title: Fatal malignant hyperthermia-like syndrome with rhabdomyolysis complicating the presentation of diabetes mellitus in adolescent males.
abstract: OBJECTIVE
  This report describes a new fatal syndrome observed in adolescent males at the initial presentation of diabetes mellitus. The features include hyperglycemic hyperosmolar coma complicated by a malignant hyperthermia-like picture with fever, rhabdomyolysis, and severe cardiovascular instability.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Pediatric intensive care units of 3 tertiary care facilities in the United States.
  
  
  METHODS
  Six adolescent males, 5/6 obese with acanthosis nigricans, 4/6 black.
  
  
  RESULTS
  Four of 6 patients died. Four of 6 patients did not have significant ketosis. Six of 6 patients had increased temperature after the administration of insulin.
  
  
  CONCLUSIONS
  The underlying etiology of this syndrome remains unclear. Possibilities include an underlying metabolic disorder such as a fatty acid oxidation defect, an unrecognized infection, exposure to an unknown toxin, or a genetic predisposition to malignant hyperthermia. Evaluation for all these possibilities and empiric treatment with dantrolene should be considered for this type of patient until this syndrome is better characterized.
authors.affiliation: Division of Pediatric Endocrinology and Metabolism, Washington University School of Medicine and St Louis, Children's Hospital, St Louis, MO 63110, USA. hollander@kids.wustl.edu
authors.forename: Abby S
authors.initials: AS
authors.lastname: Hollander
authors.forename: Robert C
authors.initials: RC
authors.lastname: Olney
authors.forename: Piers R
authors.initials: PR
authors.lastname: Blackett
authors.forename: Bess A
authors.initials: BA
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D003620:Dantrolene / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008305:Malignant Hyperthermia / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D012206:Rhabdomyolysis / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D003620:Dantrolene