General Hospital Psychiatry
Volume 28, Issue 5 , Pages 440-442, September 2006

Electroconvulsive therapy complicated by life-threatening hyperkalemia in a catatonic patient

Department of Anesthesia, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA

Received 24 May 2006; accepted 7 July 2006.

Abstract 

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.

Keywords: Hyperkalemia, Ventricular tachycardia, Immobilization, Catatonia, Electroconvulsive therapy, Succinylcholine, Neuromuscular blocking agents

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PII: S0163-8343(06)00127-7

doi:10.1016/j.genhosppsych.2006.07.003

General Hospital Psychiatry
Volume 28, Issue 5 , Pages 440-442, September 2006