What is the primary pharmacologic antidote for malignant hyperthermia?

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Multiple Choice

What is the primary pharmacologic antidote for malignant hyperthermia?

Malignant hyperthermia is a life-threatening reaction where certain anesthetic agents cause uncontrolled calcium release from the skeletal muscle cell’s storage (sarcoplasmic reticulum), leading to a rapid, dangerous rise in metabolism, heat, rigidity, acidosis, and electrolyte disturbances. The antidote that directly addresses this problem is dantrolene. It works by binding to the ryanodine receptor 1 and blocking calcium release from the sarcoplasmic reticulum in skeletal muscle. With less calcium available, the excessive muscle contraction and hypermetabolic state subside, which can stop the crisis from progressing. Because dantrolene targets the underlying mechanism, it’s the best treatment choice for malignant hyperthermia. In practice, stop the triggering agents, give 100% oxygen, and begin cooling measures while administering the drug. The typical approach starts with an IV bolus around 2.5 mg/kg, and additional doses can be given up to about a total of 10 mg/kg depending on response, with continued support and monitoring for complications like acidosis and hyperkalemia. Other drugs like epinephrine, atropine, or naloxone do not counteract the calcium dysregulation at the heart of this condition.

Malignant hyperthermia is a life-threatening reaction where certain anesthetic agents cause uncontrolled calcium release from the skeletal muscle cell’s storage (sarcoplasmic reticulum), leading to a rapid, dangerous rise in metabolism, heat, rigidity, acidosis, and electrolyte disturbances. The antidote that directly addresses this problem is dantrolene. It works by binding to the ryanodine receptor 1 and blocking calcium release from the sarcoplasmic reticulum in skeletal muscle. With less calcium available, the excessive muscle contraction and hypermetabolic state subside, which can stop the crisis from progressing.

Because dantrolene targets the underlying mechanism, it’s the best treatment choice for malignant hyperthermia. In practice, stop the triggering agents, give 100% oxygen, and begin cooling measures while administering the drug. The typical approach starts with an IV bolus around 2.5 mg/kg, and additional doses can be given up to about a total of 10 mg/kg depending on response, with continued support and monitoring for complications like acidosis and hyperkalemia. Other drugs like epinephrine, atropine, or naloxone do not counteract the calcium dysregulation at the heart of this condition.

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