We report a case which highlights the capriciousness of suxamethonium-associated hyperkalaemia. A 25-year-old male with history of intravenous drug abuse was referred to us for failure of clinical and bacteriological improvement despite 10 days of aggressive treatment for community acquired staphylococcal pneumonia. During these 10 days he had received two uneventful suxamethonium-facilitated rapid sequence intubations on days 1 and 5, and short periods (<24 hours) of invasive mechanical ventilation. The indications were respiratory distress and pleural decortication for empyema respectively. He had no other organ dysfunction, was haemodynamically stable and being mobilised for the rest of the days.
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