This document provides an overview of malignant hyperthermia (MH), including describing what MH is, its risk factors, etiology, clinical manifestations, diagnosis, management, prevention, and the pharmacology of dantrolene. MH is a rare life-threatening disorder triggered by certain anesthetic agents that causes a rapid rise in body temperature. It results from a genetic mutation affecting the ryanodine receptor in skeletal muscle. Presentation involves muscle rigidity, tachycardia, and a body temperature over 41°C. Diagnosis is based on clinical features and confirmed with in vitro muscle testing. Management involves immediately discontinuing triggers, rapidly cooling the patient, administering dantrolene to reduce calcium levels,
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
This presentation focuses on main and most common oncological emergencies that are required by any stagiaire or junior doctor.
This presentation based on three books mainly, Davison’s principles and practice of medicine, pocket guide to oncological emergencies and ESMO hand book of oncological emergencies, in addition to some researches.
Presentation on Sarcoidosis by S.K Jindal | Jindal Chest Clinic, ChandigarhJindal Chest Clinic
When the immune system overreacts, granulomas are formed, leading to a condition known as sarcoidosis. This disorder can cause mild to severe symptoms, or no symptoms at all. This Presentation describes sarcoidosis and gives an overview on Sarcoidosis including causes, symptoms, diagnosis, complications, supplements for sacrcoidosis, and treatment strategies. For more information, please contact us: 9779030507.
Overview of Scleroderma, Raynaud's Phenomenon and Current Treatments - Presented by Dr. Nadera Swiss at the Scleroderma Foundation Greater Chicago Chapter's Patient Education Conference on Saturday, April 27, 2019
ANAESTHESIA MANAGEMENT IN PATIENTS OF NEUROMUSCULAR DISORDERS.pptxSumit Tyagi
Comprehensive ppt covering myasthenia graves in details along with other neuromuscular disorders.
brief and complete solution for presentation needs of DNB/MD students in anaesthesia department.full coverage of myasthenia graves with light on all other neuromuscular disease.illustrative diagram of NMJ.Tabular list of drugs exacerbating myasthenia graves and increasing the duration of action of the muscular relaxants
This ppt describes the anti-arrhythmic drugs pharmacology and the treatment of various arrhythmias. Novel drugs in clinical trials and older drugs with repurposed formulations also have been included. Useful for MD Pharmacology residents as well as MBBS students.
The ppt is made for undergraduate students to have a basic understanding on Corticosteroids and its role in all feilds of medicine. This is also useful to Postgraduate students
Gout is a type of inflammatory arthritis that causes permanent disability if left untreated. This presentation focuses on the important salient points we need to remember in Gout in all aspects - diagnosis, managment (both non-pharmacological and pharmacological approaches).
This presentation is useful to both MBBS and Postgraduate students of Pharmacology.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. SPECIFIC LEARNING OBJECTIVES
BY THE END OF THE SESSION THE LEARNER WILL BE ABLE TO
DESCRIBE,
• What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
3. WHAT IS MALIGNANT HYPERTHERMIA?
• Malignant hyperthermia (MH) is a rare and
life-threatening pharmacogenetic disorder
triggered by volatile anesthetics, the
depolarizing muscle relaxant succinylcholine,
and rarely by strenuous exercise or
environmental heat.
• Peak body temp of 41℃ and above or acute
rise of 1-2℃ within 15 mins.
• If not treated immediately patient will go into
multiorgan failure and death.
4. EPIDEMIOLOGY
• Incidence - 1:5000 to 1:50000 during general anaesthesia
• Other causes - 1:100000
• Generally affects in age < 18 years (30-60% cases)
• Male : Female - 4:1 (But in India more female cases are reported).
5. • What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
8. • What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
11. • What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
16. • What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
17. DIAGNOSIS OF MALIGNANT HYPERTHERMIA
• Medical / Family history
• Clinical presentation
• Biochemical tests
• In vitro caffeine-halothane contracture testing
(IVCT/CHCT)
• Genetic testing
• Minimally invasive tests
18. CLINICAL PRESENTATION
• Muscular spasm or rigidity of a certain part of the body, such as
masseteric spasm or whole-body rigidity.
• Unexplained rapid pulse, fluctuating blood pressure, arrhythmia.
• Body temperature that rises rapidly in a short time (1−2°C over 5−15
minutes) and quickly reaches 38.8°C or even ultrahigh temperatures of
41−42°C.
• Respiratory and circulatory system failure in a short time: cyanosis,
arrhythmia, oliguria & cola colored urine.
23. GENETICS TESTING
• DNA testing for RYR1 mutations
• AD inheritance - If father or mother affected, test for mutations in
offsprings also.
24. MINIMALLY INVASIVE TESTS
• Nuclear Magnetic Resonance Spectroscopy - detects ATP depletion
during graded exercise (in vivo)
• Capnography - Enhanced release of CO2 is measured by inserting a
microdialysis catheter into muscle and injection of small amount of
caffeine.
31. MANAGEMENT GUIDELINES FOR SUSPECTED MH
5 ‘C’ Principles
• Cooling the body with ice packs, infusion with cold saline, cold
immersion of body till chest.
• Convulsion relief: sedation and adequate oxygen supply
• Correcting water and electrolyte imbalance, stabling the cell
membrane
• Calcium supplements and narcotic drugs should be used with caution
• Closely monitoring vital signs, temperature, blood gas indicators, acid-
base balance indicators, and serum ions for at least 24 hours
32. • What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
33. STEP 1
• Stop potent inhalational agents & succinylcholine & shift the patient on Total
Intravenous Anesthesia
STEP 2
• Increase the minute ventilation to lower the ETCO2
STEP 3
• Administer Dantrolene 2.5mg/kg initially, maximum upto 10mg/kg.
• Titrate dantrolene according to tachycardia and hypercarbia
• Dantrolene requires Mg2+ to arrest MH. So check serum Mg2+ and give MgSO4 if
needed.
34. STEP 4
• Begin cooling measures - ice packs to groin, axilla, neck
• Nasogastric lavage with iced saline or infusion of cold NS 2000mL.
• Stop cooling if body temp comes down to 38.5
STEP 5
• Treat arrhythmias with Amiodarone 3mg/kg i.v. Dantrolene also has anti-
arrhythmic action.
STEP 6
• Secure blood for ABG, myoglobin, electrolytes, CK. Urine for myoglobin
• Check coagulation profile every 6-12hrs
℃
35. STEP 7
• Treat hyperkalemia - hyperventilation, bicarbonate and intravenous
glucose and insulin (child - regular insulin 0.1U/kg i.v + 0.5g/kg
dextrose); adult - Regular insulin 10U i.v + 50mL of 50% dextrose.
STEP 8
• Treat acidosis with sodium bicarbonate - 1-2mEq/kg i.v infusion
• Continue dantrolene at 1 mg/kg every 4–8 hours for 24–48 hours
STEP 9
• Ensure urine output of 2 ml/kg/hour with mannitol (1g/kg i.v),
furosemide (0.5-1mg/kg i.v), and fluids as needed.
36. FOLLOW UP
• Tests for DIC should be done - CBC, Prothrombin time, aPTT, D-
dimer, platelet count.
• Patient should be closely monitored for 24-48 hrs after the initial
episode.
• 25 % patients may relapse even on dantrolene treatment.
37. • What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
38. PREVENTION OF MH EPISODES
• Thorough anesthetic history
• Patients with any form of myotonia should not receive
succinylcholine.
• Patients with hypokalemic periodic paralysis, CCD, Duchenne or
Becker muscular dystrophy, paramyotonia, or myotonia fluctuans
should not receive trigger agents.
• All patients receiving more than a brief general anesthetic should have
their core temperature monitored.
39. PREVENTION - contd..
• Young patients (below age 12) should not receive succinylcholine for
elective procedures, in order to avoid the possibility of hyperkalemic
response.
• Advice should be given to patients susceptible to MH to avoid heat
and humid environments.
• Dantrolene 2.5 mg/kg intravenously over one minute, approximately
75 minutes before surgery.
40. • What is Malignant Hyperthermia?
• Risk factors for MH
• Etiopathogenesis of MH
• Clinical manifestations of MH
• Diagnosis of MH
• Management of Acute MH
• Prevention of MH
• Pharmacology of Dantrolene
• Summary
41. PHARMACOLOGY OF DANTROLENE
• It is a directly acting skeletal muscle relaxant
• MOA - Ryanodine receptor 1 antagonist- prevents the receptor from
opening - reduces intracellular calcium.
• T1/2 - 4-8hrs. Metabolized in liver, excreted in urine.
• Available dosage form - Capsules and injection (20mg vial powder) -
to be reconstituted fresh in 60mL distilled water and given as bolus
immediately.
• Adult dosage needed in an acute MH crisis - 10 vials of dantrolene.
• Precautions - Dantrolene + Calcium channel blockers - fatal
hyperkalemia & cardiovascular collapse.
42. OTHER USES OF DANTROLENE
FDAAPPROVED:
• Spasms, cramping, and tightness of muscles caused by multiple sclerosis (MS),
cerebral palsy, stroke, or injury to the spine.
• Dose: Adults - 25 mg/day to max 100mg t.i.d; Children - 0.5 mg/kg twice a day.
OFF LABEL USES:
• Neurolept Malignant syndrome
• Overdose of 2,4-dinitrophenol
• To treat vasospasm following aneurysmal subarachnoid hemorrhage.
• Alzheimers disease (in research)
45. CONTRAINDICATIONS OF DANTROLENE
Oral dantrolene is contraindicated in patients with
• Liver cirrhosis
• Non-alcoholic steatohepatitis
• Hepatitis B or C infections
No contraindications for i.v dantrolene in malignant hyperthermia
46. SUMMARY
• MH - Pharmacogenetic disorder - Body temp > 42℃, Hypermetabolic state.
• M/c with halogenated anesthetics and succinylcholine
• Age < 18 yrs more common
• 3 main mutations - RyR1, DHPR, STAC3
• Emergency condition treated with RyR1 antagonist Dantrolene 2.5mg/kg i.v to
max 10mg/kg i.v.
• Cooling measures till temp reaches 38.5℃.
• Supportive measures with Sodium bicarbonate, Furosemide, mannitol, dextrose,
Insulin (for hyperkalemia).
• Watch for complications of MH- DIC, arrhythmias, CHF.
• Genetic counselling is must in MH susceptible patients.
• Rule out other possible causes of hyperthermia and rhabdomyolysis.
47. REFERENCES
• Rosenberg, H., Davis, M., James, D. et al. Malignant hyperthermia. Orphanet J Rare Dis 2,
21 (2007). https://doi.org/10.1186/1750-1172-2-21
• Malignant Hyperthermia: A Killer If Ignored, Xin Bin, DDS, PhD, Baisheng Wang, DDS,
PhD, Zhangui Tang, DDS, PhD, April 10, 2022. https://doi.org/10.1016/j.jopan.2021.08.018
• Ronald S. Litman, Sarah M. Griggs, James J. Dowling, Sheila Riazi; Malignant
Hyperthermia Susceptibility and Related Diseases. Anesthesiology 2018; 128:159–167 doi:
https://doi.org/10.1097/ALN.0000000000001877
• Yang Lukun, Tautz Timothy, Zhang Shulin, Fomina Alla, Liu Hong. The current status of
malignant hyperthermia[J]. The Journal of Biomedical Research, 2020, 34(2): 75-85. doi:
10.7555/JBR.33.20180089
• Pawan K Gupta , Philip M Hopkins, Diagnosis and management of malignant
hyperthermia, BJA Education, Volume 17, Issue 7, July 2017, Pages 249–254,
https://doi.org/10.1093/bjaed/mkw079