MALIGNANT HYPERTHERMIA AND COVID-19: IS THERE A CORRELATION?
Chest
; 162(4):A1040-A1041, 2022.
Article
in English
| EMBASE | ID: covidwho-2060759
ABSTRACT
SESSION TITLE COVID-19 Case Report Posters 2 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION:
Malignant hyperthermia (MH) is a hypermetabolic crisis where an increase in carbon dioxide is seen despite an increased minute ventilation with a proposed mechanism as a disturbance in calcium homeostasis. Commonly seen in volatile anesthetic agents and depolarizing neuromuscular blockers, rarely with nondepolarizing agents. There has been one reported case of cisatracurium-induced MH in the setting of ARDS. There have been two cases reported of nondepolarizing neuromuscular agents causing MH in the setting of COVID-19. CASE PRESENTATION A 34-year-old man with severe COVID-19 complicated by ARDS on ventilator day 16, due to refractory fevers, ventilatory dyssynchrony, high minute ventilation and auto-PEEP phenomena, the decision was made to attempt neuromuscular paralysis. After one dose of cisatracurium, the patient became hyperthermic and end-tidal carbon-dioxide increased from 58-98 with inability to oxygenate. The patient developed high peak pressures, bedside ultrasound revealed no evidence of pneumothorax also confirmed with chest x-ray. The patient then received a dose of dantrolene with end-tidal improving to 60 and tachycardia also resolved. A creatinine kinase level drawn was elevated at 571.DISCUSSION:
A proposed mechanism of MH is calcium release from sarcoplasmic reticulum, a mutation in skeletal muscle ryanodine receptor calcium release channels that can release IL-6 when activated leading to excessive muscular contraction. Proinflammatory cytokine IL-6, dantrolene may block IL-6 release which results in its therapeutic effect in the treatment of MH. IL-6 has been used to predict deterioration from COVID-19. Dantrolene in this sense has been proposed as a potential therapeutic agent against COVID-19, inhibiting intracellular calcium influx thus preventing the pathological feedback of viral entry into cells via endocytosis, as this is a calcium dependent process. Given the possible link between IL-6 release, calcium and MH, SARS-CoV-2 viral entry into cells may place patients at higher risk of MH. Patients with COVID-19 may be at higher risk of MH, even in rare agents such as non-depolarizing agents as seen in this case. Awareness of this potentially increased complication from these agents in those patients with COVID-19 is key as we continue in the ongoing global pandemic.CONCLUSIONS:
Given the possible link between IL-6 release, calcium and MH, SARS-CoV-2 viral entry into cells may place patients at higher risk of MH. Patients with COVID-19 may be at higher risk of malignant hyperthermia, even in rare agents such as non-depolarizing agents as seen in this case. Awareness of this potentially increased complication from these agents in those patients with COVID-19 is key as we continue in the ongoing global pandemic. Reference #1 Sathyanarayanan SP, Hamza M, Hamid K, Groskreutz D. Cisatracurium-Associated Malignant Hyperthermia During Severe Sars-CoV-2 Infection. Am J Ther. 2021 Aug 10;28(5)e590-e591. doi 10.1097/MJT.0000000000001437. PMID 34387563;PMCID PMC8415506. Reference #2 Chiba N, Matsuzaki M, Mawatari T, Mizuochi M, Sakurai A, Kinoshita K. Beneficial effects of dantrolene in the treatment of rhabdomyolysis as a potential late complication associated with COVID-19 a case report. Eur J Med Res. 2021 Feb 8;26(1)18. doi 10.1186/s40001-021-00489-8. PMID 33557936;PMCID PMC7868892. Reference #3 Han H, Ma Q, Li C, Liu R, Zhao L, Wang W, Zhang P, Liu X, Gao G, Liu F, Jiang Y, Cheng X, Zhu C, Xia Y. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerg Microbes Infect. 2020 Dec;9(1)1123-1130. doi 10.1080/22221751.2020.1770129. PMID 32475230;PMCID PMC7473317. DISCLOSURES No relevant relationships by Hira Bakhtiar No relevant relationships by Timothy DAmico no disclosure on file for Sarah Margolskee;No relevant relationships by Carlos Merino No relevant relationships by Joanna Moore
carbon dioxide; cisatracurium; creatine kinase; cytokine; dantrolene; endogenous compound; inhalation anesthetic agent; interleukin 10; interleukin 6; muscle relaxant agent; neuromuscular blocking agent; ryanodine receptor 1; adult; adult respiratory distress syndrome; adverse drug reaction; artificial ventilation; awareness; calcium cell level; calcium homeostasis; calcium transport; case report; clinical article; complication; conference abstract; coronavirus disease 2019; deterioration; drug therapy; end tidal carbon dioxide tension; endocytosis; fever; gene expression; gene mutation; human; human tissue; lung minute volume; male; malignant hyperthermia; microorganism; muscle contraction; nonhuman; pandemic; paralysis; pneumothorax; positive end expiratory pressure ventilation; protein fingerprinting; rhabdomyolysis; sarcoplasmic reticulum; Severe acute respiratory syndrome coronavirus 2; side effect; signal transduction; tachycardia; therapy effect; thorax radiography; ultrasound; ventilator; virus entry
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Database:
EMBASE
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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