Document Detail


Electroconvulsive therapy complicated by life-threatening hyperkalemia in a catatonic patient.
MedLine Citation:
PMID:  16950383     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Electroconvulsive therapy (ECT) requires brief general anesthesia, and succinylcholine is a depolarizing neuromuscular blocking agent that is frequently used for this procedure. Its use leads to intracellular potassium release into the extracellular space, usually increasing the serum potassium level by 0.5-1 mEq/L, with little clinical significance. However, long-term immobilization has been associated with changes at the neuromuscular junction (up-regulation of nicotinic cholinergic receptors) and subsequent serious hyperkalemia following succinylcholine administration. We report the case of a severely obese patient, immobilized due to her catatonic state, who developed life-threatening ventricular tachycardia after succinylcholine administration for ECT. Resumption of normal physical activity reverses these neuromuscular junctional changes, allowing subsequent safe succinylcholine administration. Current drug development may eliminate the need for succinylcholine use during ECT.
Authors:
Jana Hudcova; Roman Schumann
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  General hospital psychiatry     Volume:  28     ISSN:  0163-8343     ISO Abbreviation:  Gen Hosp Psychiatry     Publication Date:    2006 Sep-Oct
Date Detail:
Created Date:  2006-09-04     Completed Date:  2007-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7905527     Medline TA:  Gen Hosp Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  440-2     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA. jhudcova@tufts-nemc.org <jhudcova@tufts-nemc.org>
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MeSH Terms
Descriptor/Qualifier:
Adult
Antipsychotic Agents / adverse effects,  therapeutic use
Bipolar Disorder / blood,  drug therapy
Catatonia / blood*,  therapy*
Dose-Response Relationship, Drug
Drug Administration Schedule
Electroconvulsive Therapy / adverse effects*
Female
Haloperidol / adverse effects,  therapeutic use
Humans
Hyperkalemia / blood*,  chemically induced*
Infusions, Intravenous
Neuromuscular Depolarizing Agents / administration & dosage,  adverse effects*
Obesity, Morbid / blood,  complications
Potassium / blood
Risk Factors
Schizophrenia / blood,  drug therapy
Succinylcholine / administration & dosage,  adverse effects*
Tachycardia, Ventricular / blood,  chemically induced
Chemical
Reg. No./Substance:
0/Antipsychotic Agents; 0/Neuromuscular Depolarizing Agents; 306-40-1/Succinylcholine; 52-86-8/Haloperidol; 7440-09-7/Potassium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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