Management of Hyperkalemia with a Cation-Exchange Resin

Scherr, Lawrence; Ogden, David A.; Mead, Allen W.; Spritz, Norton; Rubin, Albert L.

doi:10.1056/nejm196101192640303

Cited by 136 publications

(94 citation statements)

References 17 publications

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“…In our experience, oral SPS/sorbitol is a useful and effective medication, and existing studies in subjects with hyperkalemia support its efficacy (12,16). We can find no studies that demonstrate that it is ineffective in lowering potassium in patients with hyperkalemia after 8 to 24 hours of treatment.…”

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confidence: 71%

“…It was known that patients could recover from acute kidney failure if they did not die of hyperkalemia, acidosis, uremia, or volume overload in the interim (11). This was the setting in which Scherr et al (12) reported the efficacy of SPS in 1961. Thirty-two hyperkalemic patients were evaluated.…”

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confidence: 99%

“…In life-threatening hyperkalemia, serum potassium reductions need not be large to prevent cardiac arrest. It is also noteworthy that Scherr et al (12) did not give SPS with a cathartic, but with water, showing that SPS was effective in reducing serum potassium without concomitant sorbitol. Sorbitol use was first described by Flinn et al in a five-patient case series, where it was used to prevent obstipation and prolonged retention of SPS (13).…”

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confidence: 99%

“…The majority of patients with hyperkalemia requiring treatment with SPS likely have advanced renal failure, so it is not clear that renal failure is a risk factor for SPS/sorbitol-associated colonic necrosis beyond the fact that such patients are more likely to receive the drug. Scherr et al showed that SPS is effective when given with water (12), and clinicians should consider administering it in water, especially in enema form.…”

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confidence: 99%

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Damned If You Do, Damned If You Don't

Watson

Abbott

Yuan

2010

Clinical Journal of the American Society of Nephrology

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Sodium polystyrene sulfonate (SPS) potassium binding resins increase colonic potassium excretion and are approved by the U.S. Food and Drug Administration (FDA) for the treatment of hyperkalemia. In 2009, the FDA recommended that sorbitol, a cathartic often given with SPS to prevent obstipation, not be added to SPS powder because of associated colonic necrosis. A premixed oral suspension of SPS in 33% sorbitol was not included in this warning. SPS resins increase stool potassium excretion in normokalemic subjects, but proportionately more potassium is excreted due to cathartics when the two are combined. In hyperkalemic patients, oral SPS mixed in water significantly decreases serum potassium within 24 hours. SPS/sorbitol-associated colonic necrosis is most commonly seen in patients who have received enemas in the setting of recent abdominal surgery, bowel injury, or intestinal dysfunction. It is a rare event, on the order of 0.2 to 0.3%, almost exclusively present in patients at risk. The agent most likely associated with colonic necrosis is 70% sorbitol, and animal data support that etiology. There is very little data to suggest that oral SPS given with 33% sorbitol (in the premixed form) or SPS powder in water orally or as an enema causes colonic necrosis. SPS ion-exchange resins are the only agents, other than dialysis and diuretics, available to increase potassium excretion in hyperkalemia, and when used appropriately, they appear to be clinically effective and reasonably safe.

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confidence: 71%

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confidence: 99%

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confidence: 99%

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Damned If You Do, Damned If You Don't

Watson

Abbott

Yuan

2010

Clinical Journal of the American Society of Nephrology

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“…1 Sodium polystyrene sulfonate (SPS) (Kayexalate) is a sodiumpotassium cation-exchange resin that can be administered in hyperkalemia, both orally and rectally. 2 Rectal SPS is commonly suspended in 20 to 25% sorbitol to prevent intestinal obstruction. However, this concentration maybe harmful to the intestinal mucosa of very low-birth-weight infants and, as a matter of fact, some cases of NEC secondary to sorbitol-suspended SPS enemas have been reported.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing enterocolitis in a 850 gram infant receiving sorbitol-free sodium polystyrene sulfonate (Kayexalate): clinical and histopathologic findings

et al. 2007

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We report a 27-week, 850 g infant with severe Streptococcus group B sepsis and life-threatening hyperkalemia due to progressive anuria. On the fourth day of life, after he failed treatment with diuretics, salbutamol, insulin, calcium gluconate and sodium bicarbonate, he was treated with sorbitol-free Kayexalate enemas. Potassium level slowly decreased from 9.2 mmol/l to normal level along with a recovery of normal urine output. On the 11th day of life, clinical and radiological signs of a perforated necrotizing enterocolitis (NEC) occurred and the patient required surgical intestinal resection. Histologic examination of the ileum specimen revealed areas of necrosis with fibrosis and giant cell reaction to a nonpolarizable material consistent with sodium polystyrene sulfonate. Usually, Kayexalate is suspended in hyperosmolar sorbitol solutions and the elevated osmolarity seems to be responsible for hemorrhagic colitis, transmural necrosis and definitely NEC. Our case report shows that Kayexalate per se, and not necessarily suspended in sorbitol, can lead to gastrointestinal tract complications and NEC in preterm infants.

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Sodium Polystyrene Sulfonate Pneumonitis

Haupt¹

1982

Arch Intern Med

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Management of Hyperkalemia with a Cation-Exchange Resin

Cited by 136 publications

References 17 publications

Damned If You Do, Damned If You Don't

Damned If You Do, Damned If You Don't

Necrotizing enterocolitis in a 850 gram infant receiving sorbitol-free sodium polystyrene sulfonate (Kayexalate): clinical and histopathologic findings

Sodium Polystyrene Sulfonate Pneumonitis

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