Fatal malignant hyperthermia-like syndrome with rhabdomyolysis complicating the presentation of diabetes mellitus in adolescent males

Abby S. Hollander, Robert C. Olney, Piers R. Blackett, Bess A. Marshall

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

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. Design. Case series. Setting. Pediatric intensive care units of 3 tertiary care facilities in the United States. Patients. 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.

Original languageEnglish
Pages (from-to)1447-1452
Number of pages6
JournalPediatrics
Volume111
Issue number6 I
DOIs
StatePublished - Jun 1 2003

Keywords

  • Diabetes mellitus
  • Malignant hyperthermia
  • Obesity
  • Rhabdomyolysis

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