Exertional Heat Illness, Exertional Rhabdomyolysis, and Malignant Hyperthermia: Is There a Link?

This short review discusses possible links between exertional heat illness (EHI), malignant hyperthermia (MH), and exertional rhabdomyolysis (ER). Evidence on clinical, genetic, and functional aspects, though limited, is compared through individual case reports and a small number of clinical studies. Typically, MH occurs during anesthesia and surgery, EHI during strenuous exercise in hot and humid environments, and ER unrelated to heat and humidity after strenuous exercise. Genetic analysis of the RYR1 gene has identified various mutations, especially in MH, but also in some cases of EHI and in number of ER cases as well. Pathophysiologically, loss of intracellular calcium control appears to be a common feature. Recommendations for treatment and recovery include cooling and administration of dantrolene for MH, cooling and aggressive fluid administration for EHI, and physical rest and aggressive intravenous fluid administration for ER.

[1]  P. Deuster,et al.  CK-MM and ACE genotypes and physiological prediction of the creatine kinase response to exercise. , 2007, Journal of applied physiology.

[2]  L. Armstrong,et al.  Recovery and return to activity following exertional heat stroke: considerations for the sports medicine staff. , 2007, Journal of sport rehabilitation.

[3]  Helen M. Binkley,et al.  Dehydration, cramping, and exertional rhabdomyolysis: a case report with suggestions for recovery. , 2007, Journal of sport rehabilitation.

[4]  L. Armstrong,et al.  Return to exercise training after heat exhaustion. , 2007, Journal of sport rehabilitation.

[5]  M. Sawka,et al.  A case report of idiosyncratic hyperthermia and review of U.S. Army heat stroke hospitalizations. , 2007, Journal of sport rehabilitation.

[6]  P. Deuster,et al.  Identification of risk factors for exertional heat illness: a brief commentary on genetic testing. , 2007, Journal of sport rehabilitation.

[7]  D. Maclennan,et al.  Mutations in ryr1 gene associated with malignant hyperthermia and a non-anaesthetic phenotype , 2007 .

[8]  P. Hopkins,et al.  Is there a link between malignant hyperthermia and exertional heat illness? , 2007, British Journal of Sports Medicine.

[9]  B. Brandom,et al.  Heatstroke in the Super-sized Athlete , 2006, Pediatric emergency care.

[10]  W. Chie,et al.  Epidemiological Analysis of Factors Influencing an Episode of Exertional Rhabdomyolysis in High School Students , 2006, The American journal of sports medicine.

[11]  P. Deuster,et al.  Is There a Link between Malignant Hyperthermia and Exertional Heat Illness? , 2004, Exercise and sport sciences reviews.

[12]  Yuval Heled,et al.  Assessment of heat tolerance for post exertional heat stroke individuals. , 2004, Medical science monitor : international medical journal of experimental and clinical research.

[13]  A. Porter Collapse from exertional heat illness: implications and subsequent decisions. , 2003, Military medicine.

[14]  N. Pollock,et al.  Malignant hyperthermia associated with exercise-induced rhabdomyolysis or congenital abnormalities and a novel RYR1 mutation in New Zealand and Australian pedigrees. , 2002, British journal of anaesthesia.

[15]  J. Warren,et al.  Rhabdomyolysis: A review , 2002, Muscle & nerve.

[16]  S. Confort-Gouny,et al.  A Noninvasive Investigation of Muscle Energetics Supports Similarities Between Exertional Heat Stroke and Malignant Hyperthermia , 2001, Anesthesia and analgesia.

[17]  V. R. Challa,et al.  Malignant hyperthermia and apparent heat stroke. , 2001, JAMA.

[18]  J. Scholz,et al.  Evidence for Susceptibility to Malignant Hyperthermia in Patients with Exercise-induced Rhabdomyolysis , 2001, Anesthesiology.

[19]  F. Wappler,et al.  Rhabdomyolysis following Severe Physical Exercise in a Patient with Predisposition to Malignant Hyperthermia , 1998, Anaesthesia and intensive care.

[20]  A. Kunselman,et al.  The Sensitivity and Specificity of the Caffeine‐Halothane Contracture Test: A Report from the North American Malignant Hyperthermia Registry , 1998 .

[21]  A. Kunselman,et al.  The sensitivity and specificity of the caffeine-halothane contracture test: a report from the North American Malignant Hyperthermia Registry. The North American Malignant Hyperthermia Registry of MHAUS. , 1998, Anesthesiology.

[22]  S. Confort-Gouny,et al.  31Phosphorus Magnetic Resonance Spectroscopy Characterization of Muscular Metabolic Anomalies in Patients with Malignant Hyperthermia: Application to Diagnosis , 1998, Anesthesiology.

[23]  F. Lehmann-Horn,et al.  In vitro contracture test for diagnosis of malignant hyperthermia following the protocol of the European MH Group: Results of testing patients surviving fulminant MH and unrelated low‐risk subjects , 1997, Acta anaesthesiologica Scandinavica.

[24]  A. Engel,et al.  Malignant Hyperthermia Testing in Patients with Persistently Increased Serum Creatine Kinase Levels , 1997, Anesthesia and analgesia.

[25]  J. Ryan,et al.  Sudden unexplained death in a patient with a family history of malignant hyperthermia. , 1997, Journal of clinical anesthesia.

[26]  A. Einstein,et al.  In vitro contracture test for diagnosis of malignant hyperthermia following the protocol of the European MH Group: Results of testing patients surviving fulminant MH and unrelated low-risk subjects , 1997 .

[27]  J. Antognini,et al.  Postexercise Muscle Cramping Associated with Positive Malignant Hyperthermia Contracture Testing , 1996, The American journal of sports medicine.

[28]  D. Figarella-Branger,et al.  Pathological findings in 165 patients explored for malignant hyperthermia susceptibility , 1993, Neuromuscular Disorders.

[29]  P. Hopkins,et al.  Evidence for related myopathies in exertional heat stroke and malignant hyperthermia , 1991, The Lancet.

[30]  E. Joosten,et al.  In vitro contraction test for malignant hyperthermia in patients with unexplained recurrent rhabdomyolysis , 1991, Journal of the Neurological Sciences.

[31]  L. Jorfeldt,et al.  Delayed recovery of muscle pH after short duration, high intensity exercise in malignant hyperthermia susceptible subjects. , 1991, British journal of anaesthesia.

[32]  W. Mauritz,et al.  Muscle biopsy for diagnosis of malignant hyperthermia susceptibility in two patients with severe exercise-induced myolysis. , 1991, British journal of anaesthesia.

[33]  H. Rosenberg,et al.  Malignant Hyperthermia in a College Football Player , 1987 .

[34]  E. Joosten,et al.  Prevention of recurrent exertional rhabdomyolysis by dantrolene sodium , 1987, Muscle & nerve.

[35]  H. Ørding Incidence of Malignant Hyperthermia in Denmark , 1985 .

[36]  H. Ording Incidence of malignant hyperthermia in Denmark. , 1985, Anesthesia and analgesia.

[37]  O. M. Jardon Physiologic stress, heat stroke, malignant hyperthermia--a perspective. , 1982, Military medicine.