Abstract Introduction Malignant hyperthermia (MH) manifests itself clinically as a hypermetabolic crisis when a susceptible individual is exposed to volatile anesthetics or succinylcholine during a surgical procedure. It is a life-threatening condition that requires prompt administration of dantrolene, along with symptomatic management and close monitoring. It has a high risk of mortality if left untreated. Case Description A 42 year old male with no past medical history presented to the hospital with abdominal pain, diffuse tenderness and guarding. No family history of MH was reported. CT abdomen and pelvis showed small bowel obstruction. He underwent exploratory laparoscopy and was transferred back to his room in stable condition. One hour after surgery, he developed altered mental status and was unable to follow commands. He was hemodynamically stable and afebrile. On examination he was noted to have masseter and ocular muscle rigidity. CBC and chemistries were at baseline. CT head showed no abnormalities. He was transferred to ICU for closer monitoring. No response was noted on naloxone and lorazepam administration. Three hours later, he developed fever with temperature of 103 degree Fahrenheit. Spasticity was now noted in his upper and lower extremities. Repeat labs showed hyperkalemia and mild respiratory acidosis. Due to high suspicion for MH, IV Dantrolene administration and active cooling measures were started after which he showed rapid improvement in symptoms. His symptoms resolved completely over the next two days. Patient was discharged home in stable condition. Discussion Malignant hyperthermia is a rare complication of anesthetics. It is usually inherited in an autosomal dominant fashion. Skeletal muscle receptor or protein abnormalities lead to excessive accumulation of intracellular calcium in response to volatile anesthetics or succinylcholine. The drug of choice used to treat this condition is dantrolene. This case was different and unique because our patient developed gradual onset of symptoms over a duration of four hours after completion of surgery. This is unlike the typical presentation of MH which starts peri-operatively with an acute onset. Prompt identification and management of malignant hyperthermia is extremely crucial which led to good outcome in our patient. This abstract is funded by: None
Khan et al. (Fri,) studied this question.