Despite recent safety concernsincluding reports of colonic necrosis, leading to a safety. Sps, kayexalate sodium polystyrene sulfonate dosing. Colonic necrosis due to sodium polystyrene sulfate kayexalate. As the resin passes along the intestine or is retained in the colon after administration by enema, the sodium ions are partially released and are replaced by healthcare inspection colorectal cancer detection. Kayexalate sodium polystryrene sulfonate, sps is a cationexchange resin often administered orally or as an enema with sorbitol to treat hyperkalemia. Colonic mucosal necrosis following administration of calcium. Kayexalate sodium polystyerene sulfonate is a cationexchange resin that was approved in 1958 as a treatment for hyperkalemia by helping to exchange sodium for potassium in the colon and thus excreting potassium from the body. The effectiveness of kayexalate in pediatric patients has not been established. Pdf colonic necrosis due to calcium polystyrene sulfonate.
Administration administer a cleansing enema before administering the sodium polystyrene sulfonate retention enema. Use sodium polystyrene sulfonate rectally as an enema as directed by your doctor, usually every 6 hours as needed. Sodium is the major cation of the extracellular fluid, constituting 90 to 95 per cent of all cations in the blood plasma and interstitial fluid. After an initial cleansing enema, a soft, large size french 28 rubber tube is inserted into the rectum for a distance of about 20 cm, with the tip well into the sigmoid colon, and taped in place.
As the resin passes along the intestine or is retained in the colon after administration by enema, the sodium ions are partially released and are replaced by. Colonic mucosal necrosis following administration of. Kayexalate should not be used as an emergency treatment for lifethreatening hyperkalemia because of its delayed onset of action see clinical pharmacology. The simultaneous oral administration of kayexalate with nonabsorbable cationdonating. After an initial cleansing enema, a soft, large size french 28 rubber tube is inserted into the rectum for a. The suspension should be approximately body temperature when administered. Historically, reports of ischemic colitis and colonic necrosis after rectal administration of sps in sorbitol solution are abundant in the literature. Raise the enema container 12 to 18 inches 30 to 45 cm above his rectum and open the clamp. Sodium polystyrene sulfonate kayexalate aspiration. Kayexalate is a cationexchange resin prepared in the sodium phase, with an in vivo exchange capacity of approximately 1 mmol in vitro approximately 3. Sodium polystyrene sulfonate kayexalate sodium polystyrene sulfonate is a potassium chelator used for the treatment of hyperkalemia. The drug is a cream to light brown finely ground, powdered form of sodium polystyrene sulfonate, a cationexchange resin prepared in the sodium phase with an in vitro exchange capacity of approximately 3. On the other hand, oral administration can be complicated by aspiration, especially in. Take this medication by mouth, or use it rectally as directed by your doctor if you are taking this medication by mouth, take it usually 1 to 4 times a day as.
The enema should be retained as long as possible and followed by a cleansing enema. Pdf sodium polystyrene sulfonate kayexalate aspiration. Kayexalate, a cation exchange resin, has been used orally or as an enema in the management of hyperkalemia for more than 30 years. Kayexalate sodium polystyrene sulfonate side effects. Retain in colon for at least 3060 min several hours if possible after completing retention, use nonsodium colonic irrigant to remove remaining resin. The sodium polystyrene sulfonate enema is usually followed with a second cleansing enema. Within a week of the enema administration, all patients had developed symptoms including abdominal pain n 4, bleeding per rectum n 1 and sepsis in a renal transplant patient n 1. Capitals indicate lifethreatening, underlines indicate most frequent. Does kayexalate have a role in the ed management of. Of course, i recommended kayexalate sodium polystyrene sulfonate in the treatment regimen.
Kayexalate sodium polystyrene sulfonate fda package. Sodium polystyrene sulfonate with sorbitol was administered to four males and two females between ages 48 and 75 years with chronic renal failure receiving dialysis for hyperkalemia 51a. You will need frequent medical tests to help your doctor determine how long to treat you with sodium polystyrene sulfonate. It can be administered orally or rectally as an enema.
Sodium polystyrene sulfonate kayexalate is a cation exchange resin. Kayexalate is a nonabsorbed, cation exchange polymer that contains a sodium counterion. The average adult dose is 30 g to 50 g every six hours 2. Food and drug administration fda is requiring the kayexalate manufacturer to conduct studies to investigate kayexalates potential to bind to other medications.
The solution should be gently agitated during administration, and the patient should retain the enema in the colon for several hours if possible, but for 30 to 60 minutes at least. Is kayexalate useful in the treatment of hyperkalemia in. Sodium polystyrene sulfonate can be given as a liquid by mouth, through a stomach feeding tube, or as a rectal enema do. Jun 21, 2019 the sodium content is approximately 100 mg 4. Kayexalate sodium polystyrene sulfonate dose, indications. Kayexalate sodium polystyrene sulfonate sps cation exchange resin exchanges na for excreted potassium in the gut most exchange takes place in the colon each gram can bind 0. What should be the correct administration and effects of. Is kayexalate sodium polystyrene sulfonate useless for. Kayexalate definition of kayexalate by medical dictionary. Does kayexalate have a role in the ed management of hyperkalemia. Stop the flow if the patient complains of fullness or pain or if fluid escapes around the tube.
Food and drug administration fda is recommending that patients avoid taking the potassiumlowering drug sodium polystyrene sulfonate kayexalate at the same time as any other medicines. Is kayexalate useful in the treatment of hyperkalemia in the. The sodium polystyrene sulfate is usually mixed with sorbitol, a cathartic, to avoid constipation and fecal impaction. The solution should be gently agitated during administration, and the patient should retain the enema in the colon for several hours if. Kayexalate fda prescribing information, side effects and. The enema will be inserted slowly while you are lying down. Colonic necrosis due to sodium polystyrene sulfate. Kayexalate sodium polystyrene sulfonate powder label fda. Advice giving kayexalate enemas general nursing allnurses. Do not give kayexalate orally by mouth to a newborn baby. Follow all directions on your prescription label and read all medication guides or instruction sheets. Administer kayexalate at least 3 hours before or 3 hours after other oral medications. An enema should not be administered to a patient with rectal bleeding, abdominal pain, prolapsed rectal tissue, myocardial infarction, or arrhythmias.
Sodium polystyrene sulfonate sps, kayexalate, kionex is a cation exchange resin that exchanges sodium for secreted k in the colon. Kayexalate sodium polystyrene sulfonate powder for suspension, for oral or rectal use. Sodium polystyrene sulfonate may bind with magnesium administered orally. Polystyrenesulfonate sodium an overview sciencedirect topics. Since that time, case reports continue to be published throughout the. Pdf colonic mucosal necrosis following administration of. So i thought, until i heard a brilliant piece by dr. As the resin passes along the intestine or is retained in the colon after administration by enema, the sodium ions are partially released and are replaced by potassium ions. Follow instructions for the use of a cleansing enema before using this medication. Polystyrene sulfonate an overview sciencedirect topics. Kayexalate rectal administration how to give kayexalate rectally how to give kayexalate enema how to dose kayexalate download here free healthcaremagic app to ask a doctor. I had only ever seen prepackaged kayexalate enemas and was a little taken aback when they sent me 2 bottles of the po solution. Do not use the medicine orally or rectally in a baby who has slow digestion caused by surgery or by using other medicines. Wait 30 seconds, then restart the flow at a slower rate.
Use warm fluid as prescribed to prepare the emulsion for enema. How to give an enema enema administration clinical nursing. Sodium polystyrene sulfonate kayexalate aspiration ncbi. Kayexalate can be given as a liquid by mouth, through a stomach feeding tube, or as a rectal enema.
Apr 04, 2019 kayexalate can be given as a liquid by mouth, through a stomach feeding tube, or as a rectal enema. Kayexalate prescription and dosage sizes information for physicians and healthcare professionals. The rectal enema form of this medicine is usually given by a healthcare professional. New questions on old drug for hyperkalemia kidney news. Despite recent safety concernsincluding reports of colonic necrosis, leading to a safety warning from the u. It is worth noting that a recent, albeit small, study failed to demonstrate any potassiumlowering effect when examining the use of singledose resins in esrd patients on hemodialysis. You may need to hold in the enema for up to several hours. The administration of sodium polystyrene sulfonate sps is used extensively for the treatment of hyperkalemia, especially in patients with renal failure. Md had me give 2 amps bicarb, mg of bumex, and wanted me to give a kayexalate enema. Total colectomy for colon perforation after kayexalate administration. Kayexalate sodium polystyrene sulfonate, usp cationexchange resin rx only can also be lost during. Administer a cleansing enema before administering the sodium polystyrene sulfonate retention enema.
Kalexate, kayexalate, kionex sodium polystyrene sulfonate. To practicing nephrologists, few drugs are more familiar than sodium polystyrene sulfonate sps kayexalate. Kayexalate sodium polystyrene side effects, images, uses. Kayexalate is a brand name of the prescription drug sodium polystyrene sulfonate, used to treat high potassium levels in the blood hyperkalemia. Generally given in a premixed preparation with sorbitol, kayexalate is widely used for the treatment of elevated potassium levels, with millions of doses prescribed every year.
Usual amount of fluid ranges from 20100 ml or approximately 34 mlg of drug. There is a known relationship between kayexalate administration and. Colonic necrosis has been described as a rare complication after administration of kayexalate in the literature 15. Kayexalate fda prescribing information, side effects and uses. Well, i started with the bicarb and bumex knowing they would work quickest and had to wait for the kayexalate to come up from pharmacy. The correct administration and effect of kayexalate is that the enema should be retain for 30 minutes to allow for sodium exchange. Concomitant administration of sorbitol with kayexalate is not recommended due to cases of intestinal necrosis, and. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. Proper use of kayexalate includes separation from oral. Easy to read fda package insert, drug facts, dosage and administration, and adverse effects for kayexalate sodium polystyrene sulfonate skip to. Give as a suspension in a small quantity of water or in syrup. Sodium polystyrene sulfonate, or kayexalate, is an ionexchange resin used to treat hyperkalemia.
Pdf in this short report we illustrate a case of extensive sodium polystyrene sulfonate sps. If using a prepackaged enema, squeeze the container. It is sometimes used with sorbitol, an osmotic laxative that prevents constipation. Polystyrenesulfonate sodium an overview sciencedirect. Kayexalate can be administered either orally or as an enema. In both children and neonates particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin.
Colonic mucosal necrosis following administration of calcium polystryrene sulfonate kalimate in a uremic patient. Complications from enema administration include muscle tone loss, fluid overflow, bowel irritation, internal hemorrhaging caused by an imbalance of electrolytes. Total colectomy for colon perforation after kayexalate. For the most part, this action occurs in the large intestine, which excretes potassium ions to. What should be the correct administration and effects of the. This drug has been a standard part of treatment of hyperkalemia for decades. In neonates, kayexalate should not be given by the oral route. Sps enemas to cause similar colonic catastrophes 21. Kayexalate two main concerns slow effect onset is at least 2 hours, may take 6 hours for max effect sps enema is more rapid, but less of a k removing enema case reports of necrotic bowel lesions recs to not use in postop, sbo, ileus patients can remove k. Retain the enema for 30 minutes to allow for sodium exchange. Jun 17, 2008 the administration of sodium polystyrene sulfonate sps is used extensively for the treatment of hyperkalemia, especially in patients with renal failure. Its administration with sorbitol has a welldocumented association with bowel necrosis and ulceration, prompting a black box warning on rectally administered kayexalate as well as the removal of 70% sorbitol containing kayexalate from the market by the fda in 2006 3, 4.
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