[Malignant hyperthermia during alcohol withdrawal]

Abstract

Heat shock is the consequence of malignant hyperthermia triggered by general anaesthesia, the use of neuroleptic drugs, or strenuous muscular exercise. Chronic alcoholism could be a contributing factor by facilitating the triggering of malignant hyperthermia. We describe two cases of malignant hyperthermia which occurred during the summer in undernourished chronic alcoholics showing withdrawal syndrome during their stay in hospital. General anaesthesia and neuroleptics were excluded as the origin of their malignant hyperthermia, and we looked for new mechanisms to explain the heat shock, other than shivering associated with the withdrawal syndrome or the high temperature of the season. These two patients were considered deficient in thiamine on admission, their plasma pyruvic acid level being sharply increased (185 mumol/l and 304 mumol/l respectively; normal range: 45.6-91.2 mumol/l). This deficiency can lead to disregulation of thermal centres. Other metabolic disorders, frequently observed in alcoholics, could facilitate heat release during withdrawal syndrome shivering. The risk of heat shock during abrupt alcohol withdrawal should not be underestimated.