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Updated: Jan 14 2017


  • Snapshot
    • A 34-year-old woman is brought to the emergency department by her husband due to an altered mental status. The husband reports that his wife has schizophrenia, and she recently had a change in dosage to her antipsychotic medication. Her temperature is 103°F (39.4°C), labile blood pressure, pulse is 105/min, and respirations are 26/min. She appears profusely diaphoretic and has muscle rigidity in her extremities. In addition to supportive care, she is started on dantrolene.
  • Introduction
    • Mechanism of action
      • blocks ryanodine receptors
        • decreases excitation-contraction coupling
        • decreases Ca2+ release from the sarcoplasmic reticulum in skeletal muscle
    • Clinical use
      • malignant hyperthermia
        • hypermetabolic crisis secondary to inhaled anesthetic use (e.g., halothane) or succinylcholine
          • patients have a genetic abnormality in ryanodine or dihydropyridine receptors, a skeletal muscle protein
            • results in excessive Ca2+ release from the sarcoplasmic reticulum
      • neuroleptic malignant syndrome (NMS)
        • medical emergency secondary to neuroleptic use (e.g., antipsychotics)
          • characterized by
            • hyperthermia
            • mental status change
            • rigidity
            • autonomic dysfunction
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