SYNDROME SYMPTOMS

MALIGNANT HYPERTHERMIA - Muscle rigidity - Hyperthermia

MALIGNANT NEUROLEPTIC SYNDROME - Muscle rigidity (with increased CK) - Hyperthermia (Impairment of sweating, Hyperpyrexia) - Autonomic instability - Rhabdomyolysis myoglobinemia, myoglobinuria ARF

SEROTONIN SYNDROME - Muscle rigidity (absent increased CK) - Myclonus - Hyperthermia

CARCINOID SYNDROME - Skin flushing (vasodilation triggered by emotion, food, alcohol) - Diarrhea ( bowel motility) - Cramping - Dyspnea and wheezing (bronchospasm) - Facial Telangiectasia - Tricuspid regurgitation and pulmonary stenosis (plaquelike thickening of endocardium and right-sided heart valves)

- Hypertension - Acidosis - pCO2 - Hypoxia - Tachycardia - Hyperkalemia NOTE: Contraction of Jaw muscles (trismus) early sign CAUSE Classically: Muscle relaxant + Inhaled anesthetic 3 drugs implicated: - Succinylcholine (muscle relaxant) - Tubocurarine (muscle relaxant) - Halothane (inhaled anesthetic) Genetic Susceptibility (Fam Hx) - Mutations in the Ryanodine Receptor and/or component of Dihydropyridine (L-type calcium channel) in skeletal muscle TREATMENT Dantrolene - acts directly on skeletal muscle

- CV instability - CNS stimulatory effects (seizures)

Classically: Haloperidol (MC) dopamine blockade Haloperidol and Fluphenazine - Antipsychotics with Extrapyramidal Symptoms (EPS) in sensitive patients

Classically: SSRI + MAOI; MAOI + meperidine (Demerol); SSRI + SNRI/2nd SSRI Other causes: - MAOIs - Tyramine (red wine & cheese) - TCAs - dextromethorphan - meperidine - St. Johns Wart - MDMA

5HT secreting Tumor NOTE: if cardiac manifestations are - Right Heart = Tumor metastasized to Liver - Left Heart = Lung Tumor NOTE: Risk of Pellagra secondary to Niacin depletion - Niacin is a cofactor in 5HT synthesis Tryptophan Serotonin

- Dantrolene, Diazepam, Dopamine agonists (e.g.

- 5HT blockers (cypropetadine)

Octreotide - somatostain analogue

to contractility - blocks Ca2+ release from SR

bromocriptine) - aggressive cooling

- Antiseizure drugs - Muscle relaxants

- effective in controlling diarrhea and flushing