Serum cholinesterase levels after thermal injury. Is treatment required?

Changes in serum cholinesterase (also known as pseudo- or non-specific cholinesterase) activity have been measured in 20 patients after thermal injury. In 19 patients a marked fall was noted at around day 5 post-burn, and recovery to normal levels was variable and in some cases prolonged. A variety of symptoms, for example, dyspnoea and confusion, have been attributed to lowered serum cholinesterase activity and some workers have gone so far as to advocate blood transfusion to treat such a condition (Price et., 1970; Frohlich, 1977). In this study we found 13 patients (65 per cent) with such symptoms coexisting with a low serum cholinesterase activity. However, we do not believe these symptoms were directly attributable to the low enzyme activity for the following reasons: In only three of the 13 patients were symptoms observed at times when the lowest cholinesterase activity was recorded. A conventional explanation for these symptoms was available, except in three cases with abdominal distension. In six cases no symptoms were observed despite very low cholinesterase levels.