Malignant hyperthermia - Revision history

Danbot: Strip excess bold

2026-03-22T09:12:36Z

Strip excess bold

← Older revision		Revision as of 09:12, 22 March 2026
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	==Triggering Agents==		==Triggering Agents==
	*~~'''~~Volatile inhalational anesthetics~~'''~~: sevoflurane, desflurane, isoflurane, halothane		*Volatile inhalational anesthetics: sevoflurane, desflurane, isoflurane, halothane
	*~~'''~~[[Succinylcholine]]~~'''~~		*[[Succinylcholine]]
	*~~'''~~Safe agents~~'''~~: propofol, etomidate, ketamine, nitrous oxide, all non-depolarizing paralytics, opioids, benzodiazepines, local anesthetics		*Safe agents: propofol, etomidate, ketamine, nitrous oxide, all non-depolarizing paralytics, opioids, benzodiazepines, local anesthetics

	==Clinical Features==		==Clinical Features==
	*Often occurs intraoperatively but can present in the PACU or ED		*Often occurs intraoperatively but can present in the PACU or ED
	*~~'''~~Earliest sign~~'''~~: unexplained rise in ~~'''~~end-tidal CO2~~'''~~ and ~~'''~~tachycardia~~'''~~		*Earliest sign: unexplained rise in end-tidal CO2 and tachycardia
	*'''Masseter muscle rigidity''' (particularly after succinylcholine) — early warning sign		*'''Masseter muscle rigidity''' (particularly after succinylcholine) — early warning sign
	*Generalized skeletal muscle rigidity		*Generalized skeletal muscle rigidity
	*~~'''~~Rapidly rising temperature~~'''~~ (may exceed 40°C; >1°C rise every 5 min)		*Rapidly rising temperature (may exceed 40°C; >1°C rise every 5 min)
	*Tachycardia, dysrhythmias, unstable blood pressure		*Tachycardia, dysrhythmias, unstable blood pressure
	*Dark urine ([[Rhabdomyolysis\|myoglobinuria]])		*Dark urine ([[Rhabdomyolysis\|myoglobinuria]])
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	==Evaluation==		==Evaluation==
	*Elevated and rapidly rising ~~'''~~end-tidal CO2~~'''~~		*Elevated and rapidly rising end-tidal CO2
	*ABG: combined respiratory and metabolic acidosis		*ABG: combined respiratory and metabolic acidosis
	*BMP: [[Hyperkalemia\|hyperkalemia]], hypercalcemia		*BMP: [[Hyperkalemia\|hyperkalemia]], hypercalcemia
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	===Immediate===		===Immediate===
	*'''STOP all triggering agents immediately'''		*'''STOP all triggering agents immediately'''
	*Call for ~~'''~~Malignant Hyperthermia Hotline: 1-800-644-9737~~'''~~ (MHAUS)		*Call for Malignant Hyperthermia Hotline: 1-800-644-9737 (MHAUS)
	*Hyperventilate with 100% O2 at high fresh gas flows		*Hyperventilate with 100% O2 at high fresh gas flows
	*Change anesthesia circuit and CO2 absorber if possible		*Change anesthesia circuit and CO2 absorber if possible

	===Dantrolene===		===Dantrolene===
	*~~'''~~[[Dantrolene]] 2.5 mg/kg IV bolus~~'''~~, repeat every 5-10 minutes until symptoms resolve<ref name="glahn">Glahn KP, et al. Recognizing and managing a malignant hyperthermia crisis. ''Br J Anaesth''. 2010;105(4):417-420. PMID 20837722.</ref>		*[[Dantrolene]] 2.5 mg/kg IV bolus, repeat every 5-10 minutes until symptoms resolve<ref name="glahn">Glahn KP, et al. Recognizing and managing a malignant hyperthermia crisis. ''Br J Anaesth''. 2010;105(4):417-420. PMID 20837722.</ref>
	*Maximum total dose: up to 10 mg/kg (no absolute ceiling if still symptomatic)		*Maximum total dose: up to 10 mg/kg (no absolute ceiling if still symptomatic)
	*Reconstitute with sterile water (each 20 mg vial in 60 mL) — time-consuming; assign dedicated team		*Reconstitute with sterile water (each 20 mg vial in 60 mL) — time-consuming; assign dedicated team
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	==Disposition==		==Disposition==
	*~~'''~~ICU admission~~'''~~ for all MH episodes		*ICU admission for all MH episodes
	*Monitor for recrudescence (recurrence in 25% within 24 hours)		*Monitor for recrudescence (recurrence in 25% within 24 hours)
	*Genetic counseling and testing for patient and family		*Genetic counseling and testing for patient and family

Danbot: Major expansion: dantrolene dosing, MHAUS hotline, triggering agents, cooling protocol, references

2026-03-21T18:37:53Z

Major expansion: dantrolene dosing, MHAUS hotline, triggering agents, cooling protocol, references

Show changes

Danbot: Add MedicationDose SMW annotations (dantrolene, sodium bicarbonate); dosing verified per MHAUS guidelines

2026-03-20T16:32:28Z

Add MedicationDose SMW annotations (dantrolene, sodium bicarbonate); dosing verified per MHAUS guidelines

← Older revision		Revision as of 16:32, 20 March 2026
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	<references/>		<references/>


			<div style="display:none">
			<!-- SMW MedicationDose annotations for malignant hyperthermia medications -->
			{{MedicationDose\|drug=Dantrolene\|dose=2.5 mg/kg IV push initial; titrate to effect (may need >10 mg/kg); then 1 mg/kg IV q4-6h x24-48h\|route=IV\|context=Specific antidote (muscle relaxant)\|indication=Malignant hyperthermia\|notes=Mix with 60 mL sterile water per vial; may need up to 36 vials; monitor for recrudescence (25% rate); call MHAUS hotline 1-800-644-9737}}
			{{MedicationDose\|drug=Sodium bicarbonate\|dose=1-2 mEq/kg IV\|route=IV\|context=Metabolic acidosis temporization\|indication=Malignant hyperthermia\|notes=Give if blood gas values not yet available}}
			</div>
	==See Also==		==See Also==
	*[[Succinylcholine]]		*[[Succinylcholine]]

Rossdonaldson1: /* Dantrolene */

2023-05-11T20:55:38Z

Dantrolene

← Older revision		Revision as of 20:55, 11 May 2023
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	*'''2.5mg/kg IV push'''		*'''2.5mg/kg IV push'''
	*Titrate to effect; may need more than 10mg/kg		*Titrate to effect; may need more than 10mg/kg
	*Call MHAUS Hotline if needed: 1-800-644-~~0737~~		*Call [https://www.mhaus.org/healthcare-professionals/ MHAUS Hotline] if needed: 1-800-644-9737
	*Continued Care		*Continued Care
	**Dantrolene 1mg/kg every 4-6 hours for 24–48 hours		**Dantrolene 1mg/kg every 4-6 hours for 24–48 hours

Elcatracho: /* Clinical Features */

2021-02-08T20:35:11Z

Clinical Features

← Older revision		Revision as of 20:35, 8 February 2021
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	==Clinical Features==		==Clinical Features==
	*Muscle contraction		*Muscle contraction
	*Fever		*[[Fever]]
	*May have dark colored urine from myoglobinuria		*May have dark colored urine from myoglobinuria
	*First signs		*First signs

Elcatracho: /* Management */

2021-02-08T20:33:32Z

Management

← Older revision		Revision as of 20:33, 8 February 2021
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	*Discontinue Triggering Agents		*Discontinue Triggering Agents
	*100% Oxygen at High Flow		*100% Oxygen at High Flow
	*Give Dantrolene		*Give [[Dantrolene]]
	*Provide [[bicarbonate]] for metabolic acidosis temporization		*Provide [[bicarbonate]] for metabolic acidosis temporization
	*Actively cool the patient		*Actively cool the patient
	*Treat any dysrhythmia		*Treat any [[dysrhythmia]]
	===Dantrolene===		===Dantrolene===
	*60ml sterile water into each vial of [[dantrolene]] may need up to 36 vials		*60ml sterile water into each vial of [[dantrolene]] may need up to 36 vials

Elcatracho: /* Dantrolene */

2021-02-08T20:33:04Z

Dantrolene

← Older revision		Revision as of 20:33, 8 February 2021
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	*Treat any dysrhythmia		*Treat any dysrhythmia
	===Dantrolene===		===Dantrolene===
	*60ml sterile water into each vial of [[dantrolene;]] may need up to 36 vials		*60ml sterile water into each vial of [[dantrolene]] may need up to 36 vials
	*If using Dantrium® (20mg/vial), each vial contains 3 g of mannitol (renal vasodilation); newer nanocrystalline dantrolene (250mg/vial) has 250mg mannitol per vial and requires mannitol supplementation		*If using Dantrium® (20mg/vial), each vial contains 3 g of mannitol (renal vasodilation); newer nanocrystalline dantrolene (250mg/vial) has 250mg mannitol per vial and requires mannitol supplementation
	*'''2.5mg/kg IV push'''		*'''2.5mg/kg IV push'''
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	**Monitor for recrudescence (rate is 25%)		**Monitor for recrudescence (rate is 25%)
	**Follow electrolytes, blood gases, CK, core temperature, urine output and color, coagulation studies		**Follow electrolytes, blood gases, CK, core temperature, urine output and color, coagulation studies

	===Bicarb===		===Bicarb===
	*1-2 mEQ/kg if blood gas values not yet available		*1-2 mEQ/kg if blood gas values not yet available

Elcatracho: /* Presentations */

2021-02-08T20:32:28Z

Presentations

← Older revision		Revision as of 20:32, 8 February 2021
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	===Presentations===		===Presentations===
	*99% Respiratory Acidosis		*99% [[Respiratory Acidosis]]
	*26% Metabolic Acidosis		*26% [[Metabolic Acidosis]]
	*80% Muscular Abnormalities		*80% Muscular Abnormalities
	Watch for it with [[succinylcholine]] use.		Watch for it with [[succinylcholine]] use.

Elcatracho: /* Likelihood of Complications */

2021-02-08T20:31:43Z

Likelihood of Complications

← Older revision		Revision as of 20:31, 8 February 2021
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	===Likelihood of Complications===		===Likelihood of Complications===
	*Increased time from 1st sign to 1st dantrolene		*Increased time from 1st sign to 1st [[dantrolene]]
	**For every 30 minute increase in the interval, complication likelihood increases x 1.6		**For every 30 minute increase in the interval, complication likelihood increases x 1.6
	*Increased maximal temperature		*Increased maximal temperature

Elcatracho: /* Clinical Features */

2021-02-08T20:30:52Z

Clinical Features

← Older revision		Revision as of 20:30, 8 February 2021
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	*Muscle contraction		*Muscle contraction
	*Fever		*Fever
			*May have dark colored urine from myoglobinuria
	*First signs		*First signs
	**Hypercarbia		**Hypercarbia