When do you give kayexalate

One of your patients has a history of end-stage renal disease and is being admitted for hemodialysis. Her potassium is 6.

Her EKG is unchanged. Another patient is being admitted with new onset renal failure and has a potassium of 6. The Medicine service calls back and requests you treat these patients for their hyperkalemia. This lady is going to poop everywhere! Population: Adult emergency department patients with life-threatening hyperkalemia. Intervention: Treatment with gastrointestinal cation-exchange resin kayexalate plus other potassium lower regimensl.

Comparison: Treatment with potassium lower regimens other than cation-exchange resins. Outcome: Hyperkalemia-related mortality, duration of hyperkalemia, adverse effects attributed to kayexalate. First years: Treatment of the oliguric patient with a new sodium-exchange resin and sorbitol, N Engl J Med ; Second years: Management of hyperkalemia with a cation-exchange resin, N Engl J Med ; Third years: Effect of single dose resin-cathartic therapy on serum potassium concentrations in patients with end-stage renal disease, J Am Soc Nephrol ; 9: Do not give this medicine orally by mouth to a newborn baby.

Do not use the medicine orally or rectally in a baby who has slow digestion caused by surgery or by using other medicines. To give this medicine orally: Mix the sodium polystyrene sulfonate powder with water, or with honey or jam to make it taste better. Avoid inhaling the oral powder while you are preparing a dose.

Do not mix the powder with any juice or other liquid that contains potassium, such as orange juice. The rectal enema form of this medicine is usually given by a healthcare professional. The enema will be inserted slowly while you are lying down. You may need to hold in the enema for up to several hours. The sodium polystyrene sulfonate enema is usually followed with a second cleansing enema.

You will need frequent medical tests to help your doctor determine how long to treat you with sodium polystyrene sulfonate. Keep using this medicine even if you feel fine. Hyperkalemia often has no symptoms that you will notice until your potassium levels are very low.

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time. Health Topics. Health Tools. Kayexalate Sodium Polystyrene Sulfonate. The evidence for this recommendation comes from 2 articles in the New England Journal of Medicine in Flinn RB et al.

Treatment of the oliguric patient with a new sodium-exchange resin and sorbitol; a preliminary report. N Engl J Med. PMID: Findings: All patients in both groups had decreased serum potassium levels at 5 days.

In spite of this, the authors argue for the use of the cation exchange resin. Scherr L et al. Management of hyperkalemia with a cation-exchange resin. Findings: Scherr and colleagues found a decrease in serum potassium by 1. Gruy-Kapral C et al. Effect of single dose resin-cathartic therapy on serum potassium concentration in patients with end-stage renal disease. J Am Nephrol ; 9 10 : Findings: The authors found no difference in serum potassium levels at 12 hours. However, the results of their studies do not defend this conclusion.

In the Flinn study, they were looking primarily at outcomes hours after administration. In the Scherr study, there was no control group and the decrease was seen at 24 hours, again, not what we would care about in the ED. These two studies from the NEJM are the basis upon which kayexlate has been prescribed for 5 decades but they prove nothing except that patients given minimal dietary potassium their serum level will fall over 24 hours.

Finally, we have a Cochrane Review Mahoney that states that potassium-absorbing resins have never been found to be effective in the first hours of treatment. Alright, so a review of the literature shows that there is virtually no benefit in the emergent setting to the use of kayexalate.

But is there a downside? As with all medications, there is. In this case, there is a rare but highly lethal complication of the drug: Colonic Necrosis. A number of case reports and case series Lillemoe , Gerstman , Rogers , Bomback detail patients with kayexalate-associated colonic necrosis.

In fact, the FDA added a warning back in cautioning against the use of the drug for this reason. Given th e absence of any significant benefit, particularly in the emergent setting, and the potential for serious harm, this recommendation from the nephrology literature seems very reasonable:. So there you have it. More dogma-lysis on a medical myth that has been passed down from generation and purported for 50 years.

All other therapies temporarily push K into cells.