Certified Nurses Operating Room (CNOR) Practice Exam

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Which fluid should NOT be used in a patient with Malignant Hyperthermia?

Normal saline
Lactated Ringers
Dextrose in water
5% dextrose in saline

The correct answer is: Lactated Ringers

Lactated Ringer's solution contains calcium, which is contraindicated in patients who have experienced Malignant Hyperthermia (MH). During an MH crisis, the hypermetabolic state can lead to increased calcium levels in muscle cells, exacerbating the condition and resulting in further complications. The intervention for MH primarily involves the rapid administration of dantrolene, which acts to reduce calcium release from the sarcoplasmic reticulum in skeletal muscle. In contrast, normal saline, dextrose in water, and 5% dextrose in saline do not contain calcium and can be used to maintain hydration and electrolyte balance in these patients without contributing to the hypercalcemia that can worsen the MH response. Thus, lactated Ringer's is the fluid that should be avoided in a patient with Malignant Hyperthermia.