Hemolysis and Hyperkalemia Complicate Malignant Hyperpyrexia During Anesthetic Death
Ward, RJ
Professor, Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA.

Eisele, JW
Medical examiner, King County Medical Examiner's Office, Seattle, WA and clinical assistant professor, Department of Pathology, University of Washington School of Medicine, Seattle, WA.

Reay, DT
Chief medical examiner, King County Medical Examiner's Office, Seattle, WA and associate professor, Department of Pathology, University of Washington School of Medicine, Seattle, WA.

Horton, WG
Staff anesthesiologist, Department of Anesthesiology, Virginia Mason Hospital, Seattle, WA and associate clinical professor, Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA.


Abstract
A healthy, 15-year-old male received a thiopental, nitrous oxide, oxygen, enflurane anesthetic for appendectomy. Cardiac arrest, following succinylcholine administration, was associated with marked hyperkalemia (potassium levels 8.7 to 11.6 meq), hemolysis (hematocrit fall from 41.7 to 26.6%, plasma hemoglobin 27 mg/dL), and creatine phosphokinase (CPK) elevation (8900 units). Vigorous resuscitative therapy including dantrolene was unsuccessful.
The diagnosis of malignant hyperthermia was made by the marked CPK elevation on blood samples drawn during resuscitation and analyzed by the Medical Examiner's Office.

Keywords:
anesthetics, death, forensic science, hyperthermia, malignant hyperthermia, pathology and biology

Paper ID: JFS312860543

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Author Ward RJ, Eisele JW, Reay DT, Horton WG Title Hemolysis and Hyperkalemia Complicate Malignant Hyperpyrexia During Anesthetic Death Symposium , Committee on