Malignant Hyperthermia: Clinical diagnosis and management 

Malignant hyperthermia (MH) is one type of severe reaction and potentially deadly hyper metabolic crisis that occurs as a complication of general anesthesia. Malignant hyperthermia is one type of disorder that can be considered a gene-environment interaction.

Signs and symptoms: The signs, which may arise at any time during anesthesia, resulting from hyper metabolism in skeletal muscle. Symptoms of malignant hyperthermia include muscle rigidity, inappropriate tachycardia, high fever, and fast heart rate. Complications can include rhabdomyolysis and high blood potassium.

Most of the malignant hyperthermia individuals have few or no symptoms unless they are exposed to a triggering agent. The volatile anesthetic gases, such as halothane, sevoflurane, desflurane, isoflurane, enflurane  are the most common triggering agents or the depolarizing muscle relaxants suxamethonium and decamethonium  are used primarily in general anesthesia. 
Malignant hyperthermia-susceptible (MHS) individuals have genetic skeletal muscle receptor abnormalities, allowing uncontrolled intracellular release of calcium from the sarcoplasmic reticulum. Prevention of Malignant hyperthermia (MH) involves avoidance of the triggering anaesthetic agents in patients with a personal or family history of MH.

Treatment: For Malignant hyperthermia early recognition and prompt treatment are essential for the patient's survival. In susceptible individuals, the medications induce the release of stored calcium ions within muscle cells. That leads to increase in calcium concentrations within the cells cause the muscle fibers to contract which can help to generate excessive heat and results in metabolic acidosis. The Malignant hyperthermia diagnosis is based on symptoms in the appropriate situation. Family members may be tested to see if they are susceptible by muscle biopsy or genetic testing.

Treatment must be initiated emergently, as soon as the diagnosis of malignant hyperthermia (MH) is considered reasonable.  Immediate treatment includes discontinuation of all trigger agents, Antiarrhythmic drug treatment, to maintain high urinary output most preferred treatments are diuretic and fluid therapy.

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