{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T19:33:54Z","timestamp":1788550434663,"version":"build-2803163510"},"reference-count":41,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,6,1]]},"abstract":"<jats:p>Objective. This report describes a new fatal syndrome observed in adolescent males at the initial presentation of diabetes mellitus. The features include hyperglycemic hyperosmolar coma complicated by a malignant hyperthermia-like picture with fever, rhabdomyolysis, and severe cardiovascular instability.<\/jats:p>\n               <jats:p>Design. Case series.<\/jats:p>\n               <jats:p>Setting. Pediatric intensive care units of 3 tertiary care facilities in the United States.<\/jats:p>\n               <jats:p>Patients. Six adolescent males, 5\/6 obese with acanthosis nigricans, 4\/6 black.<\/jats:p>\n               <jats:p>Results. Four of 6 patients died. Four of 6 patients did not have significant ketosis. Six of 6 patients had increased temperature after the administration of insulin.<\/jats:p>\n               <jats:p>Conclusions. The underlying etiology of this syndrome remains unclear. Possibilities include an underlying metabolic disorder such as a fatty acid oxidation defect, an unrecognized infection, exposure to an unknown toxin, or a genetic predisposition to malignant hyperthermia. Evaluation for all these possibilities and empiric treatment with dantrolene should be considered for this type of patient until this syndrome is better characterized.<\/jats:p>","DOI":"10.1542\/peds.111.6.1447","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"1447-1452","source":"Crossref","is-referenced-by-count":60,"title":["Fatal Malignant Hyperthermia-Like Syndrome With Rhabdomyolysis Complicating the Presentation of Diabetes Mellitus in Adolescent Males"],"prefix":"10.1542","volume":"111","author":[{"given":"Abby S.","family":"Hollander","sequence":"first","affiliation":[{"name":"Division of Pediatric Endocrinology and Metabolism, Washington University School of Medicine and St Louis, Children\u2019s Hospital, St Louis, MO 63110"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Olney","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Nemours Children\u2019s Clinic, Jacksonville, FL 32207"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piers R.","family":"Blackett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Diabetes and Endocrine Section, Children\u2019s Hospital of Oklahoma, Oklahoma City, OK 73190"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bess A.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology and Metabolism, Washington University School of Medicine and St Louis, Children\u2019s Hospital, St Louis, MO 63110"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2003,6,1]]},"reference":[{"key":"2021120821114844100_R1","doi-asserted-by":"crossref","unstructured":"White N. 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