Exertional heat illness, exertional rhabdomyolysis, and malignant hyperthermia: Is there a link?

This short review discusses possible links between exertional heat illness (EHI), malignant hyperthermia (MH), and exertional rhabdomyolysis (ER). Evidence on clinical, genetic, and functional aspects, though limited, is compared through individual case reports and a small number of clinical studies. Typically, MH occurs during anesthesia and surgery, EHI during strenuous exercise in hot and humid environments, and ER unrelated to heat and humidity after strenuous exercise. Genetic analysis of the RYR1 gene has identified various mutations, especially in MH, but also in some cases of EHI and in number of ER cases as well. Pathophysiologically, loss of intracellular calcium control appears to be a common feature. Recommendations for treatment and recovery include cooling and administration of dantrolene for MH, cooling and aggressive fluid administration for EHI, and physical rest and aggressive intravenous fluid administration for ER