15 December 2024
: Case report 
Diagnostic Challenges in Malignant Hyperthermia and Anesthesia-Induced Rhabdomyolysis: A Case Study
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Unexpected drug reaction, Rare disease
Maya Belitova
ABCDEFG 1*, Gergana Georgieva Nikolova BCDF 1, Slavyana Usheva ABCDEF 2, Maya Todorova Mladenova BCDEFG 1, Tsvetomir Marinov BCE 1, Radka Kaneva CDE 3, Theophil Sedloev ABCDEFG 2
DOI: 10.12659/AJCR.946306
Am J Case Rep 2024; 25:e946306
Table 1. Arterial blood gas analysis of a patient with malignant hyperthermia.
| Parameter (units) | 10 Min after ETI; FiO2 50% | 30 Min after ETI; FiO2 50% | 40 Min after ETI; FiO2 50% | 4 h after ETI – admission in ICU; FiO2 50% | 24 h after intubation; FiO2 21% | Reference values |
|---|---|---|---|---|---|---|
| ctHb (mg/dL) | – | 13.6 | 13.2 | 12.3 | 13.7 | 11.5–16 |
| PO (mmHg) | – | 257.8 | 248.0 | 176.5 | 99.1 | 80–100 |
| ETCO (mmHg) | 59 | 54.7 | 35 | – | – | – |
| PCO (mmHg) | – | 59 | 37.1 | 25.1 | 36.5 | 35–45 |
| pH | – | 7.24 | 7.34 | 7.46 | 7.50 | 7.35–7.45 |
| SatO | – | 99.70% | 99.80% | 99.70% | 98.40% | 75–99 |
| BE | – | −5.00 | −3.80 | −3.60 | −0.60 | −0 to +3 |
| BB (mmol/L) | – | 41.71 | 42.2 | 43.27 | 46.85 | 44–48 |
| HCO (mmol/L) | – | 22.8 | 21.5 | 18.1 | 20.70 | 21–26 |
| Lactate (mmol/L) | – | 3.1 | 1.8 | 1.65 | 1.69 | <2 |
| Temperature (°C) | 37.2 | 37.2 | 37.2 | 37.2 | 37.2 | <37.5 |
| INR | 0.99 | 0.86 | 0.97 | 1.02 | 0.8–1.1 | |
| FiO – fraction of inspired oxygen; ETI – endotracheal intubation; ICU – Intensive Care Unit; ctHb – concentration of total hemoglobin; PO – partial oxygen pressure in arterial blood; PCO – partial pressure of carbon dioxide in arterial blood; ETCO – level of carbon dioxide released at the end of an exhaled breath; Sat O – oxygen saturation in arterial blood; BE – base excess; BB – total buffer base; HCO – concentration of bicarbonate; lactate – concentration of lactic acid; INR – international normalized ratio. | ||||||