Malignant hyperthermia: A review of current concepts

It appears that MH occurs as a result of an increase in myoplasmic Ca⁺⁺ concentration due to a malfunction in Ca⁺⁺ regulation at the level of the plasma membrane, SR, mitochondria, PLA2, or some combination of these four sites. Ca⁺⁺-induced interaction between actin and myosin filaments produces contracture and rigidity.^90,93 Depletion of ATP stores in an effort to restore Ca⁺⁺ levels leads to increased metabolism, respiratory and metabolic acidosis, and heat production. The acidosis and elevated temperature alter membrane characteristics, which leads to electrolyte imbalances and myoglobinemia.¹⁶ Cardiac dysrhythmias develop secondary to acid-base and electrolyte imbalances.¹⁶ If untreated, the signs and symptoms worsen and death ensues.