title: Fatal hyperkalemia following succinylcholine administration in a child on oral propranolol.
abstract: Succinylcholine is one of the most commonly used drugs by anesthesiologists worldwide for rapid access to airway both in emergency and elective situations. Nonetheless, the very mention of succinylcholine generates the most energetic high decibel debate between its users and nonusers. Despite its potential to produce a short-acting, ultra-intense neuromuscular block rapidly in seconds, it is surrounded by a plethora of side effects and drug interactions. This case report is about one such drug interaction of this innocent yet malicious drug, which resulted in the death of a 14-year-old girl. Both β-adrenergic blockers and succinylcholine are known to cause hyperkalemia. Life-threatening hyperkalemia in susceptible individuals who have been administered succinylcholine has the most severe effect on the myocardium and can result in asystole with minimal chances of resuscitation. Both succinylcholine and a nonselective β-adrenergic blocker, propranolol, have the propensity to affect the transcellular redistribution of potassium which can result in hyperkalemia. We advocate cautious use of this drug combination till further studies confirm the drug interaction and find the potential triggering factors involved.
authors.forename: Anuradha
authors.identifier: http://orcid.org/0000-0003-3974-9361
authors.initials: A
authors.lastname: Ganigara
authors.forename: Chandrakala
authors.initials: C
authors.lastname: Ravishankar
authors.forename: Chandrika
authors.initials: C
authors.lastname: Ramavakoda
authors.forename: Madhavi
authors.initials: M
authors.lastname: Nishtala
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D004347:Drug Interactions; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006504:Hepatic Veno-Occlusive Disease / Q000188:drug therapy; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects*; D011433:Propranolol / Q000008:administration & dosage / Q000009:adverse effects*; D012082:Renal Veins; D013390:Succinylcholine / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D009467:Neuromuscular Depolarizing Agents; D011433:Propranolol; D013390:Succinylcholine