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The depolarising neuromuscular blocking agent suxamethonium chloride, frequently used during endotracheal intubation, is contraindicated in patients with chronic denervation in whom it can cause a life-threatening hyperkalaemic reaction, thought to be mediated through upregulation of nicotinic alpha7 acetylcholine receptors. An underlying neuromuscular disorder should be considered in all patients with acute respiratory insufficiency, and an alternative neuromuscular blocking drug must be used if there is any possibility of widespread denervation.

Original publication




Journal article


Clin Med (Lond)

Publication Date





292 - 293


Amyotrophic Lateral Sclerosis, Fasciculation, Fatal Outcome, Female, Humans, Hyperkalemia, Intubation, Intratracheal, Middle Aged, Neuromuscular Depolarizing Agents, Succinylcholine, Tachycardia