Fatal malignant hyperthermia--delayed onset and atypical course |
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| Authors: | Karger B Teige K |
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| Affiliation: | 1. Division of Food Chemistry, Osaka Prefectural Institute of Public Health, Nakamichi 1-3-69, Higashinari-ku, Osaka, Japan;2. Laboratory of Quantum-Beam Chemistry and Biology, Radiation Research Center, Osaka Prefecture University, 1-2 Gakuen-cho, Sakai, Osaka, Japan;1. Material Science Research Laboratory, Department of Physics, Guru Nanak Dev University, Amritsar, 143005, India;2. S.I.E.T, Ram Tirath Road, Amritsar, 143107, India;3. Thin Film Devices Section, Technical Physics Division, Bhabha Atomic Research Centre, Mumbai, 400085, India;4. National Physical Laboratory, New Delhi, 110012, India;1. Department of Physics, Jiangxi Science and Technology Normal University, Nanchang 330013, China;2. State Key Laboratory for Marine Corrosion and Protection, Luoyang Ship Material Research Institute, Qingdao 266101, China;1. Zentrum für Sonnenenergie- und Wasserstoff-Forschung Baden-Württemberg, Helmholtzstraße 8, D-89081 Ulm, Germany;2. School of Science and Technology, Chemistry Division, Camerino University, I-62032 Camerino, Italy |
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| Abstract: | A case of malignant hyperthermia (mh) in a 27-year-old man is described. In a first anaesthesia using isoflurane and succinylcholine, the end-tidal CO(2) rose from 39 to 49 mmHg 2.75 h post-intubation and the body temperature rose to 39.8 degrees C 14 h post-intubation but was normal again the next day. In a second anaesthesia using the same medication, the maximal end-tidal CO(2) was 44 mmHg and the body temperature rose to 39 degrees C after 9 h. After 4 days, the fever rose to 40 degrees C, and to 42 degrees C when death occurred 10 days after the second anaesthesia. Masseter spasms or muscle rigidity were never present. According to the death certificate, death was due to multi-organ failure from sepsis. At autopsy, the skeletal muscles were pale and oedematous. Histology demonstrated focal necroses in the skeletal muscles, shock kidneys with myoglobin excretion and myoglobin clots in small blood vessels of the lungs. Hence, the postmortem diagnosis "malignant hyperthermia" was established but accusations of medical maltreatment were rejected because of the atypical and protracted clinical course and because uncharacteristic signs of malignant hyperthermia were attributable to the clinically suspected sepsis. |
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