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Malignant Hyperthermia and Apparent Heat Stroke
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To the Editor: Malignant hyperthermia (MH) is an autosomal dominant condition in which certain anesthetics trigger calcium dysregulation in skeletal muscle, resulting in a catastrophic, life-threatening hypermetabolic syndrome.1 More than 50% of families with MH have mutations in the gene encoding the ryanodine receptor (RYR1).2 In a porcine model of MH, nonanesthetic, stress-induced deaths have been reported in pigs homozygous for the Arg614Cys mutation in the RYR1 gene,3 but this phenomenon has not been reported in humans with MH mutations. To our knowledge, we report the first case of nonanesthetic, stress-induced hyperpyrexic death in an individual with a history of MH.
Report of a Case
At age 12 years, the patient underwent general anesthesia with sevoflurane for reduction of a humerus fracture. Fifteen minutes after induction, he was found to have an abrupt increase in end tidal CO2 (>70 mm Hg), heart rate (150/min), and temperature (36.7°C to 39.4°C). Diaphoresis, but not . . . [Full Text of this Article]
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