Isoflurane Induced Malignant Hyperthermia in a Patient with Glucose 6-Phosphate Dehydrogenase Deficiency and Growth Hormone Abuse
Table 3
Clinical grading scale in our case.
Process
Clinical elements in our case
Score
Muscle rigidity
Generalized body and masseter muscle rigidity (+)
15
Muscle breakdown
Elevated CPK > 10,000 IU after anesthesia without succinylcholine (negative), cola-colored urine (negative), excess myoglobin in urine or serum (not checked), and plasma [K+] > 6 mEq/L (in absence of renal failure) (negative)
3
Temperature increase
Rapidly increasing temperature, T > 38.8°C (+)
15
Cardiac involvement
Unexplained sinus tachycardia (+)
3
Respiratory acidosis
PETCO2 > 55 mmHg and arterial PaCO2 > 60 mmHg with appropriately controlled ventilation (+), inappropriate hypercapnia, and tachypnea (+),
15
Metabolic acidosis
Base deficit > 8 mEq/L (+), pH < 7.25 (+)
20
Reaction to dantrolene
Rapid reversal of malignant hyperthermia signs of metabolic and/or respiratory acidosis with intravenous dantrolene (+)
