Patient (condition)
 
Aliases:
Sux apneoa
Scoline apnoea
Suxamethonium sensitivity
Succinylcholine sensitivity

Topic aliases are alternate phrasings for a particular topic.


Is it Congenital or Acquired?

-- CONGENITAL (autosomal recessive) Genotype

U = usual
A = Atypical
S = Silent
D = Fluoride resistant

Dibucaine number
Eu:Eu (96%) = 80
Eu:Ea (1/25) = 60
Ea:Ea (1/2800) = 20
Es:Es (1/100,000) = infinity?

Heterozygous Atypical - 7 to 30min apnoea, 1 in 25
Homozygous Atypical - 2- 4hrs apnoea, 1 in 3,000 (Dibucaine number ~20)


-- ACQUIRED
Pregnancy
Burns
Malnutrition
Liver disease
Thyrotoxicosis
Plasmapheresis and
Cardiopulmonary bypass

Drugs
Metoclopramide
Cyclophosphamide
Methotrexate
Neostigmine
MAOIs
Ester local anaesthetics
Esmolol, mivacurium

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Where resources for prolonged ventilation are limited, fresh frozen plasma (FFP) may supplement plasma cholinesterase and avoid a prolonged ventilation in ICU or recovery.
This needs to be balanced against the risk of iatrogenic viral transmission from the blood product.
#MA

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Cocaine metabolism is reduced due to pseudocholinesterase deficiency. This may prolong systemic action and potentially increased plasma levels.

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1
Pseudocholinesterase deficiency is quantified by determining the dibucaine number. Dibucaine inhibits plasma cholinesterase. When dibucaine is added to a patients serum sample, the degree of inhibition of plasma pseudocholinesterase activity (by dibucaine) on benzyl choline is the dibucaine number. eg dibucaine number of 80 means there is plenty of pseudocholinestase to be inhibited

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