Fava bean disease encounters malignant high fever

Fava bean disease encounters malignant high fever. Since the relationship between G6PD deficiency, human growth hormone abuse and malignant hyperthermia is currently unclear, further effective research is urgently needed in the future.

Malignant hyperthermia is a neuromuscular disease and a rare and serious complication of anesthesia. Fava bean disease is an X-linked incompletely dominant genetic disease. The risk of anesthesia is also greater. How does it test the anesthesiologist?

A case of malignant hyperthermia induced by isoflurane in a patient with glucose 6-phosphate dehydrogenase deficiency and growth hormone abuse. 

Malignant hyperthermia (MH) is a drug-induced genetic disease in the regulation of skeletal muscle calcium. Strong inhalation anesthetics, depolarizing muscle relaxants, succinylcholine, and stressors such as strenuous exercise and heat can be induced Uninhibited high metabolic response of muscles.
MH is diagnosed through clinical manifestations and laboratory tests.

Few studies have shown whether the occurrence of malignant hyperthermia is related to glucose 6-phosphate dehydrogenase (G6PD) deficiency, and there is no report on growth hormone adulteration in the literature.

Therefore, our main purpose is to show a rare case of malignant hyperthermia that occurred in surgical patients with growth hormone abuse and G6PD deficiency, and to try to find out whether there is an association between G6PD deficiency, growth hormone abuse and malignant hyperthermia.

The patient was a 17-year-old boy with pain and tenderness in the right lower abdomen and underwent an appendectomy.
At the end of the operation, the patient experienced increased heart rate (sinus tachycardia, up to 124 beats/min), increased body temperature and end-tidal carbon dioxide (ETCO2) (up to 153mmHg), masseter muscle stiffness, and then general stiffness, so consider Malignant high fever occurred. Urine volume and color are normal.

Therapy process:

• Immediately stop the inhalation anesthetic isoflurane;
• Dantrolene treatment, rapid intravenous injection of dantrolene 2.5 mg/kg;
• Insert urinary catheter and nasogastric tube, infuse ice salt water to cool down, add body surface to cool down;
• Body temperature, heart rate, and ETCO2 gradually decreased to 38.5°C (axillary), 80 beats/minutes, and 35 mmHg.

Then he was sent to ICU, ECG monitoring, danquling 1.0mg/kg every 6 hours for 24 hours, and related examinations and treatments were perfected.

We can hypothesize that malignant hyperthermia may be related to G6PD deficiency, but has nothing to do with the abuse of recombinant human growth hormone (rhGH).

The other main lesson this study taught us is:

Carefully and accurately record the medical history before the operation, in order to conduct pre-operative evaluation and identification of patients with suspected drug abuse in any form, so as to avoid receiving inhaled anesthetics;

Moreover, preventive measures such as avoiding extreme high temperatures and restricting exercise are taken for patients with a history of malignant hyperthermia. If malignant hyperthermia is suspected, it should be dealt with in time.

Since the relationship between G6PD deficiency, human growth hormone abuse and malignant hyperthermia is currently unclear, further effective research is urgently needed in the future.

(source:internet, reference only)

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