Pharmacokinetics of Dantrolene in the CVVH/PE Treatment of Malignant
Hyperthermia in a 14-year-old Chinese Boy: A Case Report and Literature
Review
Abstract
Malignant hyperthermia (MH) is a rare life-threatening response that
triggered by exposure to specific anesthetics commonly used during
surgery interventions. Dantrolene is a well-known drug which used as
first-line therapy for MH. A 14-year-old Chinese boy with a mutation in
RYR1 whose muscle biopsy diagnosis was central core disease (CCD)
occurred MH after cervical spine surgery underwent general anesthesia
without volatile anesthetics or succinylcholine. The MH crisis treatment
workflow was started and intravenous dantrolene was used soon which
combined with sequent continuous veno-venous hemofiltration (CVVH) and
plasma exchange (PE) therapy. We explored the pharmacokinetics of
dantrolene during the treatment and the results showed that a
one-compartment model with first-order absorption and elimination was
sufficient to characterize dantrolene pharmacokinetics. The clearance
estimate for dantrolene was 0.43 mL/(min*kg) and volume of distribution
was 0.61 L/kg. The clearance of dantrolene was significantly affected by
CVVH and PE.