Hyperkalemia sodium polystyrene sulfonate

Treatment depends on degree of hyperkalemia and presence/severity of signs and symptoms (sometimes irrespective of actual serum potassium level). Mild 5.5-6 mEq/L—furosemide and sodium polystyrene sulfonate. Moderate 6.1-7 mEq/L—insulin, glucose, sodium bicarbonate,... 

It is critically important to recognize that the treatments of hyperkalemia discussed thus far are transient, temporizing measures. They are intended to provide time to institute definitive therapy aimed at removing excess potassium from the body. Agents that increase potassium excretion from the body include sodium polystyrene sulfonate, loop diuretics, and hemodialysis or hemofiltration (used only in patients with renal failure). Sodium polystyrene sulfonate (Kayexalate , various manufacturers) can be given orally, via NG tube, or as a rectal retention enema and is dosed at 15 to 60 grams in four divided doses per day. 

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

Sodium polystyrene sulfonate is a cation-exchange resin suitable for asymptomatic patients with mild to moderate hyperkalemia. Each gram of resin exchanges 1 mEq of sodium for 1 mEq of potassium. The sorbitol component promotes excretion of exchanged potassium by inducing diarrhea. The oral route is better tolerated and more effective than the rectal route. 

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). 

An 83-year-old man with septic shock and renal insufficiency after prostatectomy was given sodium polystyrene sulfonate for hyperkalemia and developed a 3 cm esophageal ulcer. Crystals of sodium polystyrene sulfonate were found in a biopsy. 

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. 

A 650-g, 24-week-old neonate with hyperkalemia was given sodium polystyrene sulfonate enemas and... 

A 67-year-old man underwent laparotomy for a ruptured abdominal aortic aneurysm (20). Postoperatively he was treated with hemodialysis because of acute renal insufficiency. Hyperkalemia was treated with sodium polystyrene sulfonate, after which he developed ulceration of the colon and required a hemicolectomy because of intractable blood loss. 

In a patient who developed near-total colonic necrosis shortly after renal transplantation, the onset of symptoms was temporally related to the administration of sodium polystyrene sulfonate plus sorbitol enemas (Kayexalate) for hyperkalemia (22). 

Drugs that have similar names are not infrequently confused. The name of Sanofi-Synthelabo s brand of sodium polystyrene sulfonate, Kayexalate, could be confused with the names of proprietary brands of potassium chloride, such as Kay-Cee-L and Kay-Ciel. Furthermore, some formulations of potassium chloride are formulated in packaging that resembles that of Kayexalate. There have been two deaths when potassium chloride was given instead of sodium polystyrene sulfonate for hyperkalemia (31). 

Meyer I. Sodium polystyrene sulfonate a cation exchange resin used in treating hyperkalemia. ANNA J... 

Takasu T. [Treatment of hyperkalemia associated with renal insufficiency—clinical effects and side reactions of positive-ion-exchange resins, sodium polystyrene sulfonate (Kayexalate).] Nippon Rinsho 1970 28(7) 1941-6. 

Osawa A, Okoshi M, Higuchi J, Yamayoshi W. [Treatment of hyperkalemia m renal insufficiency with cation exchange resin. Experience with use of sodium polystyrene sulfonate.] Hmyokika Kiyo 1969 15(9) 645-51. 

Bennett LN, Myers TF, Lambert GH. Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a 650 gram imant with hyperkalemia. Am J Perinatol 1996 13(3) 167-70. 

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. 

Sodium polystyrene sulfonate is a potassium-removing resin, which exchanges sodium ions for potassium in large intestine. Sodium polystyrene sulfonate, a cation exchange resin removing potassium (15 g p.o. daily), is used in hyperkalemia. 

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. 

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. 

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