Suxamethonium in burns: hyperkalaemia window and safe alternatives

Meet the patient

A 30-year-old with a 30 percent total body surface area flame burn, now on day 10, is listed for a dressing change. The burns unit calls at 3am: he has deteriorated and needs emergency intubation. The duty registrar reaches for suxamethonium because the airway looks difficult and he wants a fast onset. Your job is to stop the injection before it happens.^[1][2]

The two facts that decide this patient's survival are the two facts that define the whole topic: suxamethonium opens the enormous upregulated receptor population and spills potassium, and the danger window runs from day one or two until about a year after healing. Day 10 is squarely inside the ban.^[1]

References4ShowHide

1. [1]Martyn JA, Richtsfeld M Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms Anesthesiology, 2006.PMID 16394702
2. [2]Baxter CR Fluid volume and electrolyte changes of the early postburn period Clin Plast Surg, 1974.PMID 4609676
3. [3]Borron SW, Baud FJ, Barriot P, et al. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation Ann Emerg Med, 2007.PMID 17481777
4. [4]Long B, Warix JR, Koyfman A Controversies in Management of Hyperkalemia. J Emerg Med, 2018.PMID 29731287