From the Guidelines
Dantrolene sodium is the primary medication for treating malignant hyperthermia, a rare but life-threatening condition, and should be administered at an initial dose of 2–3 mg.kg-1 with further doses as needed 1. When considering the treatment of hyperthermia, it's essential to differentiate between various forms, such as heat stroke, malignant hyperthermia, and other causes. For malignant hyperthermia, a condition triggered by certain anesthetics, dantrolene is the specific treatment.
Key Points for Treatment:
- Dantrolene should be given until the ETCO2 is < 6 kPa with normal minute ventilation and the core temperature is < 38.5°C 1.
- The management principles include eliminating the trigger agent, administering intravenous dantrolene, and starting active body cooling 1.
- For other forms of hyperthermia, such as heat stroke, rapid cooling and hydration are the primary interventions, with medications like antipyretics (e.g., acetaminophen, ibuprofen) and benzodiazepines (for shivering or seizures) playing supportive roles.
Considerations:
- The use of dantrolene is specifically recommended for malignant hyperthermia, with a focus on immediate administration upon suspicion of the condition 1.
- Other medications and interventions may be considered based on the underlying cause of hyperthermia and the patient's clinical presentation.
- It's crucial to follow the most recent guidelines for the management of malignant hyperthermia, which emphasize the importance of dantrolene availability and prompt treatment 1.
From the FDA Drug Label
Dantrolene Sodium for Injection is indicated, along with appropriate supportive measures, for the management of the fulminant hypermetabolism of skeletal muscle characteristic of malignant hyperthermia crises in patients of all ages Dantrolene Sodium for Injection should be administered by continuous rapid intravenous push as soon as the malignant hyperthermia reaction is recognized For treatment of malignant hyperthermia For Intravenous use ONLY
The medication available to treat hyperthermia is dantrolene (IV), specifically for the management of malignant hyperthermia crises 2, 2.
- Key Indication: Malignant hyperthermia crises in patients of all ages
- Administration: Continuous rapid intravenous push
- Dosage Form: Intravenous use only
From the Research
Medications for Hyperthermia
- Dantrolene sodium is a specific antagonist for malignant hyperthermia and should be available wherever general anesthesia is administered 3
- Benzodiazepine may be used as pharmacologic therapy for some drug-induced hyperthermia (DIH) syndromes 4
- Bromocriptine may be used as pharmacologic therapy for some DIH syndromes 4
- Pharmacologic therapy, such as a benzodiazepine, bromocriptine, or dantrolene, may be appropriate for some cases of hyperthermia, with the selection of a specific agent primarily determined by the medication history and suspected DIH syndrome 5, 4
Treatment Approaches
- Supportive care, including external cooling and volume resuscitation as needed, is essential for managing hyperthermia 5, 4
- Immediate discontinuation of the suspected offending agent(s) is crucial in treating drug-induced hyperthermia syndromes 5, 4
- Therapeutic hypothermia and controlled normothermia may be used in the intensive care unit to prevent or mitigate neurologic injury, with careful consideration of practical aspects and pitfalls 6