Hyperkalemia after succinylcholine admin.

Serum K increases approx 0.5 mEq/L after succinylcholine administration in most patients.
Some conditions predispose to more significant increase in serum potassium
Pathophys thought to be upregulation of extrajunctional receptors (not in NMJ)
Can lead to cardiac dysrhythmias and arrest → fatal
Not prevented by a defasciculating dose of a non-depolarizing neuromuscular blocker
Predisposing conditions:
spinal cord injuries: K released correlates with extent of motor deficit; risk begins at 48h, peaks between 4w and 5mo after injury
neuromuscular disorders (e.g. Guillain-Barré syndrome, amyotrophic lateral sclerosis, multiple sclerosis, and Friedreich ataxia)
Duchenne, Becker muscular dystrophy: avoid succ in kids
stroke: risk from 24h to months afterwards
major trauma (e.g. crush injury)
extensive burns (over 10% TBSA): avoid succ from 24h to 1y afterwards
prolonged immobility: risk significantly increases after 16d
Notably, normokalemia in chronic kidney disease does not predispose to severe increase; succ safe for use

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