Polystyrene sulfonates colonic necrosis

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. 

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. 

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. 

A 53-year-old woman took sodium polystyrene sulfonate 15 g twice, 8 days apart, and 15 days later developed colonic necrosis and perforation there were crystals of sodium polystyrene sulfonate in the inflammatory debris (24). 

Rogers FB, Li SC. Acute colonic necrosis associated with sodium polystyrene sulfonate (Kayexalate) enemas in a critically ill patient case report and review of the literature. J Trauma 2001 51(2) 395-7. 

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. 

Cheng ES, Stringer KM, Pegg SP. Colonic necrosis and perforation following oral sodium polystyrene sulfonate (Resomum A/Kayexalate) in a burn patient. Burns 2002 28(2) 189-90. 

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

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. ... 

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. 

Gastrointestinal Ischemic colitis [56 ], colonic necrosis 58, 59 ], colonic perforation [60 ], and deal perforation [61 ] have again been reported in patients taking sodium polystyrene sulfonate. 

Yuan CM, Nee R, Little DJ, Abbott KC. Incidence of sodium polystyrene sulfonate-associated colonic necrosis. Am J Med September... 

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. 

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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