One Oral Dose of Sodium Polystyrene Sulfonate Associated with Ischemic Colitis and Crystal Deposition in Colonic Mucosa

Edhi, Ahmed I.; Cappell, Mitchell S.; Sharma, Nisha; Amin, Mitual; Patel, Atulkumar

doi:10.14309/crj.2018.74

Cited by 12 publications

(4 citation statements)

References 5 publications

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“…The histological sign of cytotoxicity of PSS is the formation of specific crystals (Figure 1, f). As shown by other researchers, PSS is an anion exchange resin that replaces sodium ions with potassium ions [33] and causes inflammation and tissue necrosis [34]. The adhesive properties of PEI, PAH, PSS polyelectrolytes were studied on the h-MSC culture (Figure 2).…”

Section: Resultsmentioning

confidence: 92%

“…We hypothesize that improvement of the adhesive properties of h-MSCs when cultured on polyelectrolyte nanofilms made from synthetic polymers PEI, PAH, and PSS promotes adhesion and, therefore, proliferation and growth of cell biomass for therapeutic purposes. These polyelectrolytes have adhesive properties for cell cultures and have long been used in various biomedical studies for the manufacture of nanofilms and microcapsules [27,29,33,34]. In particular, the anchor properties of the PEI and PAH polycations are established on the cells of human embryonic kidney HEK-293 and pheochromocytoma of rat PC-12 as well as on the neural cells of animals and humans [27,35].…”

Section: Discussionmentioning

confidence: 99%

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Growth characteristics of human bone marrow mesenchymal stromal cells at cultivation on synthetic polyelectrolyte nanofilms in vitro

Mezhevikina

Reshetnikov

Fomkina

et al. 2021

Heliyon

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This study examines the adhesive properties and cytotoxicity of polyelectrolyte nanofilms from polyethyleneimine (PEI), polyallylamine hydrochloride (PAH) and sodium polystyrene sulfonate (PSS) on human bone marrow mesenchymal stromal cells (h-MSCs) and mouse adipose tissue (m-MSC) in vitro. Films are formed on 24-and 96well culture plates in the combinations: PEI, PAH, PEI-PSS, PEI-PSS-PAH, PEI-PSS-PEI. An analysis of the culture results show that direct contact of h-MSCs with the PEI surface promotes adhesion (93-95% of adhesive cells versus 40% in the control). On the PEI surface, h-MSCs are evenly distributed, form colonies and 80% monolayer after 72 h of culture, as in the control on culture plastic. On nanofilms from PAH and PEI-PSS-PAH, cells grow in the form of rosette-like colonies with long and thin processes similar to neurites. The cytotoxic properties of PSS were revealed in direct contact with h-MSCs (more than 40% of nonviable cells with damaged plasma membranes). On the PSS surface, cells lost their adhesiveness. To culture and stably grow the cell mass of h-MSCs, it is better to use monolayer nanofilms made of highly adhesive and non-toxic PEI polyelectrolyte, which can bind the growth factors of blood serum and platelet lysate, ensuring the growth of h-MSCs under in vitro deprivation conditions.

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Section: Resultsmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Growth characteristics of human bone marrow mesenchymal stromal cells at cultivation on synthetic polyelectrolyte nanofilms in vitro

Mezhevikina

Reshetnikov

Fomkina

et al. 2021

Heliyon

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“…The pathognomonic histologic findings include basophilic angulated striated crystals in a “fish scale” pattern [ 11 ]. Cholestyramine could give rise to similar histologic findings; therefore, it should be excluded by patient history [ 12 ]. The treatment of Kayexalate-caused bleeding esophageal ulcer is the discontinuation of Kayexalate therapy and standard management approach of upper gastrointestinal bleeding from any other etiology such as nothing per os (NPO), hemodynamic resuscitation, intravenous proton-pump inhibitor, and endoscopic therapy of actively bleeding lesion or lesion with high-risk bleeding stigmata.…”

Section: Discussionmentioning

confidence: 99%

Kayexalate-Induced Esophageal Ulceration in a Patient with Decompensated Cirrhosis: A Review of the Literature

Kumar

Patel

Saad

et al. 2021

Case Reports in Gastrointestinal Medicine

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Hyperkalemia is one of the most common electrolyte abnormalities encountered in clinical practice. The treatment of hyperkalemia includes removal of excess potassium from the body using cation exchange resins, e.g., sodium polystyrene sulfonate (Kayexalate) is one of the most practiced modalities in clinical medicine. Colonic mucosal necrosis and perforation are the serious gastrointestinal side effects associated with sodium polystyrene sulfonate (SPS) use, which have been reported with or without concomitant use of sorbitol. However, the catastrophic bleeding esophageal ulcer has been rarely described in our literature search. Due to the risk of colonic necrosis, the FDA has issued a warning to avoid concomitant sorbitol use with Kayexalate. We present an individual with acute hematemesis due to bleeding esophageal ulcer immediately after treatment with Kayexalate therapy. Though the exact mechanism by which Kayexalate causes esophageal ulcer to be elucidated, nonetheless it is worthwhile to be vigilant about its potential adverse effects. Our case highlights the rare but certainly the life-threatening complication of Kayexalate therapy.

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“… 2 , 5 , 6 However, even after this recommendation, cases of colonic injuries using SPS formulations without sorbitol have been reported, suggesting that SPS itself may be pathogenic. 7 , 8 Various histopathologic features are associated with SPS-induced GI injury, including mucosal ulceration and erosion, transmural necrosis, inflammatory exudates, pseudomembrane formation, and acute/chronic serositis. The hallmark of SPS toxicity is the identification of kayexalate crystals, visible with standard hematoxylin and eosin staining and showing characteristic polygonal, refractile, basophilic appearance and typical fish scale/mosaic pattern, which displays red color on periodic acid-Schiff and acid-fast stains.…”

Section: Discussionmentioning

confidence: 99%

Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use

et al. 2021

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Sodium polystyrene sulfonate (kayexalate) is a cation-exchange resin widely used in the management of hyperkalemia. Gastrointestinal adverse events are uncommon; symptoms are nonspecific, and mucosal injury can range from mild ulceration to bowel perforation. An 81-year-old man was admitted because of decompensation of cirrhosis with acute kidney injury and hyperkalemia, treated with sodium polystyrene sulfonate. During admission, he presented multiple episodes of hematochezia, accompanied by tachycardia and hemoglobin drop. Colonoscopy revealed colonic ulceration, and histopathological findings were compatible with ulceration due to kayexalate injury. Despite rare, the widespread use of sodium polystyrene sulfonate puts a large population at risk of serious complications related to its use.

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One Oral Dose of Sodium Polystyrene Sulfonate Associated with Ischemic Colitis and Crystal Deposition in Colonic Mucosa

Cited by 12 publications

References 5 publications

Growth characteristics of human bone marrow mesenchymal stromal cells at cultivation on synthetic polyelectrolyte nanofilms in vitro

Growth characteristics of human bone marrow mesenchymal stromal cells at cultivation on synthetic polyelectrolyte nanofilms in vitro

Kayexalate-Induced Esophageal Ulceration in a Patient with Decompensated Cirrhosis: A Review of the Literature

Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use

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