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      Severe Rhabdomyolysis due to Malignant Hyperthermia during Renal Transplantation Procedure Can Cause Delayed Graft Function

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          A case of rhabdomyolysis from malignant hyperthermia occurred during renal transplantation surgery is presented. After the completion of vascular and uretherovesical anostomosis, the patient’s heart rate began to rise, sweatiness was observed and body temperature increased to 41°C. Additionally, metabolic and respiratory acidosis and hyperkalemia were detected. Serum creatine kinase and lactic dehydrogenase levels were increased significantly. After external cooling and the administration of dantrolene sodium, body temperature and heart rate were decreased. During this period; furosemide, mannitol and sodium bicarbonate were given. Three hours after the completion of surgery, urine output was begun and urine myoglobin was found to be positive. Renal function improved gradually and serum creatinine level decreased to 1.6 mg/dl on the 14th postoperative day. Malignant hyperthermia can lead to severe rhabdomyolysis and delayed graft function in renal transplant recipients. Early diagnosis and intervention is crucial for protecting renal function.

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          Malignant hyperthermia.

           M Denborough (1998)
          A specific inherited muscle membrane disorder predisposes to a variety of clinical problems. The most common is malignant hyperthermia (MH), a dangerous hypermetabolic state after anaesthesia with suxamethonium and/or volatile halogenated anaesthetic agents. MH may also be triggered in susceptible individuals by severe exercise in hot conditions, infections, neuroleptic drugs, and overheating in infants. Inbred pigs have provided a helpful model, and experiments on these animals and in MH-susceptible patients have shown that the essential biochemical abnormality is an increase in calcium ions in the muscle cells. This knowledge has led to a specific muscle test to identify susceptibility to MH and to a specific treatment, dantrolene; and as a result the case-fatality rate in MH has fallen from 70% in the 1970s to 5% today. In pigs susceptibility to MH is caused by a single mutation in the ryanodine receptor (RYR) in skeletal muscle. In man the genetics is more complex and three clinical myopathies that predispose to MH have been defined. By far the most common is inherited as a mendelian dominant characteristic and at present mutations in the human RYR account for no more than 20% of susceptible families.

            Author and article information

            Am J Nephrol
            American Journal of Nephrology
            S. Karger AG
            February 2002
            28 March 2002
            : 22
            : 1
            : 81-83
            Departments of aNephrology, bAnaesthesiology, and cSurgery, Gülhane Medical School, Etlik, Ankara, Turkey
            46678 Am J Nephrol 2002;22:81–83
            © 2002 S. Karger AG, Basel

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            Page count
            Tables: 1, References: 9, Pages: 3
            Self URI (application/pdf):
            Case Report

            Cardiovascular Medicine, Nephrology

            Rhabdomyolysis, Malignant hyperthermia, Renal transplantation


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