Causes of upregualtions of NAChR


Upregulation of Acetylcholine receptors leads to increased sensitivity to Succinylcholine and risk for hyperkalemia due to depolarization of the muscle membrane. May occur in:

1) Spinal Cord Injury

2) Stroke

3) Burns

•    After immobilization, upregulation of NAChRs

•    Avoid Succinylcholine – especially after 24 hours post burn and for up to 1-2 years post burn (may take months to years to return to preburn levels of NAChR)

•    Resistance to nondepolarizing NMBDs and increased sensitivity to succinylcholine

4) Prolonged immobility

5) Prolonged exposure to neuromuscular blockers

•    Typically seen in ICUs to facilitate mechanical ventilation, tetanus, status epilepticus, reduction in oxygen consumption

6) Multiple Sclerosis

•    Demyelination of the CNS

•    Attention autonomic dysfunction

7) Guillain Barre’ syndrome

•    Demyelination and axonal degeneration produce functional denervation of muscle and upregulation of NAchRs at the postsynaptic membrane

•    Pay attention to autonomic dysfunction

•    Maintain adequate preload, temperature control, postural changes, blood loss


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