Abnormal High Fever (Malignant Hyperthermia), A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Abnormal High Fever, Diagnosis and Treatment and Related Diseases
Malignant hyperthermia (or abnormal high fever) is an genetic disorder that produces a rapid increase in body temperature (fever) and severe muscle contractions (myalgia) when the affected person is provides with general anesthesia.
This disorder is not the same as hyperthermia due to medical emergencies such as heat stroke.
This is a rapid rise in temperature normally activated by an anesthetic and tends to be lethal
It is an inherited myopathy caused by a genetic mutation.
Linkage studies reveal that in the majority of families the defect is in the ryanodine receptor gene (RYR1) at chromosome 19q13.1
Malignant hyperthermia is an autosomal dominant trait, indicating it needs only one parent carrying the disorder for a child to inherit the disorder.
It may be linked with muscular diseases such as multi-mini-core myopathy and central core disease.
A form of malignant hyperthermia is produced by a defect in the ryanodine receptor (RYR1) gene
Malignant hyperthermia (MH) reactions happen with the onset postponed for several hours into anesthesia using:
1. Halothane especially,
2. Desflurane,
4. Sevoflurane, and
5. Isoflurane
It has been limked with:
1. Myotonia congenita
2. Duchenne muscular dystrophy and
3. Becker's muscular dystrophy.
Non-depolarizing neuromuscular blockers such as pancuronium are harmless.
Nitrous oxide and barbiturates such as thiopental are safe.
Symptoms are:
1. Rapid rise in temperature to 105 degrees F or higher
2. Muscle rigidity and stiffness
3. Dark brown urine (myoglobulin)
4. Muscle ache without obvious exercise to explain sore muscles
Onset may be during or within a few hours after anesthesia.
Spasm of the masseter muscle is often first noted.
There is muscular rigidity despite a paralyzing agent
There is tachycardia and the skin is flushed.
There is hypoxia, hyper-capnea and a metabolic acidosis.
Temperature may rise above 40° but normo-thermia does not exclude the condition.
Diagnosis:
There can be a family history of malignant hyperthermia or non-explained death during anesthesia.
Genetic testing is used to institute a diagnosis, but the caffeine halothane contracture test (CHCT) is the criterion standard.
Diagnosis is made by the muscle biopsy.
Caffeine, halothane, succinylcholine and raised potassium induce amplified contractions.
DNA testing cannot be used as the only test for MH susceptibility
Treatment
For an episode of malignant hyperthermia, a cooling blanket can help reduce fever.
The treatment with a drug called dantrolene throughout events of malignant hyperthermia has largely decreased the number of deaths.
Dantrolene, the antidote, decreases the loss of calcium from the sarcoplasmic reticulum in the skeletal muscle and restores normal metabolism
Fluids given orally and intravenously, and certain medicines, are important for maintaining the kidney function during an acute episode.
1.Call for help, as management can be difficult and complex for one person.
2.Switch from volatile anesthetics to alternative forms of anesthesia.
3.Give 100% oxygen and adjust ventilation according to blood gas analysis and end expiratory pCO2.
4.Deepen anesthesia with opioids, benzodiazepines, barbiturates or propofol.
5.Monitor blood gases, electrolytes, CK, myoglobin and lactate.
6.Stop surgery if it is elective and if there are signs of masseter spasm or a fulminant crisis.
7.Continue surgery, if there is no hyper-kalemia, no acidosis and there are no triggers.
8.Intravenous dantrolene should be given but prophylactic administration of dantrolene is now regarded as obsolete.
9.Arrhythmia may be treated with a beta-blocker or lidocaine.
TABLE OF CONTENT
Introduction
Chapter 1 Abnormal High Fever
Chapter 2 C

• Language: English
• Publisher: Kenneth Kee
• Release date: Nov 9, 2017
• ISBN: 9781370789993

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Abnormal High Fever

(Malignant Hyperthermia),

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2017 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Abnormal High Fever, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Abnormal High Fever)

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If the patient would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 amazon kindle books and 200 into Smashwords.com eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Abnormal High Fever (Malignant Hyperthermia)

What is Abnormal High Fever (Malignant hyperthermia)?

Malignant hyperthermia (or abnormal high fever) is an genetic disorder that produces a rapid increase in body temperature (fever) and severe muscle contractions (myalgia) when the affected person is provides