Key Points
- Confirm diagnosis early with highest-yield tests (e.g., MRV for CVST, CTA for mesenteric ischemia).
- Dose-and-route precision for high-risk medications; monitor for adverse effects.
- Explicit ICU criteria and consultation triggers.
Clinical Synopsis & Reasoning
Hypermetabolic crisis triggered by volatile anesthetics or succinylcholine. Stop triggers, call MH cart, give dantrolene promptly, and institute aggressive cooling and supportive care; treat hyperkalemia and acidosis, monitor for recrudescence.
Treatment Strategy & Disposition
Stabilize airway/breathing/circulation; initiate guideline-concordant first-line therapy; tailor escalation or de-escalation to clinical response and objective metrics; define clear disposition criteria (e.g., ICU triggers, ward acceptability, outpatient safety).
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitating factors
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Anemia/leukocytosis | Context-specific | Trend with therapy |
| BMP | Electrolytes/renal | Derangements common | Renal dosing |
| Condition-specific imaging | See topic | Diagnostic hallmark | Do not delay when red flags present |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Dantrolene | Ryanodine receptor inhibitor | Minutes | Initial 2.5 mg/kg IV bolus; repeat to effect (up to ~10 mg/kg) | Prepare large volumes; watch for weakness |
| Sodium bicarbonate | Buffer | Minutes | Treat severe metabolic acidosis | Check ABG; avoid over-alkalinization |
| Insulin with dextrose | Shifts K+ intracellularly | Minutes | Adjunct for hyperkalemia | Monitor glucose & K+ |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy
Patient Education / Counseling
- Explain red flags, adherence, and follow-up plan
References
- Authoritative guideline/review; see internal bibliography — Link