Dantrolene for MH

dantrolene malignanthyperthermia mh safety volatileagents Mar 11, 2024
During a Malignant Hyperthermia (MH) emergency, dantrolene administration is the priority and is the only known antidote for this life threatening condition. ‼️
 
Here is all you need to know about Dantrolene: 👇
 
Dantrolene is a muscle relaxant that works intracellularly in skeletal muscle, is metabolised in the liver and has a half life of 4 to 8 hours.
 
How does it work for MH?
 
When MH is triggered, the defective ryanodine receptor in the skeletal muscle causes a massive release of calcium, leading to sustained muscle contraction, rigidity, excessive heat production, tachycardia and high carbon dioxide. 🥵
 
Dantrolene reduces that muscle contraction by binding to the ryanodine receptor, inhibiting the release of calcium and therefore inhibiting the sustained muscle contraction and all that follows.
 
Dantrolene comes in two IV preparations
👉 Dantrium 20mg in a 65mL vial
🔺Each vial to be reconstituted with 60mL WATER FOR INJECTION
🔺Shake until the solution is clear!
🔺Final concentration 0.33mg/mL
👉 Ryanodex 250mg in a 20mL vial
🔺Each vial to be reconstituted with 5mL of WATER FOR INJECTION
🔺Produces an orange coloured suspension
🔺 Final concentration is 50mg/mL
 
So, what’s the dose?
👉 2.5mg/kg every 10-15 minutes until symptoms resolve!
👉 That means if your patient weighs 100kg, you will need 13 vials of Dantrum for EACH DOSE!!
 
As MH is rare, and due to the high cost and short shelf life of dantrolene, many hospitals only stock enough for 1-2 doses. This means you may need to promptly source the subsequent doses from nearby centres. 🏥
 
Be sure to check out our Advanced Anaesthesia Live Series on Malignant Hyperthermia where we are joined by Dr Phillip Nelson, head of the Malignant Hyperthermia Investigation Unit at the Royal Perth Hospital! 😎
 
Build knowledge ✅
Improve safety ✅
 
Ref: https://www.ncbi.nlm.nih.gov/books/NBK535398/

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