A Case Report of Suspected Malignant Hyperthermia: How Will the Diagnosis Affect a Patient’s Insurability?

Table 4

Larach et al.’s clinical grading scale for malignant hyperthermia¹.

Clinical finding; (maximum score)	Manifestation
Respiratory acidosis; (15 points)	End-tidal CO2 >55 mmHg, PaCO2 >60 mmHg
Cardiac involvement (3 points)	Unexplained sinus tachycardia, ventricular tachycardia, or ventricular fibrillation
Metabolic acidosis (10 points)	Base deficit >8 mEq/L, pH <7.25
Muscle rigidity (15 points)	Generalized rigidity, severe masseter muscle rigidity
Muscle breakdown (15 points)	Serum creatine kinase concentration >20,000/L units, cola-colored urine, excess myoglobin in urine or serum, plasma [K+] >6 mEq/L
Temperature increase; (15 points)	Rapidly increasing temperature, T >38.8° C
Other	Rapid reversal of MH signs with dantrolene (score=5 points), elevated resting serum creatine kinase concentration (score=10 points)
Family history (15 points)	Consistent with autosomal dominant inheritance

(1) From Rosenberg H, Sambuughin N, Riazi S, Dirksen R. Malignant hyperthermia susceptibility; synonym: malignant hyperpyrexia. 2003 [Updated 2013]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews [Internet]. University of Washington, Seattle; 1993-2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1146/. Accessed October 13, 2018.