Sorbitol Polystyrene sulfonate

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. 

Sodium polystyrene sulfonate 15-60 g in 20% sorbitol suspension enterally. As an enema, prepare 50 g in 70% sorbitol plus 100 mL tap water. This solution should be retained for 30-60 min... 

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. 

Sodium Polystyrene Sulfonate (Kayexalate) [Potassium Removing Resin] Uses Rx of T K Action NaVK" ion-exchange resin Dose Adults. 15-60 g PO or 30-60 g PR q6h based on serum Peds. 1 g/kg/dose PO or PR q6h based on serum (given w/ agent, eg, sorbitol, to promote movement through the bowel) Caution [C, M] Contra T Na" Disp Powder, susp SE T Na", -i Na retention, GI upset, fecal impaction Interactions T Risk of systemic alkalosis W/ Ca- or Mg-containing antacids EMS Monitor ECG for h5 pokalemia (flattened T waves) OD Not systemically absorbed but may cause h5 pokalemia and the associated effects (muscle weakness, confusion) and bowel obstruction s5rmpto-matic and supportive... 

Following reports of colonic necrosis, the Pharmaceutical Affairs Bureau of Japan has revised the product information for enemas of polystyrene sulfonate cation exchange resin suspension in sorbitol solution for potassium removal (31). Although a causal relation has not been established definitively, the Bureau has decided that sorbitol solution should not be used for enemas of sodium polystyrene sulfonate cation exchange resins. 

Gerstman BB, Kirkman R, Platt R. Intestinal necrosis associated with postoperative orally administered sodium polystyrene sulfonate in sorbitol Am J Kidney Dis 199220(2) 159-61. 

Rashid A, Hamilton SR. Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (kayexalate) in sorbitol an underrecognized condition. Am J Surg Pathol 1997 21(l) 60-9. 

Anonymous. Sorbitol as a solvent for cation exchange resin enemas composed of polystyrene sulfonate-revised data sheet-colonic necrosis. WHO Newslett 1996 5,6 4. 

The incidence of intestinal necrosis has been estimated in 752 hospitalized patients who had received sodium polystyrene sulfonate, of whom 117 were exposed within 1 week of surgery (17). There were two cases of intestinal necrosis, both in patients who had received oral sodium polystyrene sulfonate in sorbitol. Based on these two cases, the postoperative incidence of intestinal necrosis associated with sodium polystyrene sulfonate was 1.8%. In 862 patients, who had undergone hemodialysis, renal transplantation, or cardiac transplantation, but had not received sodium polystyrene sulfonate, there were no cases of idiopathic intestinal necrosis. 

Two patients, who had died after cardiac surgery, were in renal insufficiency, and had received sodium polystyrene sulfonate in sorbitol, had colonic luminal crystals of sodium polystyrene sulfonate associated with underlying mucosal necrosis, submucosal edema, and transmural inflammation (21). 

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). 

In another case, colonic necrosis presented as an acute abdomen within 24 hours of administration of sodium polystyrene sulfonate in sorbitol (23). After prompt surgical resection of the necrotic transverse colon there was rapid recovery of bowel function. 

Abraham SC, Bhagavan BS, Lee LA, Rashid A, Wu TT. Upper gastrointestinal tract injury in patients receivmg Kayexalate (sodium polystyrene sulfonate) in sorbitol cUn-ical, endoscopic, and histopathologic findings. Am J Surg Pathol 2001 25(5) 637-44. 

Scott TR, Graham SM, Schweitzer EJ, Bartlett ST. Colonic necrosis following sodium polystyrene sulfonate (Kayexalate)-sorbitol enema in a renal transplant patient. Report of a case and review of the literature. Dis Colon Rectum 1993 36(6) 607-9. 

Potentially fatal colonic necrosis may occur if sodium polystyrene sulfonate is given as an enema with sorbitol. 

Five patients with uraemia developed severe eolonie necrosis after being given enemas containing sodium polystyrene sulfonate and sorbitol for the treatment of hyperkalaemia. Four of the 5 died as a result. Associated studies in uraemic rats found that all of them died over a 2-day period after being given enemas of sodium polystyrene sulfonate with sorbitol. Extensive haemorrhage and transmural necrosis developed. No deaths occurred when enemas without sorbitol were given. ... 

Information is very limited and the interaction is not firmly established, nevertheless its seriousness indicates that sodium polystyrene sulfonate should not be given as an enema in aqueous vehicles containing sorbitol. More study is needed. Note that the manufacturer advises against the concurrent use of both oral and rectal sorbitol with sodium polystyrene sulfonate, because of the risk of colonic necrosis. ... 

Trottier V, Drolet S, Morcos MW. Ileocolic perforation secondary to sodium polystyrene sulfonate in sorbitol use a case report. Can J Gastroenterol 2009 23(10) 689-90. 

McGowan CE, Saha S, Chu G, Resnick MB, Moss SF. Intestinal necrosis due to sodium polystyrene sulfonate (Kayexalate) in sorbitol. South Med J 2009 102(5) 493-7. 

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. 

Rokutan H. Is sodium polystyrene sulfonate truly guilty without sorbitol Am J Med July 2014 127(7) e37. 

Watson MA, Baker TP, Nguyen A, SebastianelH ME, Stewart HE, Oliver DK, et al. Association of prescription of oral sodium polystyrene sulfonate with sorbitol in an inpatient setting with colonic necrosis a retrospective cohort study. Am J Kidney Dis September 2012 60(3) 409-16. [97] Albeldawi M, Gaur V, Weber L. Kayexalate-induced colonic ulcer. Gastroenterol Rep (Oxf) August 2014 2(3) 235-6. 

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