Calcium polystyrene sulfonate

Calcium Polystyrene Sulfonate Calcium polystyrene sulfonate may affect the oral absorption of tetracyclines. 

Calcium polystyrene sulfonate can cause hypokalemia and hypercalcemia (4,5). 

In five infants of extremely low birth weights, who were given either sodium polystyrene sulfonate or calcium polystyrene sulfonate orally for hyperkalemia, masses were palpable in the left upper quadrant of the abdomen and visible radiographically as opaque masses in the stomach (15). At autopsy, the palpable mass was identified as a solid chalk-like concretion and X-ray diffraction showed that the material was Brushite. The authors suggested that oral exchange resins should not be used in critically HI, extremely low birth-weight infants. 

Colonic perforation has been attributed to calcium polystyrene sulfonate in a premature infant (26). 

A boy delivered at 28 weeks was given calcium polystyrene sulfonate 0.2 mg rectally for hyperkalemia (7.1 mmol/1). His abdomen, already distended, became larger with abdominal wall discoloration. An X-ray showed distended loops of bowel and at laparotomy he was found to have a perforation at the rectosigmoid junction. 

Since calcium salts can bind tetracyclines, leading to reduced absorption (SED-14, 910), an interaction of this kind might be expected with calcium polystyrene sulfonate, but it does not seem to have been reported. 

Fassinger N, Dabbagh S, Mukhopadhyay S, Lee DY. Mineral content of infant formula after treatment with sodium polystyrene sulfonate or calcium polystyrene sulfonate. Adv Perit Dial 1998 14 274-7. 

Calcium polystyrene sulfonate Cation exchanger Each gram exchanges about 1.3 mEq K+ Calcium Resonium... 

A 63-year-old woman developed right upper quadrant abdominal pain while taking calcium polystyrene sulfonate orally and rectally for hyperkalemia. Colonoscopy showed a circular ulcerative mass in the proximal ascending colon and a biopsy showed inflammation and necrotic debris. There were basophihc angu-lated crystals adherent to the ulcer bed and normal mucosa, morphologically consistent with calcium polystyrene sulfonate. 

Lee SH, Kim SJ, Kim GE, Lee WJ, Hong WK, Baik GH, Choi YH, Kim DJ. [Calcium polystyrene sulfonate induced colonic necrosis in patient with chronic kidney disease.] Korean J Gastroenterol 2010 55(4) 261-5. 

Castillo-Cejas MD, De-Torres-Ramirez 1, Alonso-Cotoner C. Colonic necrosis due to calcium polystyrene sulfonate (Kalimate) not suspended in sorbitol. Rev Esp Enferm Dig April 2013 105(4) 232-4. 

Takeuchi N, Nomura Y, Meda T, lida M, Ohtsuka A, Naba K. Development of colonic perforation during calcium polystyrene sulfonate administration a case report. Case Rep Med 2013 2013 102614. 

Lai TP, Yang CW, Siaop FY, Yen HH. Calcium polystyrene sulfonate bezoar in the ileum diagnosis and treatment with double-balloon... 

Kato S, Qno Y, Takagi T, Yoshida J, Hirakawa M, Ito T, et al. Case report a case of ileus due to ileal stenosis caused by oral intake of calcium polystyrene sulfonate. Nihon Naika Gakkai Zasshi January 10,2013 102(l) 150-2. 

The degree of inversion may be varied by time and temperature of the reaction, which is limited by the formation of - 5-hydroxymethyllurfural under forced conditions. Enrichment to high fructose contents is performed by chromatographic separation on columns filled with calcium polystyrene sulfonate ion exchange resins. 

Water is softened by removing calcium and magnesium ions from hard water in exchange for sodium ions at sites on cation-exchange resin. Water softeners typically use a gel polystyrene sulfonate cation-exchange resin regenerated with a 10% salt brine solution (25). 

The definitive treatment of severe hyperkalemia in ESRD is hemodialysis. Temporary measures include calcium gluconate, insulin and glucose, nebulized albuterol, and sodium polystyrene sulfonate. 

Drugs that may be affected by calcium include sodium polystyrene sulfonate, tetracyclines, verapamil. Iron salts and quinolones (oral only) digitalis glycosides (parenteral only). 

Interference with T4 absorption Cholestyramine, chromium picolinate, colestipol, ciprofloxacin, proton pump inhibitors, sucralfate, sodium polystyrene sulfonate, raloxifene, sevelamer hydrochloride, aluminum hydroxide, ferrous sulfate, calcium carbonate, bran, soy, coffee. 

Stationary Phase Use prepacked macroreticular polystyrene sulfonate divinylbenzene cation-exchange resin (2% to 8% cross-linked, 8- to 25-ptm particle size), preferably in the calcium or silver form. Examples of acceptable resins are Bio-Rad Aminex HPX-87C, or equivalent, for separating DPi-DP4 saccharides, and Aminex HPX-42C and HPX-42A, or equivalent, for separating DP1-DP7 saccharides. Maintain the column at 85° during operation. 

Polystyrene sulfonic acid has been used as sodium, potassium, and calcium salts. Sodium polystyrene sulfonate has been used to treat hyperkalemia in patients with renal insufficiency and as an adjuvant during hemodialysis. It can be given orally or rectally in all age groups (1). It has also been added to feeding formulae and nutritional supplements to reduce their potassium contents and so prevent hyperkalemia however, the reduction in potassium content was more than balanced by a concomitant increase in sodium content, presumably because of exchange of the sodium with calcium and magnesium (2,3). The uses and adverse effects of sodium polystyrene sulfonate have been reviewed (4,5). 

Potassium polystyrene sulfonate has been used to treat hypercalciuria and renal calculi. Calcium polystjrene sulfonate has been used to treat hyperkalemia, particularly in patients who cannot tolerate the extra sodium that would be provided by the sodium salt. 

Cation-containing antacids and laxatives (for example magnesium hydroxide, calcium carbonate) can reduce the effect of polystyrene sulfonate and metabolic acidosis can develop. This has been reported in both children (9,10) and adults. 

Hyperkalemia History of renal failure, diabetes, recent dialysis, dialysis fistulas, medications Calcium chloride, insulin, glucose, sodium bicarbonate, sodium polystyrene sulfonate, dialysis... 

The general treatment approach for patients with hyperkalemia is outlined in Fig. 50-2. In patients who are symptomatic, calcium should be administered to prevent or treat any cardiac manifestations of hyperkalemia. Once the patient is hemodynamically stabilized, the serum potassium concentration should be rapidly decreased within minutes by administering drugs that result in an intracellular shift. If the patient is asymptomatic, rapid correction is not necessary. The clinician can administer an ion exchange resin (e.g., sodium polystyrene sulfonate SPS) that results in removal of potassium from the body over several hours. 

Treat hyperkalemia (see p 37), if greater than 5.5 mEq/L, with sodium bicarbonate (1 mEq/kg), glucose (0.5 g/kg IV) with insulin (0.1 U/kg IV), or sodium polystyrene sulfonate (Kayexalate, 0.5 g/kg PO) Do not use calcium it may worsen ventricular arrhythmias. Mild hyperkalemia may actually protect against tachyarrhythmias. 

In another case, an elderly man treated with quinapril 20 mg daily for essential hypertension was found to have hyperkalaemia (serum potassium 7 to 7.4 mmol/L) and azotaemia after 20 days of treatment with co-tri-moxazole for mild acute pyelonephritis. Co-trimoxazole and quinapril were stopped, and nifedipine was given to control blood pressure. After treatment with dextrose, insulin, sodium polystyrene sulfonate and calcium gluconate, the azotaemia and hyperkalaemia resolved over 36 hours. ... 

---