Hyperkalemia is seen with succinylcholine , in all of the following cases except
**Core Concept**
Succinylcholine, a depolarizing muscle relaxant, can cause hyperkalemia by releasing potassium ions from muscle cells. This is particularly concerning in patients with pre-existing conditions that predispose them to hyperkalemia.
**Why the Correct Answer is Right**
Succinylcholine works by mimicking the action of acetylcholine at the neuromuscular junction, causing depolarization of muscle cells. In patients with conditions that lead to muscle damage or increased muscle cell permeability, such as burns, trauma, or neuromuscular diseases, succinylcholine can cause a significant release of potassium ions into the bloodstream, leading to hyperkalemia. This is because the depolarization caused by succinylcholine triggers the opening of potassium channels in the muscle cell membrane, allowing potassium ions to flow out of the cell.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because patients with chronic kidney disease (CKD) have impaired potassium excretion, making them more susceptible to hyperkalemia after succinylcholine administration.
**Option B:** This option is incorrect because patients with spinal cord injuries may have muscle atrophy and denervation, making them more susceptible to hyperkalemia after succinylcholine administration.
**Option C:** This option is incorrect because patients with thyroid disease, particularly hypothyroidism, may have impaired muscle function and increased muscle cell permeability, making them more susceptible to hyperkalemia after succinylcholine administration.
**Option D:** This option is incorrect because patients with liver disease typically do not have an increased risk of hyperkalemia after succinylcholine administration.
**Clinical Pearl / High-Yield Fact**
When administering succinylcholine, it is essential to carefully assess the patient's medical history for conditions that may increase the risk of hyperkalemia. This includes burns, trauma, neuromuscular diseases, CKD, spinal cord injuries, and thyroid disease.
**Correct Answer:** D.