Our efforts at controlling HICP encompass the use of first-line therapies (CSF withdrawal, sedation, osmotics, hyperventilation, CPP optimisation). If all of these fail and the patient is salvable, we are obliged to use ''second-tier'' therapies, including barbiturates, hypothermia and decompressive craniectomy. High doses of barbiturates are still recommended to control HICP refractory after the failure of maximal standard medical and surgical therapy [52] . Along with many other severe side effects, the most important being haemodynamic instability and pulmonary complications, dyskalaemia has been described as a severe adverse effect in case reports [53, 54] . Thiopentone inhibits voltage-dependent potassium currents and inhibits phosphofructokinase, causing intracellular sequestration of potassium during its administration and an extracellular release when it is stopped. For this reason, the discontinuation of the drug must not be abrupt; it has to be slowly tapered. However, the real incidence and characteristics of dyskalaemia during and after barbiturate coma have not been well described. Ng et al.