Can You Die From Malignant Hyperthermia?
Yes, you can die from malignant hyperthermia (MH).1 Currently the mortality rate of malignant hyperthermia is less than 5% due to the early diagnosis of malignant hyperthermia, treatment with Dantrolene and proper management and with the introduction of malignant hyperthermia testing. The morbidity is about 34% which is quite high despite the low mortality rate.
The complications that can occur with malignant hyperthermia are loss of consciousness/coma, pulmonary edema, cardiac dysfunction, kidney dysfunction, liver dysfunction, and disseminated intravascular coagulation. Most of these complications can lead to multi-organ dysfunction and death.
Early Clinical Signs Of Malignant Hyperthermia
The following clinical signs appear early in malignant hyperthermia patients
- Muscle rigidity – definitive sign of malignant hyperthermia, about 50-80% of patients presents with generalized muscle rigidity.
- Muscle contractures occur if succinylcholine has been used.
- Unexplained sinus tachycardia – this is one of the earliest and frequent signs of malignant hyperthermia.
- Unexplained rise of end-tidal carbon dioxide levels – this is also one of the earliest and frequent clinical signs of malignant hyperthermia especially in mechanically ventilated and intubated patients. This can be diagnosed through a capnography. This sign is seen more when succinylcholine is used as the muscle relaxing agent.
- Increased oxygen consumption
- Sweating excessively
- Mottling of skin
Late Clinical Signs Of Malignant Hyperthermia
Metabolic Acidosis – can be diagnosed by an arterial blood gas analysis.
Respiratory Acidosis – can be diagnosed by an arterial blood gas analysis.
Blood Pressure: Unstable blood pressure
Hyperthermia – earlier this was considered as a specific sign of malignant hyperthermia, but it is actually a late sign of malignant hyperthermia and some patients never get hyperthermia. Therefore, should not wait until hyperthermia to occur to diagnose malignant hyperthermia. When hyperthermia occur the temperature increase 1-2℃ every five minutes and temperature rise more than 44℃ rapidly.
Hyperkalemia – increase in potassium levels, this can cause cardiac arrhythmias.2
Rhabdomyolysis – when the skeletal muscles are damaged the myglobin is released to the blood and excreted in urine. The urine becomes dark in color due to myglobinuria. Accumulation of myglobin in kidneys can cause acute kidney failure. Blood and urine myglobin levels will be high if tested.
Very High Levels Of Creatinine Phosphokinase Levels –this also released form damaged muscle cells.
Cardiac Arrhythmias And Cardiac Arrest – ventricular ectopics and ventricular bigemini can occur. These can result in cardiac arrest if not treated immediately.
Disseminated Intravascular Coagulation – formation of small blood clots throughout the blood vessels, results in fibrin generation deposition in blood vessels, this leads to formation of small thrombi in the body resulting in multi-organ failure. Development of disseminated intravascular coagulation is considered as a poor prognostic feature in malignant hyperthermia.
As you see malignant hyperthermia can give rise to severe complications in the body which can be fatal and can even cause death. Prevention, early diagnosis and immediate treatment can save many lives of patients who develop malignant hyperthermia. All the above sequence of events can occur within minutes, one second the patient looks fine and the next second patient is unconscious. The anesthetist and other doctors should suspect malignant hyperthermia if the above early signs develop in a patient who was administered volatile inhalation anesthetics and succinylcholine as this can be the first time the patient develop malignant hyperthermia.
Yes, you can die from malignant hyperthermia if it is not diagnosed early and proper treatment and monitoring is not carried out. The complications that can occur with malignant hyperthermia are loss of consciousness/coma, pulmonary edema, cardiac dysfunction, kidney dysfunction, liver dysfunction, and disseminated intravascular coagulation. Most of these complications can lead to multi-organ dysfunction and death, especially development of disseminated intravascular coagulation is considered as poor prognostic feature in malignant hyperthermia. Prevention, early diagnosis and immediate treatment can save many lives of patients who develop malignant hyperthermia.
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