Evaluation of Sodium Polystyrene Sulfonate Dosing Strategies in the Inpatient Management of Hyperkalemia

Abstract

Mild hyperkalemia can be effectively treated with a single 60-g oral dose of SPS as monotherapy, with minimal risk of hypokalemia. Moderate to severe hyperkalemic episodes warrant alternative therapy. The potassium-lowering effect is correlated to SPS dose and is independent of interindividual characteristics.

Evidence in support of hyperkalaemia management strategies: A systematic literature review

“…Of the 29 unique non‐randomised interventional studies identified in this SLR, 13 investigated temporising agents and 6 ZS or organic cation‐binding agents for the management of hyperkalaemia . Twelve out of 43 unique observational studies identified in the SLR reported on management of hyperkalaemia with SPS or CPS and 11 focused on temporising agents; however, a comparison of temporising agents was not in the scope of this work, given their use in the emergency setting …”

Менеджмент Гиперкалиемии У Детей С Хронической Болезнью Почек

“…Дійсно, хоча ЕКГ вважається основним інструментом для діагностики гіперкаліємії, у нашому дослідженні тільки у 18 пацієнтів (22,5 %) із 80 відповідали критеріям зміни ЕКГ, що відображають гіперкаліємію. [1,6,9,10,14,17,19]. ПСН призначали перорально з розрахунку 1 г/кг маси тіла на добу, поділяючи розраховану дозу на 3 прийоми.…”

Treatment of Severe Hyperkalemia: Confronting 4 Fallacies

“…To dispel the doubt that these 3 studies cast on potassium lowering by sodium polystyrene sulfonate, all 7 of the most recent case series of sodium polystyrene sulfonate use confirmed its effectiveness in almost 800 patients; single 60- to 80-g doses were followed by average falls in serum potassium of 0.9 to 1.7 mmol/l. 36 , 37 , 38 , 39 , 40 , 41 , 42 The average decreases in serum potassium increased significantly from 0.6 to 0.9 to 1.2 mmol/l as sodium polystyrene sulfonate doses increased from 15 to 30 to 60 g. 36 , 37 , 38 , 40 , 42 Regarding onset of action, a significant fall of 0.6 mmol/l was noted in potassium concentrations measured from 0 to 4 hours after sodium polystyrene sulfonate administration. 39 …”

“…The potassium-lowering response to sodium polystyrene sulfonate is unpredictable, although higher doses generally produce greater decreases than lower doses, and a 60-g dose decreases potassium by approximately 1.2 mmol/l (range: 0.9–1.7 mmol/l in different studies). 36 , 37 , 38 , 40 , 42 A lesser response can be anticipated in patients who release potassium because of cell breakdown, as happens with rhabdomyolysis, and in larger patients, whose greater muscle mass contains a greater excess of total body potassium. 24 The goal is to reduce the serum potassium to ≤5.5 mmol/l, so 60 g of sodium polystyrene sulfonate with 33% sorbitol should be given when potassium is >6.5 mmol/l.…”