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

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Kishore Kumar ◽  
Harish Patel ◽  
Muhammad Saad ◽  
Ahmed Baiomi ◽  
Anil Dev
Keyword(s):  
Clinical Medicine ◽  
The Body ◽  
Decompensated Cirrhosis ◽  
Sodium Polystyrene Sulfonate ◽  
Esophageal Ulcer ◽  
Polystyrene Sulfonate ◽  
Colonic Necrosis ◽  
Cation Exchange Resins ◽  
Gastrointestinal Side Effects ◽  
Exchange Resins

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.

▼Patiromer for the management of hyperkalaemia

2018 ◽  
Vol 56 (1) ◽  
pp. 6-9
Keyword(s):  
Cation Exchange ◽  
Sodium Polystyrene Sulfonate ◽  
Potassium Ions ◽  
Polystyrene Sulfonate ◽  
Efficacy And Safety ◽  
High Concentration ◽  
Threatening Condition ◽  
Cation Exchange Resins ◽  
Life Threatening ◽  
Exchange Resins

Hyperkalaemia is a potentially life-threatening condition, in which there is an abnormally high concentration of potassium ions in the blood.1,2 Cation-exchange resins (e.g. calcium or sodium polystyrene sulfonate) that bind potassium in the gastrointestinal tract to increase faecal elimination have been used as part of the management of hyperkalaemia but they have some serious adverse effects, including potentially fatal gastrointestinal necrosis.3,4 Patiromer (▼Veltassa – Vifor Fresenius) is a cation-exchange polymer that is licensed for the treatment of hyperkalaemia in adults and, unlike other exchange resins, its licence is not restricted to people with anuria, severe oliguria or those requiring or undergoing dialysis.5,6 Here, we review the evidence for the efficacy and safety of patiromer and consider its place in the management of hyperkalaemia.

Risk of Intestinal Necrosis With Sodium Polystyrene Sulfonate: A Systematic Review and Meta-analysis

2021 ◽  
Vol 16 (8) ◽  
Author(s):  
Jürgen L Holleck ◽  
Andrea E Roberts ◽  
Elizabeth A Marhoffer ◽  
Alyssa A Grimshaw ◽  
Craig G Gunderson
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Cochrane Library ◽  
Selective Reporting ◽  
Sodium Polystyrene Sulfonate ◽  
Composite Outcome ◽  
Polystyrene Sulfonate ◽  
Intestinal Necrosis ◽  
Increased Risk ◽  
Gastrointestinal Side Effects

BACKGROUND: Reports of severe gastrointestinal side effects associated with sodium polystyrene sulfonate (SPS), particularly intestinal necrosis, have led some to recommend costlier alternative medications. No prior systematic review has included studies with controls reporting intestinal necrosis rates associated with SPS. METHODS: A systematic literature search was conducted using Cochrane Library, Embase, Medline, Google Scholar, PubMed, Scopus, and Web of Science Core Collection from database inception through October 4, 2020. We included any clinical trial, cohort, or case-control study reporting an association between SPS and intestinal necrosis or severe gastrointestinal side effects. RESULTS: Six studies including 26,716 patients treated with SPS with controls met inclusion criteria. The pooled odds ratio (OR) of intestinal necrosis was 1.43 (95% CI, 0.39-5.20). The pooled hazard ratio (HR) for intestinal necrosis from the two studies that performed survival analysis was 2.00 (95% CI, 0.45-8.78). The pooled HR for the composite outcome of severe gastrointestinal adverse events was 1.46 (95% CI, 1.01-2.11). CONCLUSION: Based on our review of six studies, the risk of intestinal necrosis with SPS is not statistically greater than controls, although there was a statistically significantly increased risk for the composite outcome of severe gastrointestinal side effects based on two studies. Because of the risk of bias from potential confounding and selective reporting, the overall strength of evidence to support an association between SPS and intestinal necrosis or other severe gastrointestinal side effects is low. PROSPERO registration CRD42020213119.

Incidence of Sodium Polystyrene Sulfonate-associated Colonic Necrosis

2013 ◽  
Vol 126 (9) ◽  
pp. e13 ◽  
Author(s):  
Christina M. Yuan ◽  
Robert Nee ◽  
Dustin J. Little ◽  
Kevin C. Abbott
Keyword(s):  
Sodium Polystyrene Sulfonate ◽  
Polystyrene Sulfonate ◽  
Colonic Necrosis

scholarly journals Patiromer in a Patient with Severe Hyperkalemia on Incremental Hemodialysis with 1 Session per Week: A Case Report and Literature Review

2021 ◽  
pp. 158-166
Author(s):  
José C. De La Flor ◽  
Javier Deira ◽  
Alexander Marschall ◽  
Francisco Valga ◽  
Tania Linares ◽  
...  
Keyword(s):  
Volume Overload ◽  
Sodium Polystyrene Sulfonate ◽  
Dialysis Dose ◽  
Cation Exchange Resins ◽  
Incremental Hemodialysis ◽  
Severe Hyperkalemia ◽  
Exchange Resins ◽  
Potassium Binders ◽  
Sodium Zirconium Cyclosilicate

Hyperkalemia is common in patients with ESRD, undergoing hemodialysis (HD), and is associated with an increase in hospitalization and mortality. Residual kidney function in long-term dialysis patients is associated with lower morbidity and mortality in HD patients. Although the 2015 National Kidney Foundation-Kidney Disease Outcomes Quality Initiate (NKD-KDOQI) guidelines allow the reduction in the weekly HD dose for patients with a residual kidney urea clearance (Kur) &#x3e;3 mL/min/1.73 m<sup>2</sup>, very few centers adjust the dialysis dose based on these criteria. In our center, the pattern of incremental hemodialysis (iHD) with once-a-week schedule (1 HD/W) has been an option for a group of patients showing very good results. This pattern is maintained as long as residual diuresis is &#x3e;1,000 mL/24 h, Kur is &#x3e;4 mL/min, and there is no presence of edema or volume overload, as well as no analytical parameters persistently outside the advisable range (serum phosphorus &#x3e;6 mg/dL or potassium [K<sup>+</sup>] &#x3e;6.5 mmol/L). Management of hyperkalemia in HD patients includes reduction of dietary intake, dosing of medications that contribute to hyperkalemia, and use of cation-exchange resins such as calcium or sodium polystyrene sulfonate. Two newer potassium binders, patiromer sorbitex calcium and sodium zirconium cyclosilicate, have been safely used for potassium imbalance treatment in patients with ESRD in HD with a conventional regimen of thrice weekly, but has not yet been studied in 1 HD/W schedules. We present the case of a 76-year-old woman in iHD (1 HD/W) treated with patiromer for severe HK and describe her clinical characteristics and outcomes. In addition, we review the corresponding literature. Based on these data, it can be anticipated that the use of patiromer may overcome the risk of hyperkalemia in patients with incident ESRD treated with less-frequent HD regimens.

scholarly journals Sodium Polystyrene Sulfonate-Induced Gastric Pneumatosis: A Rare Side Effect

2021 ◽  
pp. 878-883
Author(s):  
Neethi Dasu ◽  
Yaser Khalid ◽  
Kirti Dasu ◽  
Lucy Joo ◽  
Brian Blair
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Side Effect ◽  
Case Reports ◽  
Sodium Polystyrene Sulfonate ◽  
Polystyrene Sulfonate ◽  
Unique Case ◽  
Rare Side Effect ◽  
Colonic Necrosis ◽  
The Usa

Kayexalate has been used in the USA since 1975 for the treatment of hyperkalemia. Prior case reports have shown that sorbitol added to kayexalate has been known to cause rare side effects of colonic necrosis. We present a unique case report of gastric pneumatosis as a complication of kayexalate.

Managing Hyperkalemia: Stepping Into a New Frontier

2016 ◽  
Vol 30 (5) ◽  
pp. 557-561 ◽  
Author(s):  
Antony Q. Pham ◽  
Jessica Sexton ◽  
Dexter Wimer ◽  
Isha Rana ◽  
Timothy Nguyen
Keyword(s):  
Action Potentials ◽  
Normal Serum ◽  
The Body ◽  
Sodium Polystyrene Sulfonate ◽  
Polystyrene Sulfonate ◽  
Novel Treatments ◽  
Cellular Processes ◽  
Sodium Zirconium ◽  
New Frontier ◽  
Sodium Zirconium Cyclosilicate

Maintaining potassium balance in the body is essential for cellular function. Even a slight increase in normal serum potassium levels (3.5-5.0 mEq/L) can interfere with metabolism, electrical action potentials, and cellular processes. Hyperkalemia is commonly seen in patients with chronic kidney disease (CKD) and in patients on renin–angiotensin–aldosterone system (RAAS) inhibitors. Sodium polystyrene sulfonate (SPS), diuretics, and hemodialysis are currently available methods for removing potassium from the body; however, these options have their limitations. Patiromer (Veltassa) and sodium zirconium cyclosilicate are 2 new therapeutic options that can potentially lead a new frontier in the management of hyperkalemia. This article will review these novel treatments.

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