder of ryanodine receptors. While typically associated with exposure to inhaled anesthetics or depolarizing neuromuscular blocking agents (NMBAs), there have been reported cases following exposure to other conditions and medications including nondepolarizing neuromuscular blocking agent (NDNMBA). We report a case of suspected MH in a critically ill patient following a dose of rocuronium, a NDNMBA. Case Description A 46‐year‐old male with a history of pulmonary valve insufficiency, pulmonary arterial hypertension, and congestive heart failure presented to the emergency department in respiratory distress requiring intubation. After administration of a 1.2 mg/kg dose of rocuronium for rapid sequence intubation, his temperature started to slowly rise over 4–5 h. After a repeat dose, his fever rapidly rose to a maximum temperature of 41.0°C approximately 13 h after the initial dose. After cooling measures failed to lower the patient′s body temperature, the decision was made to give 2.5 mg/kg of IV dantrolene for suspected MH. The patient′s temperature dropped to 37.2°C within 2 h. The patient eventually recovered and was discharged home. Conclusions Although rare, there have been several case reports of possible MH following exposure to NDNMBA. It is important to bring awareness to these agents as a possible cause of MH given the importance of a quick diagnosis and prompt initiation of treatment to prevent fatal outcomes.
Woodring et al. (Thu,) studied this question.