Kayexalate (sodium polystyrene sulphonate) in sorbitol associated with intestinal necrosis in uremic patients.
BACKGROUND
Kayexalate (sodium polystyrene sulphonate) in sorbitol is commonly used to treat hyperkalemia in patients with renal insufficiency. Isolated case reports and one recent large series have documented intestinal necrosis following administration of kayexalate in sorbitol.


METHODS
Two patients with luminal kayexalate crystals associated with intestinal pathology were first identified in the pathology department, and clinicopathological correlation was carried out.


RESULTS
Both patients were seriously ill, had prior cardiac surgery and were in renal failure (uremic). Examination of autopsy and colonic resection showed luminal kayexalate crystals associated with underlying mucosal necrosis, submucosal edema and transmural inflammation.


CONCLUSIONS
Although occurring in complex clinical settings, the pathological findings provide additional evidence that kayexalate in sorbitol may be associated with intestinal necrosis and inflammation in uremic patients and that this may be a clinically and pathologically under-recognized iatrogenic bowel injury.
Gardiner
G W
GW
St. Michael's Hospital, Department of Pathology, Toronto, Ontario.
D000368:Aged; D002411:Cation Exchange Resins / Q000009:adverse effects* / Q000627:therapeutic use; D003106:Colon / Q000187:drug effects* / Q000473:pathology; D004234:Diuretics, Osmotic / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D006947:Hyperkalemia / Q000150:complications / Q000188:drug therapy; D007410:Intestinal Diseases / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D009336:Necrosis; D011137:Polystyrenes / Q000009:adverse effects* / Q000627:therapeutic use; D013012:Sorbitol / Q000009:adverse effects* / Q000627:therapeutic use; D014511:Uremia / Q000150:complications* / Q000188:drug therapy
D002411:Cation Exchange Resins; D004234:Diuretics, Osmotic; D011137:Polystyrenes; D013012:Sorbitol; C003321:polystyrene sulfonic acid