A Case Report of Suspected Malignant Hyperthermia: How Will the Diagnosis Affect a Patient’s Insurability?

Abstract

The purpose of this case report is to increase awareness that a diagnosis of malignant hyperthermia may have long-lasting or permanent effects on a patient's insurance eligibility or premiums despite legislation providing varying levels of protection from preexisting conditions or genetic discrimination. We present a case of severe rigors, unexplained severe metabolic acidosis, and severe hyperthermia in a patient after general anesthesia for extensive head and neck surgery. The patient was treated for malignant hyperthermia and demonstrated a significant clinical improvement with the administration of dantrolene. Even with an “almost certain” diagnosis of malignant hyperthermia by clinical presentation, genetic testing was negative and the gold-standard caffeine-halothane contracture test has yet to be performed. Laboratory results, clinical grading scales, and genetic testing support a diagnosis of malignant hyperthermia but the gold standard is a live muscle biopsy and caffeine-halothane contracture test. A clinical diagnosis of MH or a positive caffeine-halothane contracture test could result in exclusion from genetic discrimination legislature due to the fact that diagnosis can be confirmed without genetic testing. The fate of the Affordable Care Act may also affect how insurance companies scrutinize this disease. Improving accuracy of MH diagnosis in hospital discharge records will be crucial.

Malignant Hyperthermia in Bariatric Surgery: A Case Study With Clinical, Pathophysiological, Biochemical and Biophysical Correlations

“…Several case reports have different descriptions with or without the dantrolene addition. In some cases, dantrolene was administered immediately after the MH crisis triggering, both during the intraoperative [ 4 , 13 , 40 , 49 , 50 ] and postoperative [ 32 , 51 , 52 ] periods and all patients were discharged from the hospital in stable conditions. Late addition of dantrolene is also reported in intra- and postoperative MH cases with different results, and some were fatal, while others had no additional complications [ 2 , 45 , 53 , 54 ].…”

Malignant hyperthermia in a regional facility: A case study

“…If a patient has received a triggering agent and has symptoms, then MH should be considered as a differential diagnosis 2 . Immediate treatment is recommended to avoid cell death and possible cardiac arrest 15 . Dantrolene is a safe medication when given with appropriate ventilatory support 1 .…”