Fish scale crystals: an under-recognised cause of intestinal necrosis

Rectal ulcer in a hemodialysis patient receiving Kayexalate®

“…Kayexalate ® is commonly prescribed for the treatment of hyperkalemia; however, two new potassium-binding agents, sodium zirconium cyclosilicate and patiromer, appear to have greater binding selectivity for potassium compared with that of SPS, but they are not yet available in all countries and for the treatment of all causes of hyperkalemia. [27][28][29] In Belgium and in many countries of Europe, sodium zirconium cyclosilicate (ZS-9) is not available and patiromer is not freely commercialized and can be prescribed only by a nephrologist or cardiologist. All our dialysis patients who have chronic uncontrolled hyperkalemia receive 15 g of kayexalate during their main meal, the days without dialysis.…”

“…Kayexalate ® is commonly prescribed for the treatment of hyperkalemia; however, two new potassium‐binding agents, sodium zirconium cyclosilicate and patiromer, appear to have greater binding selectivity for potassium compared with that of SPS, but they are not yet available in all countries and for the treatment of all causes of hyperkalemia 27‐29 …”

Adverse Gastrointestinal Effects with Kayexalate or Kalimate: A Comprehensive Review

“…Intestinal necrosis and perforation are potential complications of Kayexalate and may present in a delayed stage up to 2 months. 28,[51][52][53] However, Kayexalate-or Kalimate-related toxicities in the upper GI tract have been rarely described in the literature. 20,22 Most of these cases do have simultaneous damage to colon.…”

“…This change may possibly be due to the trend for the use of oral, instead of rectal Kayexalate or Kalimate. 5,[22][23][24][25][26][27][28][51][52][53] However, regardless of the location of Kayexalate or Kalimate-associated injury, mortality remains high. The elevated mortality may be a result of aggravated damage along with the large comorbid disease burden of affected patients.…”