Act Fast When Dantrolene Is Needed for Malignant Hyperthermia

There's no time to spare when a patient needs treatment for malignant hyperthermia.

This potentially fatal reaction to anesthesia causes uncontrolled calcium release in muscles...which leads to severe spasms and a rapid, dramatic increase in body temperature.

Prompt administration of IV dantrolene (Dantrium, Revonto, Ryanodex, etc) is critical to stop the calcium release.

Be ready to help manage malignant hyperthermia.

When taking a med history, alert your pharmacist if a patient mentions a previous reaction to anesthesia meds (desflurane, succinylcholine, etc) or a family history of malignant hyperthermia.

Document this info to help ensure preventive measures are taken in these patients. For example, certain anesthetics may need to be avoided if a patient at risk for malignant hyperthermia requires surgery.

In patients with malignant hyperthermia, expect to see dantrolene 2.5 mg/kg IV bolus doses...up to 10 mg/kg in most cases.

Help get dantrolene to the patient within 10 minutes of onset.

In most cases, you'll have a malignant hyperthermia cart or kit with dantrolene and sterile water for injection...plus meds to treat arrhythmias and high potassium that can accompany malignant hyperthermia.

Don't be surprised if a cart or kit is called for in areas other than operating rooms. Malignant hyperthermia can occur several hours after surgery...or after a patient is intubated using succinylcholine.

Keep in mind, Dantrium and Revonto vials contain dantrolene 20 mg...to be reconstituted with 60 mL of sterile water. But Ryanodex vials contain dantrolene 250 mg...to be reconstituted with 5 mL of sterile water.

Alert your purchaser if a malignant hyperthermia cart or kit is used. They'll need to keep at least 36 vials of Dantrium or Revonto or 3 vials of Ryanodex...enough to treat an average-sized adult...in-house at all times.

Ensure used carts or kits are promptly and properly refilled and replaced...and that all carts or kits are kept in-date.

Get our new chart, Malignant Hyperthermia Prevention and Treatment, for more on managing carts or kits, med prep, and mock drills.

Key References

  • www.ismp.org/tools/bestpractices/tmsbp-for-hospitals.pdf
  • https://medlineplus.gov/ency/article/001315.htm
  • www.ashp.org/news/2016/05/20/readiness_for_malignant_
    hyperthermia_can_be_survey_stumbling_block
Hospital Pharmacy Technician's Letter. Feb 2018, No. 340223



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