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CRITICAL CARE AND TRAUMA

A Noninvasive Investigation of Muscle Energetics Supports Similarities Between Exertional Heat Stroke and Malignant Hyperthermia

David Bendahan, PhD^*, Geneviève Kozak-Ribbens, MD, PhD^*, Sylviane Confort-Gouny, PhD^*, Badih Ghattas, PhD, Dominique Figarella-Branger, MD, PhD, Michel Aubert, MD, and Patrick J. Cozzone, PhD^*

*Centre de Résonance Magnétique Biologique et Médicale and Service d’Anatomie Pathologique, Faculté de Médecine de Marseille, Marseille, France; Groupement de Recherche en Econométrie Quantitative d’Aix-Marseille, Centre de la Vieille Charité, Marseille, France; and Service d’Anesthésie-Réanimation, Hôpital d’Instruction des Armées de Laveran, Marseille, France

Address correspondence and reprint requests to Professor Patrick J. Cozzone, Centre de Résonance Magnétique Biologique et Médicale, UMR CNRS n° 6612, Faculté de Médecine de Marseille, 27, Bd J. Moulin 13005, Marseille, France. Address e-mail to patrick .cozzone{at}medecine.univ-mrs.fr

Exertional heat stroke (EHS) is usually triggered by strenuous exercise performed under hot and humid environmental conditions. Although the pathogenesis of an EHS episode differs from that of a clinical malignant hyperthermia (MH) crisis, both conditions share some similarities in symptoms, such as the abnormal increase in core temperature. By use of ³¹P magnetic resonance spectroscopy, we analyzed the muscle energetics of 26 post-EHS subjects for whom in vitro halothane/caffeine contracture tests were abnormal and investigated possible similarities with subjects susceptible to MH. An early decrease of pH was noted during the first minute of exercise in EHS subjects as compared with controls. EHS subjects were divided into two subgroups according to the diagnostic score previously developed for MH subjects. The 19 subjects (73%) with a score higher than 2 displayed significantly larger caffeine-induced and earlier ryanodine-induced contractures on muscle biopsies as compared with the rest of the group (7 subjects). The results demonstrate that muscle energetics are abnormal in subjects who have experienced EHS and suggest a possible link between MH and EH, although all EHS cannot be considered as MH.

IMPLICATIONS: ³¹P magnetic resonance spectroscopy of forearm muscles in subjects having developed exertional heat stroke shows a failure in muscle energetics and suggests a possible link with malignant hyperthermia.

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