Category: Professional Posters
Purpose: Succinylcholine is a depolarizing neuromuscular blocker and widely used for urgent intubation. Succinylcholine can increase serum potassium due to efflux of potassium from muscle cells. The purpose of this chart review was to evaluate baseline serum potassium in patients receiving succinylcholine.
Methods: The Institutional Review Board approved this retrospective medical record review of patients receiving succinylcholine for urgent intubation. Inclusion criteria included patients 19 years or older who received succinylcholine in the intensive care or emergency department. Patients were evaluated from May 2017 to December 2017. Patients receiving succinylcholine for a surgical procedure were excluded. The primary endpoint of this study was to determine if baseline potassium was assessed prior to the administration of succinylcholine. The secondary endpoint of this study was to examine if the patient developed hyperkalemia (potassium > 5 mEq/L) and describe the treatment of hyperkalemia. Descriptive statistics were utilized to summarize all outcomes of interest.
Results: 1112 patient charts were identified; 86 patient charts met the criteria of receiving succinylcholine in the intensive care or emergency department. The biggest reason patients were excluded from this study was because the patient was given the succinylcholine in the surgical suite or had an order for succinylcholine but no documented administration. The 86 subjects had a mean age of 53 years (19-96) and were 64% male. The baseline potassium was assessed in 73 patients and averaged 4.2 mEq/L. Patients in the emergency department with urgent intubation were less likely to have a baseline potassium drawn before administration of succinylcholine. 6 patients (8%) developed hyperkalemia within 12 hours of receiving succinylcholine with no negative sequelae. Two patients received additional crystalloid fluids. The average succinylcholine dose given was 1.25 mg/kg.
Conclusion: Periodic quality reviews of high-risk medications are necessary to improve quality of care by identifying problems, implementing and monitoring corrective action if needed. It is important clinicians are aware of hyperkalemia caused by succinylcholine and the associated risk factors for toxicity. This data demonstrated 85% of patients receiving succinylcholine for urgent intubation had a baseline potassium assessment. Patients who did not have a documented baseline potassium, presented to the emergency department where a clinical decision for rapid intubation was made.