Administration Of Sodium Polystyrene Sulfonate Research Articles

Awareness about appropriate practice of Sodium Polystyrene Sulfonate administration.

In patients of Chronic Kidney Disease (CKD) one of the most frequent and threatening complication is hyperkalemia. Sodium polystyrene sulfonate (SPS) commonly known as Kayexalate is one of the treatment options in management of hyperkalemia. Food and Drug Authority (FDA) has recently issued a warning that SPS is not to be administered at the same time with other oral drugs. Objectives: To assess the prevailing concepts about Sodium Polystyrene Sulfonate administration and its interactions with other drugs among doctors and patients. Study Design: A Descriptive study. Setting: Three Tertiary Care Health Centers of Lahore. Period: 1st January 2018 till 31st July 2018. Material & Methods: The study population includes adult patients who had suffered from hyperkalemia, and the doctors who have been prescribing the drug and gave consent to participate in the survey. The statistical analysis was performed on SPSS version 23. Results: The total number of study participants were 75, where 50 were doctors and 25 were patients receiving Kayexalate treatment. The age range for doctors was between 24 to 55 years with mean age of 31.4 ±7.2 years. Among doctors 37 (74%) prescribe SPS at some interval from other medications, whereas only 4 (8%) prescribe at the interval recommended by FDA (3 hours). Only 19 (38%) said they knew about the latest guidelines of FDA about SPS interaction with other drugs and 38 (76%) had knowledge that SPS hampers absorption of other drugs. Among population comprising of patients receiving kayexalate, the age range was between 27 to 68 years with mean age of 49.2 ±8.5 years. 11 (44%) patients were advised to take this drug at some interval from other drugs. Conclusion: Hyperkalemia is commonly seen in tertiary care setups, especially in CKD patients. Kayexalate being an affordable option for its treatment, there is a need for improvement in training of doctors about its use and its interactions with food and other medications.

Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age

Sodium polystyrene sulfonate is commonly prescribed for the treatment of hyperkalemia. Case reports of intestinal injury after administration of sodium polystyrene sulfonate with sorbitol resulted in a US Food and Drug Administration warning and discontinuation of combined 70% sorbitol-sodium polystyrene sulfonate formulations. There are ongoing concerns about the gastrointestinal (GI) safety of sodium polystyrene sulfonate use. To assess the risk of hospitalization for adverse GI events associated with sodium polystyrene sulfonate use in patients of advanced age. Population-based, retrospective matched cohort study of eligible adults of advanced age (≥66 years) dispensed sodium polystyrene sulfonate from April 1, 2003, to September 30, 2015, in Ontario, Canada, with maximum follow-up to March 31, 2016. Initial data analysis was conducted from August 1, 2018, to October 3, 2018; revision analysis was conducted from February 25, 2019, to April 2, 2019. Cox proportional hazards regression models were used to examine the association of sodium polystyrene sulfonate use with a composite of GI adverse events compared with nonuse that was matched via a high-dimensional propensity score. Additional analyses were limited to a subpopulation with baseline laboratory values of estimated glomerular filtration rate and serum potassium level. Dispensed sodium polystyrene sulfonate in an outpatient setting. The primary outcome was a composite of adverse GI events (hospitalization or emergency department visit with intestinal ischemia/thrombosis, GI ulceration/perforation, or resection/ostomy) within 30 days of initial sodium polystyrene sulfonate prescription. From a total of 1 853 866 eligible adults, 27 704 individuals were dispensed sodium polystyrene sulfonate (mean [SD] age, 78.5 [7.7] years; 54.7% male), and 20 020 sodium polystyrene sulfonate users were matched to 20 020 nonusers. Sodium polystyrene sulfonate use compared with nonuse was associated with a higher risk of an adverse GI event over the following 30 days (37 events [0.2%]; incidence rate, 22.97 per 1000 person-years vs 18 events [0.1%]; incidence rate, 11.01 per 1000 person-years) (hazard ratio, 1.94; 95% CI, 1.10-3.41). Results were consistent in additional analyses, including the subpopulation with baseline laboratory values (hazard ratio, 2.91; 95% CI, 1.38-6.12), and intestinal ischemia/thrombosis was the most common type of GI injury. The use of sodium polystyrene sulfonate is associated with a higher risk of hospitalization for serious adverse GI events. These findings require confirmation and suggest caution with the ongoing use of sodium polystyrene sulfonate.

Portal Venous Gas in a Methamphetamine User: An Unfortunate Outcome After Sodium Polystyrene Sulfonate Administration

Portal Venous Gas in a Methamphetamine User: An Unfortunate Outcome After Sodium Polystyrene Sulfonate Administration

Replace “Have to” With “Want to”

Replace “Have to” With “Want to”

Evaluation of Appropriate Sodium Polystyrene Sulfonate Use With a Hyperkalemia Order Set: A Pilot Study

Background: No consensus guidelines exist to assist practitioners in the management of hyperkalemia. Sodium polystyrene sulfonate (SPS) is a common treatment option for hyperkalemia. To aid health-care professionals, a hyperkalemia order set was created at a 979-bed community teaching hospital. Objective: The objective of this study was to determine whether use of a hyperkalemia order set is associated with appropriate use of SPS. Methods: Orders for SPS were evaluated for appropriateness in this retrospective cohort of adult patients. Data were collected from December 1, 2015, to December 31, 2016. All orders for SPS not from an order set were randomly matched to those from the order set in a 2:1 fashion. Appropriate use was defined as potassium level >5.5 mEq/L and no contraindications to use. The primary outcome was the absolute difference in the proportion of patients with appropriate SPS use in the order set group compared to the nonorder set group. Results: A total of 120 patients were analyzed, 40 in the order set group and 80 in the nonorder set group. Baseline characteristics were similar between the groups. Appropriate use occurred in 97.5% of order set patients compared to 60% in the nonorder set group (P < .001). Use of the order set was associated with a greater reduction in serum potassium, quicker follow-up potassium level, and lower incidence of gastrointestinal adverse effects. Conclusions: The use of a hyperkalemia order set is associated with appropriate use of SPS. Requiring the use of the hyperkalemia order set for administration of SPS may enhance patient care and safety.

Let food be thy medicine and medicine be thy food?

Ensuring adequate nutrition in children with chronic kidney disease whilst avoiding hyperkalaemia can be a difficult balance to achieve. Pre-treatment of feeds, whether milk, formula or enteral nutrition, with sodium polystyrene sulfonate (SPS) is practiced in some paediatric centres internationally. Such treatments are purported to avoid the potentially serious complications of direct administration of SPS, such as intestinal necrosis, aspiration pneumonitis and metabolic alkalosis to name but a few. Although described some 45 years ago, this study by Palma et al. is only the second retrospective study to describe the clinical consequence of pre-treating feeds with SPS with the majority of earlier studies describing only the in vitro effects of this method. Whilst effective in reducing serum potassium, the authors justifiably highlight the high incidence of complications, such as hypokalaemia (31.6%) and hypernatraemia (26.3%). We have further highlighted this with a summary of the available literature on this subject demonstrating the gross alterations of the electrolyte composition of feeds following SPS pre-treatment and clinical complications in its application. We heartily agree and support the conclusion by Palma et al. that where this therapy is practiced, close monitoring of electrolytes is essential and much more work is needed to identify those patient cohorts for which this can indeed be considered a safe and effective intervention.

Treatment of pediatric hyperkalemia with sodium polystyrene sulfonate.

To describe the safety and efficacy of sodium polystyrene sulfonate (SPS) in pediatric patients with acute hyperkalemia. A retrospective chart review of all patients less than 18years of age administered SPS for acute hyperkalemia at Texas Children's Hospital between 2011 and 2014. Our cohort consisted of 156 patients (mean age 6.8 ± 6.1years). The peak mean potassium concentration observed was 6.5 ± 0.77mmol/l prior to administration of SPS. The mean SPS dose was 0.64 ± 0.32g/kg. The majority (91%) of the SPS doses were given orally. The nadir mean potassium concentration in the 48h post-SPS was 4.7 ± 1.2mEq/l, which occurred at 16.7 ± 14.7h post-dose. In the 48h following SPS administration, 68 (43%) patients required at least one additional intervention after SPS dose. Patients who required an additional intervention after initial SPS dose differed significantly in weight, baseline serum potassium, and were more likely to have received SPS treatment via the rectal route. A gastrointestinal adverse event was documented in 24 (15%) patients. SPS was used effectively and safely in the majority of patients in this report. However, it may not be appropriate as a first single-line agent in patients with severe acute hyperkalemia who require a greater than 25% reduction in serum potassium levels or those at a high risk for cardiac arrhythmias.

Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective study.

Hyperkalemia is a common problem in hospitalized patients, especially those with underlying chronic kidney disease, but evidence-based guidelines for its treatment are lacking. Sodium polystyrene sulfonate (SPS), a cation exchange resin first approved by the FDA for the treatment of hyperkalemia in 1958, is frequently used alone or in conjunction with other medical therapies to lower serum potassium. Recently, the safety and efficacy of SPS have come into question based on multiple reported cases of bowel necrosis associated with SPS administration. The primary objective of this study was to evaluate the use of SPS for the treatment of hyperkalemia, at a large tertiary community teaching hospital, to determine its effectiveness and the incidence of related adverse side effects. A retrospective chart review was performed on all adult inpatients receiving single-dose SPS at a 466-bed tertiary community teaching hospital over a 3-year period. 501 patients received SPS for the treatment of hyperkalemia during their index hospital stay. Serum potassium levels decreased by 0.93 mEq/L on average at first recheck after SPS administration, with or without additional medical treatments. Our study identified 10 cases of hypernatremia (greater than 145 mEq/L), 31 cases of hypokalemia (less than 3.5 mEq/L), and 2 cases of bowel necrosis related to the administration of SPS. Our results suggest a serum potassium reduction of less than 1 mEq/L after administration of SPS for the treatment of acute hyperkalemia. Additionally, this study offers some evidence that the use of SPS may be associated with harm. We further note the need for standardized guidelines for the treatment of hyperkalemia at our institution.

A Rare Case of Sodium Polystyrene Sulfonate-Induced Gastric Injury

Sodium polystyrene sulfonate (sps) also known as Kalexate®, Kayexalate®, Kionex®, and SPS® is a cation exchange resin that exchanges sodium for hydrogen in the stomach and then hydrogen for potassium in the colon, allowing potassium to be excreted with the feces. Commonly used as a first-line agent for life-threatening hyperkalemia. Gastrointestinal (GI) injury is a significant adverse reaction associated with sps, ranging from mucosal7 7inflammation to full-thickness necrosis. The mechanism of injury is poorly understood. Once thought to be due to sorbitol given as a laxative with sps, GI injury has been documented without sorbitol. We present a case of gastric injury after a single dose of sps in a man who presented with abdominal pain. A 48 year old diabetic man presented with abdominal pain, nausea, vomiting, fevers, chills and increased urinary frequency after eating a large portion of lasagna and not taking insulin for 2 days. He reported chronic, post-prandial, right upper quadrant pain. Previous GI evaluation during the past ten years included a negative esophagogastroduodenoscopy (EGD), colonoscopy, and gastric emptying study. He was admitted for diabetic ketoacidosis and abdominal pain. CT scan showed no acute intra-abdominal process. EGD was pursued and revealed a normal esophagus and gastroesophageal junction. Upon entry into the stomach the mucosa was noted to be erythematous, nodular, and friable extending circumferentially from the fundus to the body. The stomach wall did not distend normally. Biopsies revealed PAS positive crystals with mucosal inflammation consistent with sps-induced injury. Upon further review it was noted that he was given a single dose of sps the afternoon before his EGD for a potassium of 5.8 MEQ/L. The patient did well and was discharged with outpatient follow-up. Sodium polystyrene sulfonate can cause severe inflammation throughout the GI tract. Onset of injury ranges from 3 hours to several days after administration. Risk factors include CKD, ESRD, and recent surgical procedures, though it can occur in healthy patients. Colonic injury is most common, accounting for 3/4th of cases. However, injury also occurs in the esophagus, stomach and small bowel. Chronic use is more often associated with GI injury. This case illustrates the severity of injury that can occur with only a single dose. Clinicians should carefully consider administration of sodium polystyrene sulfonate in potentially vulnerable patients.Figure 1Figure 2

Carvedilol-Induced Hyperkalemia in a Patient With Chronic Kidney Disease

A 69-year-old male was admitted to the hospital with a chief complaint of abdominal pain, nausea, and vomiting. He had an extensive past medical history, including diabetes mellitus type 2 and chronic kidney disease stage III. Prior to admission, the patient was taking carvedilol 3.125 mg twice daily with no abnormality in his serum potassium. During hospitalization, his carvedilol was increased to 6.25 mg twice daily. The patient’s serum potassium then rose from 4.8 to 6.7 mEq/L, with no improvement following administration of sodium polystyrene sulfonate. Nephrology concluded the carvedilol could be contributing to the hyperkalemia. The dose was decreased back to 3.125 mg twice daily, leading to the potassium normalizing to 4.4 mEq/L. The reported incidence of beta-blocker–induced hyperkalemia is less than 5%. A literature search revealed several cases of beta-blocker–induced hyperkalemia, but to the authors’ knowledge, this is the first case describing carvedilol specifically. Utilization of the Naranjo probability scale indicated a possible probability that the carvediol was the cause.

Daptomycin-induced hyperkalemia in a patient with normal renal function

A case of episodic hyperkalemia associated with daptomycin administration is reported. A 46-year-old African-American woman was hospitalized for treatment of a shoulder abscess. Initially treated with i.v. vancomycin, the patient was switched to daptomycin 9 mg/kg i.v. (500 mg daily) after three days. On day 10 of daptomycin therapy, she was noted to have a serum potassium concentration of 5.4 meq/L, with an increase to 6.1 meq/L on day 11. Reversal of hyperkalemia was achieved with oral sodium polystyrene sulfonate and other agents, and daptomycin was withheld for one day, during which time the patient's serum potassium level normalized. One day after daptomycin therapy was resumed at a lower dose (7 mg/kg), the potassium concentration increased again (to 5.5 meq/L). With a further dosage reduction and continued administration of sodium polystyrene sulfonate, the patient completed the full course of daptomycin therapy. There was a close temporal relationship between daptomycin administrations and the serum potassium fluctuations; other potential causes of hyperkalemia were ruled out. Evaluation of this case using the algorithm of Naranjo et al. yielded a score of 6, indicating that the serum potassium elevations probably constituted an adverse reaction to daptomycin. A literature search identified no other reports of hyperkalemia associated with daptomycin use in a patient with normal renal function. A 46-year-old women with normal renal function developed hyperkalemia after receiving high-dose daptomycin therapy. The potassium levels normalized when daptomycin was withheld but increased again when the patient was rechallenged with the drug.

Management of mild hyperkalemia with sodium polystyrene sulfonate: is it necessary?

Aim: There is no consensus defining clinically significant hyperkalemia or settings which require potassium (K+) lowering therapy. We explored the management of mild hyperkalemia, defined as a serum K+ ≤5.6 mEq/l, when treated with sodium polystyrene sulfonate (SPS). Materials & methods: Medical records of patients ≥18 years, who had received SPS for serum K+ ≤5.6 mEq/l, were reviewed. Results: A total of 106 SPS doses were given to 92 patients for a serum K+ ≤5.6 mEq/l. Significant delays between the pre-SPS serum K+ and SPS administration and between SPS administration and follow-up serum K+ were evident. Conclusion: Mild elevations in potassium, which may not be clinically significant, are often treated with SPS while its therapeutic monitoring remains inadequate.

To Bind or to Let Loose: Effectiveness of Sodium Polystyrene Sulfonate in Decreasing Serum Potassium

Background. The use of sodium polystyrene sulfonate in decreasing serum potassium has recently been questioned due to the lack of documented effectiveness. Methods. A retrospective cohort analysis of all hospitalized patients who received sodium polystyrene sulfonate over four months was performed. The change in serum potassium was noted over a period of 24 hours. Patients who received any other form of potassium-altering drug or treatment were excluded. Results. The administration of sodium polystyrene sulfonate reduced serum potassium by 16.7% (P < 0.001) as compared to the baseline serum potassium over a period of 24 hours. During this same time, no change in serum creatinine was identified (P = 0.73). In addition, there was no correlation between potassium and creatinine change (r2 = 0.0004 and P = 0.99). Patients with higher initial serum potassium (≥5.6 mEq/L) reduced their potassium concentration 4% more than those with initial serum potassium of <5.6 mEq/L; however, this reduction did not reach statistical significance (P = 0.32). There was no significant difference in the effectiveness of 15 gm and 30 gm resin preparation (P = 0.54). Thirteen deaths were noted in our cohort, of which one death was due to ischemic colitis. Conclusion. We conclude that sodium polystyrene sulfonate is effective in lowering serum potassium.

The use of sodium polystyrene sulfonate in the inpatient management of hyperkalemia

Limited data exist on the precise dose of sodium polystyrene sulfonate (SPS) needed for specific potassium concentrations in the management of mild to moderate hyperkalemia in an inpatient hospital setting. A retrospective cohort study involving a review of electronic medical records of inpatients receiving SPS for the treatment of hyperkalemia was conducted at the Jesse Brown Veteran Affairs Medical Center, between January 1, 2006 and December 31, 2006. Hyperkalemia was defined as a serum potassium concentration >5.1 mmol/L. The primary endpoint was the mean change in potassium concentration associated with specific SPS dosage administration. A total of 122 patients were selected for inclusion in the analysis. The mean potassium concentrations before SPS administration were 5.40 ± 0.18 mmol/L, 5.51 ± 0.30, 5.83 ± 0.46, and 5.92 ± 0.30 in the 15, 30, 45, and 60 gm groups, respectively. The mean potassium concentration decreased by 0.82 ± 0.48 mmol/L in the 15 gm group, 0.95 ± 0.47 in the 30 gm group, 1.11 ± 0.58 in the 45 gm group, and 1.40 ± 0.42 in the 60 gm group. After a single dose of SPS, the mean potassium concentration was within normal range in 115 patients (94%). A possible direct dose response relationship between SPS and the reduction in serum potassium concentration was found and should be evaluated prospectively.

Hypernatremia in a patient treated with sodium polystyrene sulfonate

Severe hyperkalemia requires urgent medical attention and correction in order to prevent arrhythmic complications. Sodium polystyrene sulfonate (SPS) is a cation exchange resin commonly used in the management of hyperkalemia. A recent review raised concerns regarding its effectiveness and potential adverse effects. Hypernatremia in adults in the setting of sodium polystyrene sulfonate therapy has not been described in the literature. We report the case of a woman who developed hypernatremia in the setting of excessive SPS administration and hope to increase awareness among clinicians regarding this potential side effect of SPS therapy.

Sodium Polystyrene Sulfonate Dosing Guidelines for the Treatment of Adult Hyperkalemia

Standard treatment of hyperkalemia has consisted of the administration of a number of medications including sodium polystyrene sulfonate (SPS) suspension orally or as an enema. Dosage ranges of 15 to 60 g are described in the literature, but specific dosing recommendations based on a patient's serum potassium are lacking. The purpose of this study was to develop a dosing guideline for the oral administration of SPS in the treatment of adult hyperkalemia at our institution. A retrospective review was conducted for adult patients receiving only SPS to treat hyperkalemia during a 3-month period. Serum levels of potassium were recorded prior to and following SPS administration. The retrospective review demonstrated that a 30 g SPS dose resulted in an average decrease in serum potassium of 0.99 mEq/L with a standard deviation (SD) of 0.64. Based on these results, an SPS dose of 30 g was recommended for a serum potassium level greater than 5 mEq/L but less than 6.0 mEq/L in the guidelines. A SPS dose of 60 g was recommended for a serum potassium level of 6 mEq/L or greater. After an internal review in the pharmacy and physician approval, the guidelines were instituted. Clinical outcomes were monitored for 1 month following implementation of the guideline. The prospective analysis resulted in an average decrease of 1.01 mEq/L (SD = 0.67) in serum potassium with a 30 g SPS dose, supporting the guideline.

Colonic necrosis and perforation following oral sodium polystyrene sulfonate (Resonium A ®/Kayexalate ®) in a burn patient

Colonic necrosis and perforation is rare in burn patients, however, it can lead to serious morbidity and mortality. Here we present a case of unexplained colonic necrosis and perforation in a 53-year-old woman with 25% total body surface area burns. No identifiable cause of bowel necrosis was found except for the presence of sodium polystyrene sulfonate (SPS) crystals in the inflammatory debris on histological examination. Colonic necrosis has been described in the literature following the administration of SPS in sorbitol for hyperkalaemia in uraemic patients. However, this condition has never been documented in any burn patients previously.

Multiple Delayed Peak Lithium Concentrations following Acute Intoxication with an Extended-Release Product

To describe delayed peak lithium concentrations after an overdose of extended-release lithium tablets. A patient with borderline personality disorder and depression ingested extended-release lithium approximately 20.25 g along with other agents. At presentation, the lithium concentration was 1.4 mEq/L. Significant enteral intake was initiated 27 hours after presentation and the lithium concentration 5 hours later increased to 3.2 mEq/L. A second lithium peak concentration of 5.0 mEq/L was noted 40 hours after presentation. Two hemodialysis sessions lasting 4 hours each were performed along with administration of sodium polystyrene sulfonate in sorbitol 20% to enhance lithium elimination and decrease absorption. Eighty-eight hours after presentation, the lithium concentration had decreased to 1.5 mEq/L. Delayed and secondary peak lithium concentrations have been reported following an overdose with an extended-release product. Extended-release lithium may form an aggregate in the gastrointestinal tract and/or have delayed absorption secondary to coingested drugs. Toxicity may result if the patient begins enteral intake of drugs, fluids, or nutrition. Continued monitoring of lithium concentrations after an acute ingestion with an extended-release product are recommended until lithium concentrations are less than 1.5 mEq/L and there are no signs of toxicity, particularly once the patient begins significant enteral intake.

Effect of Delayed Treatment with Sodium Polystyrene Sulfonate on Serum Lithium Concentrations in Mice

To determine the efficacy of sodium polystyrene sulfonate (SPS) in lowering serum lithium (Li) concentrations. Specifically, to determine the effects of both different doses of SPS and different times to treatment with SPS on serum Li levels. The study was a controlled, single-dose murine trial of SPS on serum Li levels. Male CD-1 mice (n = 525) were given orogastric LiCl and then divided into three main treatment groups: group SPS received a single orogastric administration of SPS in a dose of 5 gm/kg body weight at either 0, 15, 30, 45, or 90 minutes after LiCl; group half-SPS received a single orogastric administration of SPS in a dose of 2.5 gm/kg body weight at times equivalent to those of group SPS; and the control group received orogastric deionized water in a volume equivalent to that of group SPS at 0, 15, 30, 45, or 90 minutes after LiCl. Subgroups of seven to ten mice in each of the four treatment groups were sacrificed at one, two, four, and eight hours after administration of LiCl, and their blood was analyzed for Li concentration. 1) Single doses of SPS significantly lowered serum Li concentrations; 2) this effect was dose-related; 3) the delays in administration of SPS used in this study did not significantly reduce its ability to lower serum Li concentrations; and 4) even when administered after peak serum Li concentrations had been achieved, a single dose of SPS was effective in lowering serum Li levels. SPS may be efficacious in the treatment for Li toxicity under certain circumstances, even when there is delay to treatment. Additional study is warranted to further characterize the ability of SPS to alter Li kinetics.

Lithium absorption prevented by sodium polystyrene sulfonate in volunteers

To determine if sodium polystyrene sulfonate prevents absorption of lithium in human beings. Prospective, crossover study. Healthy volunteers age 22 to 34 years (three women and three men). After an eight-hour fast, subjects ingested 0.5 mEq/kg (18.5 mg/kg) lithium carbonate. One hour later, they ingested either 857 mg/kg sodium polystyrene sulfonate in 4 mL water/g sodium polystyrene sulfonate (experimental) or an equal volume of water without sodium polystyrene sulfonate (control). Serum lithium levels were drawn zero, one, two, three, four, six, eight, ten, 12, and 24 hours after lithium ingestion. The sodium polystyrene sulfonate group had a smaller mean area under the serum concentration curve (11.6 +/- 1.0 mEq/L.hr versus 13.6 +/- 1.5 mEq/L.hr, P < .001) and lower mean highest measured lithium level (0.85 +/- 0.11 mEq/L versus 1.05 +/- 0.10 mEq/L, P < .05) compared with the control group. There was no significant difference in 24-hour urine lithium excretion or in serum sodium and potassium levels. Sodium polystyrene sulfonate administration decreased absorption of lithium after a lithium carbonate overdose. Sodium polystyrene sulfonate may be useful clinically for gastric decontamination after lithium overdoses.