Nurse standing at a medication cart

What Should Be in Your Malignant Hyperthermia Cart (According to a Consultant Pharmacist)

It may not make major headlines or dye the river green, but the month of March includes an important awareness campaign for increasing patient safety across healthcare facilities: it’s Malignant Hyperthermia (MH) awareness month. As a consultant pharmacist, MH is an issue of concern for the ambulatory healthcare facilities with which I work.

Is MH an issue for your facility? It depends: does your facility use MH-triggering agents such as inhaled general anesthetics or succinylcholine?

If your answer is yes, you should know what steps to take and the medications that must be included in the MH cart if a crisis occurs.  To ensure you are fully prepared, you can work with your consultant pharmacist (View Our Services if you don’t yet have a Consultant Pharmacist).

Responding to an MH event requires quick and efficient action: it truly is a situation that’s n ‘all-hands-on-deck’.  According to the Malignant Hyperthermia Association of the United States (MHAUS), the following four steps are recommended for handling MH events:

  1. Notify the surgeon to halt the procedure as soon as possible and discontinue any triggering agents.
  2. Retrieve the dantrolene/MH cart and call 911.
  3. Hyperventilate the patient with 100% oxygen at flows of 10L/minute.
  4. Give IV dantrolene at 2.5 mg/kg rapidly.

Do you know what medications should be in the cart?

According to MHAUS, the cart must include the following:

  1. Dantrolene: either 36 vials of Dantrium/Revonto or 3 vials of Ryanodex.
  2. Sterile water for injection (without preservative):
    If you’re stocking Dantrium/Revonto, each vial requires 60mL of sterile water for reconstitution.  Each vial of Ryanodex only requires 5mL of sterile water.
  3. Sodium bicarbonate: (8.4%) – 50 mL x 4.
  4. Dextrose: 50% – 50 mL vials x 2.
  5. Calcium chloride: (10%) – 10 mL vial x 2.
  6. Lidocaine for injection: (2%) – 100 mg/5 mL or 100 mg/10 mL in preloaded syringes x 3. Amiodarone is also acceptable.

The following two items, although still part of the cart, must be kept in a refrigerator.

  1. Regular insulin – 100 units/mL x 1.
  2. Refrigerated saline solution – A minimum of 3,000 mL for IV cooling

View the complete list of MHAUS recommended MH cart contents.

Still have questions?  Contact us for a free consultation today: we can help you set up a system to ensure compliance and enhance patient safety.

The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centerssenior care facilities and pharmacies  We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.


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