Clinical indicators of acute malignant hyperthermia

Hypercarbia*	Controlled ventilation:
	ETCO₂ >55 mmHg
	PaCO₂ >60 mmHg
	Spontaneous ventilation:
	ETCO₂ >60 mmHg
	PaCO₂ >65 mmHg
Muscle rigidity	Generalized muscular rigidity (sustained contracture) during anesthesia with triggering agents
Muscle rigidity	Severe masseter muscle spasm shortly following succinylcholine administration that does not abate within 1 minute
Arrhythmias	Tachycardia
Arrhythmias	Ventricular arrhythmias (indicating acute hyperkalemia)
Acidosis	Primarily respiratory acidosis but may include varying degrees of metabolic acidosis
	Arterial pH <7.25
	Base deficit >8 mEq/L
Hyperthermia	Core temperature >38.8°C
Hyperthermia	Rapid rise in temperature
Rhabdomyolysis	CK >20,000 international units after anesthesia with succinylcholine
	CK >10,000 international units after anesthesia without succinylcholine
	Cola-colored urine in perioperative period
	Urine myoglobin >60 mcg/L
	Serum myoglobin >170 mcg/L
	Serum potassium >6 meq/L (without renal failure)

ETCO₂: end-tidal carbon dioxide; PaCO₂: partial pressure of arterial carbon dioxide; CK: creatine kinase.
* These values are approximate guidelines determined by experts with knowledge of and expertise in managing malignant hyperthermia events.

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Clinical indicators of acute malignant hyperthermia