Malignant hyperthermia as a rare cause of SIRS after cardiac surgery
© Theuerkauf et al; licensee BioMed Central Ltd. 2014
Published: 18 August 2014
Use of extracorporal circulation (cardiopulmonary bypass) during cardiac surgery can cause a systemic inflammatory response. This so called „post-perfusion-syndrome“ (PPS) occurs in about a quarter of patients and results in clinical signs and symptoms of „systemic inflammatory response syndrome“ (SIRS) in 2-10% of patients. This condition is clinically associated with mild hyperthermia, acidosis, tachycardia and vasoplegia. It is generally treated with cristalloid infusions and vasopressors, and is mostly subsided by the next morning, at the latest after 48h.
Malignant hyperthermia is associated with a severe combined (respiratory and metabolic) acidosis, hyperlactatemia, hypercapnia, hyperthermia, grossly elevated serum levels of creatine kinase (CK) and acute renal failure.
Metabolic parameters and adrenergic drug application during the hospital stay of the patient. D=day; WBC=white blood count; CK=creatine kinase; TNI=troponine I; NA=noradrenalin, VP=vasopressin; DBX=dobutamin; ADR=adrenalin; MIL=milrinone
High volume requirements and vasopressor-dependency occur commonly following surgical mitral valve repair, especially in patients with severely impaired left ventricular function. Differential diagnosis of hyperthermia on the ICU includes microbial triggers of the systemic inflammatory process, which could have been the case in this patient, where an infection might have been suspected. PPS and SIRS do not prompt any suspicion of malignant hyperthermia. Nevertheless, rare causes of both, hyperthermia and volume-depletion should be taken into account, even if the clinical course is rather mild in a way so that MH appears almost unlikely.
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