Malignant hyperpyrexia
Malignant hyperpyrexia (also known as malignant hyperthermia) is a rare condition which can occur after exposure to halogenated general anaesthetic gas, or the depolarizing muscle relaxant succinylcholine, resulting in:
- widespread skeletal muscle rigidity
- hyperpyrexia
- acidosis
On exposure to the initiating agent, there is an acute rise in intracellular calcium which causes rigidity, muscle necrosis and hyperpyrexia with a rate of increase of greater than 2 degrees centigrade every hour.
Plasma levels of creatine kinase may be extremely high during the acute phase and the diagnosis is made by in vitro exposure of muscle to halothane or suxamethonium.
It occurs in about 1 in 100,000 adults and 1 in 30,000 in children, and the mortality rate is 3% to 5%, even when properly treated.
Nitrous oxide and xenon, although they are inhaled anaesthetics, are not halogenated and have not been implicated in malignant hyperthermia.
Reference
- Rosenberg H et al. Malignant hyperthermia: a review. Orphanet J Rare Dis. 2015 Aug 04;10:93
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