A Clinical Case of Laboratory Diagnosis of Malignant Hyperthermia

The article presents data on a rare case of malignant hyperthermia (MH) that occurred on the operating table in patient M. during routine treatment in a multifunctional hospital. Hematological, biochemical, and immunological laboratory analysis are presented, which were carried out to patient M. under suspicion of anesthesiologists at the beginning of the operation and allowed timely prevention of complications causing multiple organ failure and timely therapy to stop the symptoms of developing shock. Further molecular genetic studies revealed a mutation in the RYR1 gene, with the replacement of nucleotide bases G>C, which provided the basis for confirming this disease. The diagnostic algorithm draws attention to key laboratory indicators - a significant increase in creatinekinase to 1493 IU/l on the day of surgery and to 4376 IU/l in subsequent days, myoglobin more than 700 ng/ml, which exceeds the upper reference intervals by several dozen times, as well as a simultaneous increase in lactate levels to 3.1 mmol/l, a disorders of the acid-base state of the blood, manifested by acidosis up to 7,18 units, hypercapnia and an increase in buffer excess. This publication may be of interest to anesthesiologists, pathology and laboratory medicine doctors and other specialists in the clinic of surgical diseases and emergency medicine, as an example of identifying the cause and algorithms for confirming a preliminary diagnosis of MH or observed unusual changes in laboratory parameters during surgery. This laboratory data allow us to confirm the preliminary diagnosis of MH and begin a set of therapeutic measures to stop the complication