Colonic Necrosis Due to Oral Kayexalate in a Critically-Ill Patient

Thomas, Anish; James, B R; Landsberg, David

doi:10.1097/maj.0b013e31818dd715

Cited by 23 publications

(12 citation statements)

References 5 publications

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“…Despite this, reports of similar injury have continued to occur with both preparations of sodium polystyrene sulfonate containing lower sorbitol concentrations and those without sorbitol. 10,11 Despite a Food and Drug Administration black-box warning on its use with sorbitol and contention regarding its efficacy in reducing serum potassium levels, sodium polystyrene sulfonate continues to be widely prescribed for the management of acute and chronic hyperkalemia. 3,4,[12][13][14][15][16] This practice may be placing patients at unnecessary risk.…”

mentioning

confidence: 99%

Gastrointestinal Adverse Events with Sodium Polystyrene Sulfonate (Kayexalate) Use: A Systematic Review

Harel

Har-El

Shah

et al. 2013

The American Journal of Medicine

280

273

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confidence: 99%

Gastrointestinal Adverse Events with Sodium Polystyrene Sulfonate (Kayexalate) Use: A Systematic Review

Harel

Har-El

Shah

et al. 2013

The American Journal of Medicine

280

273

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“…Sodium polystyrene sulfonate (SPS, Kayexelate; Sanofi‐Aventis, Bridgewater, NJ, USA) is a cation‐exchange resin indicated for individuals with hyperkalaemia. Sodium polystyrene sulfonate has been associated with colonic ischaemia and rare instances of colonic necrosis with most reported patients having uraemia . Sodium polystyrene sulfonate‐induced colonic ischaemia is easier to diagnose than most other medication‐induced colonic ischaemia since biopsy with haematoxylin and eosin staining typically shows basophilic kayexalate crystals forming a crystalline mosaic, either adherent to the epithelium or mixed with inflammatory cells .…”

Section: Pharmacologic Agents Strongly Associated With Colon Ischaemiamentioning

confidence: 99%

Review article: the pharmacological causes of colon ischaemia

Vodusek

Feuerstadt

Brandt

2018

Aliment Pharmacol Ther

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Summary Background Colon ischaemia is the most common ischaemic disorder of the gastrointestinal system, can affect any segment of the colon, and may present with a range of symptoms. Diagnosis can be challenging due to symptom overlap with other conditions, varied aetiology, and often rapid and self‐resolving course. Aim To review comprehensively the literature regarding the pharmacological aetiologies of colonic ischaemia to enhance the understanding of the various mechanisms of disease, presentations, distribution, and outcomes. Methods A PubMed search for “colon ischaemia” and “ischaemic colitis” alone as well as in combination with various known pharmacologic causes was performed. Only the highest quality and relevant literature was included in this review. The quality of the literature for each association was rated by the authors and a consensus was made when discrepancies were encountered. Only associations that were deemed “moderate” or “strong” were included. Results The literature considering pharmacologically associated colonic ischaemia is diverse, lacks codification and is characterised by numerous case reports and case series. Constipation‐inducing drugs, digoxin, hormonal therapies, illicit drugs, immunomodulators, laxatives, and NSAIDs were strongly associated with colonic ischaemia. Antimicrobials, appetite suppressants, chemotherapies, decongestants, diuretics, ergot alkaloids, serotonin agents, statins, and vasopressor agents were moderately associated. Conclusions Patients presenting with abdominal pain, diarrhoea, or bloody stool need to be evaluated for the possibility of this condition and treated accordingly. Timely diagnosis is necessary to improve patient outcomes. This review aims to increase awareness among clinicians regarding the presentation of pharmacologically induced colonic ischaemia.

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“…Patients may be susceptible to intestinal ischemia even in the absence of end stage renal disease, surgical intervention, or significant comorbidity (20, 21). …”

Section: Elimination Of Potassium From the Bodymentioning

confidence: 99%

Treatment and pathogenesis of acute hyperkalemia

Mushiyakh

Dangaria

Qavi

et al. 2012

Journal of Community Hospital Internal Medicine Perspectives

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This article focuses on the pathogenesis, clinical manifestations, and various treatment modalities for acute hyperkalemia and presents a systematic approach to selecting a treatment strategy. Hyperkalemia, a life-threatening condition caused by extracellular potassium shift or decreased renal potassium excretion, usually presents with non-specific symptoms. Early recognition of moderate to severe hyperkalemia is vital in preventing fatal cardiac arrhythmias and muscle paralysis. Management of hyperkalemia includes the elimination of reversible causes (diet, medications), rapidly acting therapies that shift potassium into cells and block the cardiac membrane effects of hyperkalemia, and measures to facilitate removal of potassium from the body (saline diuresis, oral binding resins, and hemodialysis). Hyperkalemia with potassium level more than 6.5 mEq/L or EKG changes is a medical emergency and should be treated accordingly. Treatment should be started with calcium gluconate to stabilize cardiomyocyte membranes, followed by insulin injection, and b-agonists administration. Hemodialysis remains the most reliable method to remove potassium from the body and should be used in cases refractory to medical treatment. Prompt detection and proper treatment are crucial in preventing lethal outcomes.

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Colonic Necrosis Due to Oral Kayexalate in a Critically-Ill Patient

Cited by 23 publications

References 5 publications

Gastrointestinal Adverse Events with Sodium Polystyrene Sulfonate (Kayexalate) Use: A Systematic Review

Gastrointestinal Adverse Events with Sodium Polystyrene Sulfonate (Kayexalate) Use: A Systematic Review

Review article: the pharmacological causes of colon ischaemia

Treatment and pathogenesis of acute hyperkalemia

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