A patient was admitted following a self-administered salicylate overdose. She rapidly deteriorated and died in spite of resuscitative measures. Features of her death included hyperthermia convulsions, hypoxia, acidaemia, extreme muscular rigidity, a high serum creatine phosphokinase, hypocalcaemia, hyperphosphataemia, raised potassium, and increasingly abnormal coagulation parameters. The patient had been receiving phenelzine 45 mg daily but none was detected on analysis of gastric aspirate. Her serum salicylate level was extremely high (120 mg/100 ml).
Malignant hyperthermia, its association with monoamine oxidase inhibitors, and its possible relationship in this case to salicylate overdosage with acidaemia are discussed.
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