Monitoring
In the first 2 days following an episode of MH, the patient requires continuous and then frequent documentation of vital signs including respiratory rate and depth, and core temperature. Muscle tone should also be noted frequently. At intervals depending on the severity of illness, blood gases (ideally central venous) and electrolytes should be assessed for acidosis and potassium concentration. Fluid balance including urine output should be documented. If intensive care is not needed and neurologic and muscular function are normal, the patient can be transferred to a lower acuity area. Creatine kinase should be assayed daily until it is stable.
Follow-up tests to confirm the diagnosis of MH and investigate occult muscle diseases should be arranged. These include consultation with a neurologist interested in muscle disease and referral to an MH Diagnostic Contracture Testing Center. Genetic testing will be more useful when guided by the recommendations of these experts. It is very important to pursue a definitive diagnosis in the patient, because the symptoms of MH are not specific. The definitive diagnosis has important implications for the family. All blood relatives should be informed of the results of the diagnostic tests on the patient so that they too can undergo testing as indicated.[1]
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