Discontinue Triggering Agents
100% Oxygen at High Flow
Give Dantrolene
Provide bicarbonate for metabolic acidosis temporization
Actively cool the patient
Treat any dysrhythmia
60ml sterile water into each vial of dantrolene may need up to 36 vials
If using Dantrium® (20mg/vial), each vial contains 3 g of mannitol (renal vasodilation); newer nanocrystalline dantrolene (250mg/vial) has 250mg mannitol per vial and requires mannitol supplementation
2.5mg/kg IV push
Titrate to effect; may need more than 10mg/kg
Call<unk> AUS Hotline if needed: 1-800-644-0737
Continued Care
Dantrolene 1mg/kg every 4-6 hours for 24–48 hours
Monitor for recrudescence (rate is 25%)
Follow electrolytes, blood gases, CK, core temperature, urine output and color, coagulation studies
Dantrolene 1mg/kg every 4-6 hours for 24–48 hours
Monitor for recrudescence (rate is 25%)
Follow electrolytes, blood gases, CK, core temperature, urine output and color, coagulation studies
1-2 mEQ/kg if blood gas values not yet available
Most patietns will have a core temperature >39 deg C (102.2 deg F)
Stop cooling when temperature reaches 100.4
Dysrhythmias usually respond to treatment of acidosis and hyperkalemia
AVOID CA CHANNEL BLOCKERS as they may cause hyperkalemia or cardiac arrest in presence of dantrolene
Not always present but can occur
Treat hyperkalemia with standard treatment, remember to check glucose levels q1h after treatment with insulin/glucose
Malignant hyperthermia
Infectious
Nitrogen narcosis
Sepsis
CO2 narcosis
Meningitis
Spinal shock
Encephalitis