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To the Editor.
—The article titled "Idiopathic Malignant Hyperthermia" by Justin A. Bergman, MD, that appeared in the Archives (93:232, 1975) provides a concise review of the pathophysiology of this disease. However, I should like to point out what I consider to be an error in the treatment of the disease that Bergman presents in the case report.The primary biochemical abnormality in malignant hyperthermia is a high concentration of calcium in the myoplasm, probably from the sarcoplasmic reticulum. Hence, drugs that inhibit the uptake of calcium by the sarcoplasmic reticulum should not be used. As Britt has pointed out (N Engl J Med 290:1141, 1974), lidocaine and the cardiac glycosides are agents that extrude calcium from the sarcoplasmic reticulum, and so they never should be administered during crises of malignant hyperthermia. Procaine and procainamide are drugs that lower myoplasmic calcium levels by transporting calcium out of the myoplasm into
Saviello GM. Treatment of Idiopathic Malignant Hyperthermia. Arch Ophthalmol. 1976;94(5):867. doi:10.1001/archopht.1976.03910030435016