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Hyperkalemia occurs in a small subset of patients after succinylcholine (SCh) administration and can be severe and fatal. In a review of cases and the pathophysiology of succinylcholine hyperkalemia (SChK), the author describes 2 mechanisms that lead to the disorder: upregulation of acetylcholine receptors and rhabdomyolysis.
Upregulation is caused by a change in the subunit type of acetylcholine receptors and by an increase in their density as they spread over the muscle surface outside the motor endplate area. Causes of upregulation include burns, severe muscle trauma, upper or lower motor neuron denervation (e.g., stroke or spinal cord injury, respectively), and prolonged ICU care (bed rest, steroids, prolonged neuromuscular blockade). In…