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Clinical indicators of acute malignant hyperthermia

Clinical indicators of acute malignant hyperthermia
Hypercarbia* Controlled ventilation:
ETCO2 >55 mmHg
PaCO2 >60 mmHg
Spontaneous ventilation:
ETCO2 >60 mmHg
PaCO2 >65 mmHg
Muscle rigidity Generalized muscular rigidity (sustained contracture) during anesthesia with triggering agents
Severe masseter muscle spasm shortly following succinylcholine administration that does not abate within 1 minute
Arrhythmias Tachycardia
Ventricular arrhythmias (indicating acute hyperkalemia)
Acidosis Primarily respiratory acidosis but may include varying degrees of metabolic acidosis
Arterial pH <7.25
Base deficit >8 mEq/L
Hyperthermia Core temperature >38.8°C
Rapid rise in temperature
Rhabdomyolysis CK >20,000 international units after anesthesia with succinylcholine
CK >10,000 international units after anesthesia without succinylcholine
Cola-colored urine in perioperative period
Urine myoglobin >60 mcg/L
Serum myoglobin >170 mcg/L
Serum potassium >6 meq/L (without renal failure)
ETCO2: end-tidal carbon dioxide; PaCO2: partial pressure of arterial carbon dioxide; CK: creatine kinase.
* These values are approximate guidelines determined by experts with knowledge of and expertise in managing malignant hyperthermia events.
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