title: Trauma, systemic inflammatory response syndrome, dietary supplements, illicit steroid use and a questionable malignant hyperthermia reaction.
abstract: BACKGROUND
  Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle calcium regulation associated primarily, but not exclusively, with mutations in the skeletal muscle ryanodine receptor. Associated environmental factors, however, may also be important for expression of the syndrome.
  
  
  RESULTS
  A 24-yr-old trauma patient developed a fulminant MH crisis after a 3 minute exposure to sevoflurane. A thorough evaluation of underlying co-morbidities revealed a number of environmental factors that could have altered skeletal muscle calcium regulation, and may have potentially influenced the effects of volatile inhaled anesthetics. Since MH is a syndrome characterized by abnormal skeletal muscle calcium regulation, other factors that alter calcium homeostasis may exacerbate the impact of inhaled MH-triggering drugs.
  
  
  CONCLUSIONS
  While a thorough history of MH episodes in a proband and family is emphasized as part of a complete preanesthetic evaluation, obtaining a history of other environmental entities that may alter calcium regulation may be equally important to knowing the family history.
authors.affiliation: Uniformed Services University of the Health Sciences, Department of Anesthesiology, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA. jcapacchione@usuhs.mil
authors.forename: John F
authors.initials: JF
authors.lastname: Capacchione
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Radimer
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Sagel
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Kraus
authors.forename: Nyamkhishig
authors.initials: N
authors.lastname: Sambuughin
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Muldoon
mesh_terms: D045930:Anabolic Agents / Q000009:adverse effects*; D000769:Anesthesia, Inhalation; D003402:Creatine Kinase / Q000097:blood; D003646:Debridement; D003937:Diagnosis, Differential; D019587:Dietary Supplements / Q000009:adverse effects*; D006119:Groin / Q000293:injuries; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008305:Malignant Hyperthermia / Q000175:diagnosis*; D018482:Muscle, Skeletal / Q000378:metabolism; D013256:Steroids / Q000009:adverse effects*; D018746:Systemic Inflammatory Response Syndrome / Q000139:chemically induced / Q000150:complications*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D013287:Illicit Drugs; D013256:Steroids; D003402:Creatine Kinase