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$Unique_ID{BRK03962}
$Pretitle{}
$Title{Malignant Hyperthermia}
$Subject{Malignant Hyperthermia Fulminating Hyperpyrexia Hyperthermia of
Anesthesia Malignant Fever Malignant Hyperpyrexia MH Pharmacogenic Myopathy
Neuroleptic Malignant Syndrome Noonan Syndrome King Syndrome }
$Volume{}
$Log{}
Copyright (C) 1984, 1988, 1989, 1990, 1992 National Organization for Rare
Disorders, Inc.
8:
Malignant Hyperthermia
** IMPORTANT **
It is possible the main title of the article (Malignant Hyperthermia) is
not the name you expected. Please check the SYNONYMS listing on the next
page to find alternate names and disorder subdivisions covered by this
article.
Synonyms
Fulminating Hyperpyrexia
Hyperthermia of Anesthesia
Malignant Fever
Malignant Hyperpyrexia
MH
Pharmacogenic Myopathy
Information on the following disease can be found in the Related
Disorders section of this report:
Neuroleptic Malignant Syndrome
Noonan Syndrome
King Syndrome
General Discussion
** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Malignant Hyperthermia is hereditary disorder in which a person does not
react appropriately to certain drugs due to a genetic abnormality. The
patient develops a rapid, high fever after the administration of general
anesthesia or certain muscle relaxants. Drugs that could cause this respond
include halothane, cyclopropane, or succinylcholine.
Symptoms
Malignant Hyperthermia occurs in patients who may have been previously
unaffected by anesthesia or injection of muscle relaxants, although a few may
have reported previous episodes of muscle cramps or weakness following the
administration of certain medications. After certain anesthetic drugs or
muscle relaxants are administered, the patient quickly develops a very high
fever, sometimes as high as 110 degrees. Muscles twitch and become hard,
stiff and rigid. Headache, nausea, vomiting, low blood pressure
(hypotension), rapid heart beat (tachycardia) and irregular heartbeat
(cardiac arrhythmias) may be present. Major life threatening complications
include skeleton muscle degeneration (rhabdomyolysis), renal (kidney)
failure, accumulation of fluid in the lungs (pulmonary edema) and disruption
of blood clotting mechanisms. Levels of creatine phosphokinase are elevated
in the patient.
Causes
People may inherit a predisposition to malignant hypothermia through an
autosomal dominant gene. Human traits, including the classic genetic
diseases, are the product of the interaction of two genes, one received from
the father and one from the mother. In dominant disorders a single copy of
the disease gene (received from either the mother or the father) will be
expressed "dominating" the other normal gene and resulting in the appearance
of the disease. The risk of transmitting the disorder from affected parent
to offspring is fifty percent for each pregnancy regardless of the sex of the
resulting child.
Malignant Hyperthermia may also be related to abnormally high levels of
calcium in muscle tissue (sarcoplasmic tissue). The gene that regulates the
release of calcium from muscles and causes this disorder has been mapped to
region q13.1 of chromosome 19.
Affected Population
Malignant Hyperthermia is extremely rare. Males and females are affected
equally. Since most people have no symptoms unless they take certain drugs,
the great majority of people with Malignant Hyperthermia are not diagnosed.
Anyone with a relative who died during surgery for an unknown reason may want
to be tested for Malignant Hyperthermia.
Related Disorders
Symptoms of the following disorders can be similar to those of Malignant
Hyperthermia. Comparisons may be useful for a differential diagnosis:
Boys affected with King syndrome (slanted low set eyes, receding chin,
webbed neck, spinal abnormalities and short stature) or perhaps Noonan
syndrome may experience Malignant hyperthermia and should be monitored
closely during procedures requiring anesthesia. (For more information on
this disorder, choose "Noonan Syndrome" as your search term in the Rare
Disease Database).
A similar syndrome may also occur in myotonic disorders, Duchenne
muscular dystrophy, branchial hypertonic myopathy, central core disease or in
a congenital myopathy with dysmorphic features. It is not yet known exactly
what percentage of patients with these muscle disorders are at risk. (For
more information on this disorder, choose "Duchenne Muscular Dystrophy" as
your search term in the Rare Disease Database).
Neuroleptic Malignant Syndrome is a potentially fatal reaction to any of
a group of antipsychotic drugs or major tranquilizers (neuroleptics). These
drugs are commonly prescribed for the treatment of schizophrenia and other
neurological, mental or emotional disorders. Symptoms of Neuroleptic
Malignant Syndrome include a very high fever (102 to 104 degrees), irregular
pulse, rapid heartbeat (tachycardia), increased rate of respiration
(tachypnea), muscle rigidity, altered mental states, high or low blood
pressure and profuse perspiration. (For more information on this disorder
choose "Neuroleptic Malignant Syndrome" as your search term on the Rare
Disease Database).
Therapies: Standard
Malignant Hyperthermia is best prevented by presurgical detection of those at
risk. The most successful test for early detection involves a biopsy of
muscle from the thigh. This test is generally reserved for patients from
families where a Malignant Hyperthermia episode has occurred, or for patients
who have had a suspicious reaction to anesthesia. The test is available at a
few test centers in the United States.
In those who are susceptible to Malignant Hyperthermia, surgery is often
performed under regional or local anesthesia. Malignant Hyperthermia
patients should be certain that the drug dantrolene sodium is available at a
hospital where they are to undergo surgery. Dantrole sodium is a drug that
can stop progress of symptoms if given immediately when the reaction to
anaesthesia is identified as Malignant Hyperthermia.
Therapies: Investigational
Scientists studying Malignant Hyperthermia are attempting to develop a less
invasive diagnostic test for this disorder and are also trying to develop
more effective therapies for the syndrome.
Dr. Ron Gregg and Dr. Kirk Hogan at the University of Wisconsin are
trying to develop a test to identify persons at risk for Malignant
Hyperthermia. Members of families in which two or more persons have developed
Malignant Hyperthermia are needed for the study. Interested parties may
contact:
Dr. Kirk Hogan
University of Wisconsin
Dept. of Anesthesiology
CSC B6/387
600 Highland Ave.
Madison, WI 53792
(608) 262-6042
This disease entry is based upon medical information available through
August 1992. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
For more information on Malignant Hyperthermia please contact:
National Organization of Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 847-0407
Malignant Hyperthermia Association of the United States
P.O. Box 191
Westport, CT 06881-0191
(203) 847-0407
The North American MH Registry
Department of Anesthesia
Penn State College of Medicine
P.O. Box 850
Hershey, PA 17033
For names of on-call physicians available to treat MH emergencies, call
24 hours a day:
Medic Alert Foundation International
(209) 634-4917
Ask for: INDEX ZERO, Malignant Hyperthermia Consultant List.
For Genetic Information and Genetic Counseling referrals:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
Following is a list of Malignant Hyperthermia clinics:
Mayo Clinic Dept. of Anesthesiology
200 1st St., SW
Rochester, MN 55905
(507) 285-5601
University of Texas Medical Branch at Galveston
Dept. of Anesthesiology
Galveston, TX 77550
(409) 761-1906
Hahnemann University Medical School
Dept. of Anesthesiology
Broad and Vine Streets
Philadelphia, PA 19102
(215) 448-7960
Massachusetts General
Dept. of Anesthesiology
Room ACC3
Fruit Street
Boston, MA 02114
(617) 726-8800
University of Toronto
MH Investigatory Unit Room 5268
Medical Sciences Building
Toronto, Ontario M5S-1A
References
MENDELIAN INHERITANCE IN MAN, 9th ed.: Victor A. McKusick; Johns Hopkins
University Press, 1990. Pp. 499-500.
CECIL TEXTBOOK OF MEDICINE, 19th Ed.: James B. Wyngaarden, and Lloyd H.
Smith, Jr., Editors; W.B. Saunders., 1990. Pp. 2262-2263.
MALIGNANT HYPERTHERMIA. J.L. Moore & E.L. Rice. American Family
Physician (May 1992; 45(5)). Pp. 2245-51.
MALIGNANT HYPERTHERMIA. R.E. Larew. Postgrad Med (June 1989; 85(8)).
Pp. 117-8, 128-9.