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June 4, 2026A&A Practice1 citations

Probable Malignant Hyperthermia Presenting With Refractory Hypotension in a Young Trauma Patient: A Case Report

MAMuhammad Y. AzarJAJannah H. AzarAAAngela E. Azar

Key Points

  • This report aims to highlight the presentation of malignant hyperthermia in a trauma patient, particularly focusing on hemodynamic instability.
  • Case report of a 25-year-old trauma patient developing refractory hypotension after anesthetic exposure.
  • Monitoring included Et co 2 levels and treatment response to dantrolene (Ryanodex).
  • Refractory hypotension and rising Et co 2 noted despite increased ventilation; hemodynamic instability unresponsive to fluids and vasopressors.
  • Rapid reversal of symptoms following dantrolene administration, underscoring the effectiveness of early treatment.

Abstract

Malignant hyperthermia (MH) is a rare, life-threatening anesthetic complication caused by dysregulated skeletal muscle calcium homeostasis. We report a 25-year-old trauma patient who developed refractory hypotension with rising Et co 2 despite progressive increases in minute ventilation, followed by hyperthermia, 2.5 hours after exposure to succinylcholine and sevoflurane. Hemodynamic instability was unresponsive to fluids and vasopressors but reversed rapidly after treatment for probable MH with dantrolene (Ryanodex). This case highlights early hemodynamic instability as a prominent manifestation of MH and emphasizes rising Et co 2 despite increased ventilation as a critical diagnostic clue requiring prompt dantrolene administration.

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Cite This Study

Azar et al. (2026) studied this question.

synapsesocial.com/papers/6a2116fad499ed480b16fe27https://doi.org/10.1213/xaa.0000000000002213
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Incidence of Malignant Hyperthermia in Denmark1985 · 182 citations
  2. 2In vitro contracture test for diagnosis of malignant hyperthermia following the protocol of the European MH Group: Results of testing patients surviving fulminant MH and unrelated low‐risk subjects1997 · 300 citations
  3. 3Ryanodine receptor mutations in malignant hyperthermia and central core disease2000 · 344 citations
  4. 4Functional Defects in Six Ryanodine Receptor Isoform-1 (RyR1) Mutations Associated with Malignant Hyperthermia and Their Impact on Skeletal Excitation-Contraction Coupling2003 · 114 citations
  5. 5European Malignant Hyperthermia Group 2025 guidelines for the investigation of malignant hyperthermia susceptibility2026 · 16 citations