TY - JOUR
T1 - The relationship between exertional heat illness, exertional rhabdomyolysis, and malignant hyperthermia
AU - Capacchione, John F.
AU - Muldoon, Sheila M.
N1 - Funding Information:
Supported by the Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
PY - 2009/10
Y1 - 2009/10
N2 - Exertional heat illness, exertional rhabdomyolysis, and malignant hyperthermia (MH) are complex syndromes with similar pathophysiology. All three are hypermetabolic states that include high demand for adenosine triphosphate, accelerated oxidative, chemical, and mechanical stress of muscle, and uncontrolled increase in intracellular calcium. Although there are no controlled clinical studies to support a relationship, there is evidence to suggest an association between unexpected heat/exercise intolerance and MH susceptibility. There are multiple case reports and a small number of clinical studies that have used in vitro muscle contracture testing and/or genetic testing to make the association. However, such methodology is problematic in that these tests are validated for clinical MH in association with anesthesia, and not for exertional heat illness or exertional rhabdomyolysis. Nevertheless, these relationships may have implications for some MH-susceptible patients and their capacity to exercise, as well as for clinicians treating and anesthetizing patients with histories of unexplained exertional heat and exercise illnesses.
AB - Exertional heat illness, exertional rhabdomyolysis, and malignant hyperthermia (MH) are complex syndromes with similar pathophysiology. All three are hypermetabolic states that include high demand for adenosine triphosphate, accelerated oxidative, chemical, and mechanical stress of muscle, and uncontrolled increase in intracellular calcium. Although there are no controlled clinical studies to support a relationship, there is evidence to suggest an association between unexpected heat/exercise intolerance and MH susceptibility. There are multiple case reports and a small number of clinical studies that have used in vitro muscle contracture testing and/or genetic testing to make the association. However, such methodology is problematic in that these tests are validated for clinical MH in association with anesthesia, and not for exertional heat illness or exertional rhabdomyolysis. Nevertheless, these relationships may have implications for some MH-susceptible patients and their capacity to exercise, as well as for clinicians treating and anesthetizing patients with histories of unexplained exertional heat and exercise illnesses.
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U2 - 10.1213/ane.0b013e3181a9d8d9
DO - 10.1213/ane.0b013e3181a9d8d9
M3 - Review article
C2 - 19617585
AN - SCOPUS:70349568135
SN - 0003-2999
VL - 109
SP - 1065
EP - 1069
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 4
ER -